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Bonomi R, Hillmer AT, Woodcock E, Bhatt S, Rusowicz A, Angarita GA, Carson RE, Davis MT, Esterlis I, Nabulsi N, Huang Y, Krystal JH, Pietrzak RH, Cosgrove KP. Microglia-mediated neuroimmune suppression in PTSD is associated with anhedonia. Proc Natl Acad Sci U S A 2024; 121:e2406005121. [PMID: 39172786 PMCID: PMC11363315 DOI: 10.1073/pnas.2406005121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/16/2024] [Indexed: 08/24/2024] Open
Abstract
Dynamic brain immune function in individuals with posttraumatic stress disorder is rarely studied, despite evidence of peripheral immune dysfunction. Positron emission tomography brain imaging using the radiotracer [11C]PBR28 was used to measure the 18-kDa translocator protein (TSPO), a microglial marker, at baseline and 3 h after administration of lipopolysaccharide (LPS), a potent immune activator. Data were acquired in 15 individuals with PTSD and 15 age-matched controls. The PTSD group exhibited a significantly lower magnitude LPS-induced increase in TSPO availability in an a priori prefrontal-limbic circuit compared to controls. Greater anhedonic symptoms in the PTSD group were associated with a more suppressed neuroimmune response. In addition, while a reduced granulocyte-macrophage colony-stimulating factor response to LPS was observed in the PTSD group, other measured cytokine responses and self-reported sickness symptoms did not differ between groups; these findings highlight group differences in central-peripheral immune system relationships. The results of this study provide evidence of a suppressed microglia-mediated neuroimmune response to a direct immune system insult in individuals with PTSD that is associated with the severity of symptoms. They also provide further support to an emerging literature challenging traditional concepts of microglial and immune function in psychiatric disease.
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Affiliation(s)
- Robin Bonomi
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
| | - Ansel T. Hillmer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- Yale Positron Emission Tomography Center, Yale School of Medicine, New Haven, CT06519
| | - Eric Woodcock
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
| | - Shivani Bhatt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
| | | | | | - Richard E. Carson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- Yale Positron Emission Tomography Center, Yale School of Medicine, New Haven, CT06519
| | - Margaret T. Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven, CT06516
| | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven, CT06516
| | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- Yale Positron Emission Tomography Center, Yale School of Medicine, New Haven, CT06519
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- Yale Positron Emission Tomography Center, Yale School of Medicine, New Haven, CT06519
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven, CT06516
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven, CT06516
| | - Kelly P. Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06511
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT06520
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, Veterans Affairs Connecticut Healthcare System, West Haven, CT06516
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Lu W, Bullock D, Ruszczyk L, Ettinger S, Srijeyanthan J, Caldwell B, Oursler J, Minor T, Beninato J, Hauck E. Positive PTSD Screening and Its Health Correlates in Patients With HIV in Urban Primary Care Settings. J Psychosoc Nurs Ment Health Serv 2024; 62:25-36. [PMID: 38095852 DOI: 10.3928/02793695-20231206-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Posttraumatic stress disorder (PTSD) is underdiagnosed and undertreated in primary care, especially among African American individuals. The current study assessed documentation rates of PTSD and clinical health correlates among 135 predominantly African American patients with HIV and positive PTSD screens in a primary care unit. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and a retrospective chart review of 135 patients with HIV were conducted. On the PCPTSD-5 (cut point of 3), approximately one half of patients (49.6%; n = 67) had probable PTSD; however, only 11.9% of patients (n = 16) had a chart diagnosis of PTSD. A positive PTSD screen was associated with higher rates of depression and insomnia, but not anxiety, alcohol use, drug use, or pain in patients with HIV. Multi-morbidity of HIV, major depression, and positive PTSD screens was associated with increased risk for asthma, number of medical diagnoses, depression, insomnia, and anxiety. Findings highlight the need for trauma-informed care in primary care settings for people with PTSD and HIV. Larger samples are warranted to further explore health correlates of PTSD. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 25-36.].
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Ojeaburu SO, Dorward J, Violette LR, Gibbs A, Shozi H, Sookrajh Y, Mhlongo T, Ngobese H, Garrett N, Drain PK. Intimate Partner Violence and HIV Outcomes Among Women Living with HIV in Durban, South Africa. AIDS Behav 2024; 28:2247-2257. [PMID: 38869756 PMCID: PMC11199217 DOI: 10.1007/s10461-024-04318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 06/14/2024]
Abstract
We examined the impact of past-year intimate partner violence (IPV) on HIV outcomes among women living with HIV (WLHIV) in Durban, South Africa. We assessed past-year IPV using the WHO Violence Against Women Questionnaire. We conducted logistic regression to assess associations between demographic variables and IPV at baseline, and between IPV at baseline and longitudinal HIV outcomes. Among 235 WLHIV, 17% reported past-year emotional, physical, or sexual IPV. At baseline, HIV-disclosure to partner was associated with 4.35-fold odds of past-year IPV (95% CI 1.17-16.10) after controlling for children, education, and harmful alcohol use. In the prospective analysis, IPV was associated with not achieving the co-primary outcome of retention in care and viral suppression in univariate (OR = 2.32, 95% CI 1.04-5.18), but not in the multivariate model. In the context of rapid treatment scale-up, the high burden of IPV among WLHIV needs to be prioritized, with an emphasis on disclosure support.
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Affiliation(s)
- Sheila O Ojeaburu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
| | - Jienchi Dorward
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lauren R Violette
- Department of Allergy & Infectious Diseases, School of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Research Unit, Durban, South Africa
- Centre for Rural Health School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College, London, UK
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Yukteshwar Sookrajh
- Centre for Rural Health School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Thobile Mhlongo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Hope Ngobese
- Prince Cyril Zulu Communicable Disease Centre, eThekwini Municipality, Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, USA
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA
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Aronoff JE, Koning SM, Adair LS, Lee NR, Carba DB, Kuzawa CW, McDade TW. Intimate partner violence, depression, and chronic low-grade inflammation among middle-aged women in Cebu, Philippines. Am J Hum Biol 2024; 36:e24053. [PMID: 38353326 PMCID: PMC11144095 DOI: 10.1002/ajhb.24053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES Recent discussions in human biology have highlighted how local ecological contexts shape the relationship between social stressors and health across populations. Chronic low-grade inflammation has been proposed as a pathway linking social stressors to health, with evidence concentrated in high-income Western contexts. However, it remains unclear whether this is an important pathway in populations where prevalence is lower due to lower adiposity and greater infectious exposures. To investigate this further, we tested associations between multiple types of intimate partner violence (IPV), a highly prevalent stressor and health crisis globally, and C-reactive protein (CRP), a commonly used measure of chronic low-grade inflammation, in Cebu, Philippines. For reference, we compared results for CRP to depression, a well-established and consistently observed health outcome of IPV. METHODS Data came from 1601 currently partnered women (ages 35-69 years) as part of the Cebu Longitudinal Health and Nutrition Survey. IPV exposures included physical, emotional, and controlling behavior. Depression scores were measured using a modified version of the Center for Epidemiologic Studies-Depression Scale for this population, whereas plasma CRP was measured from overnight-fasted morning blood samples. RESULTS All three types of IPV were associated with a higher depression score. However, none of the IPV measures were associated with CRP. In a post hoc interaction test, emotional IPV became positively associated with CRP as waist circumference increased above the mean. CONCLUSIONS Our results suggest a complex relationship between social stressors and chronic low-grade inflammation, which is likely dependent on the population-specific context of lifestyle and environmental factors.
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Affiliation(s)
- Jacob E Aronoff
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | | | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Delia B Carba
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | - Christopher W Kuzawa
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Thomas W McDade
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
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Deaterly C, Richards V, Weaver M, Villalba K, Varma D, Payton I, Cook R. Associations of Intimate Partner Violence and Drug Use on Viral Suppression Among Women Living With HIV in South Florida: A Secondary Analysis. J Assoc Nurses AIDS Care 2024; 35:245-251. [PMID: 38417080 PMCID: PMC11216898 DOI: 10.1097/jnc.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
ABSTRACT Suboptimal viral suppression is associated with worse outcomes and increased HIV transmission among women with HIV (WWH). Based on syndemic theory, we hypothesized that women exposed to recent intimate partner violence (IPV) and current drug use would be most likely to have suboptimal HIV viral suppression. We analyzed baseline data from a longitudinal clinical trial (WHAT-IF? Will Having Alcohol Treatment Improve My Functioning?) that enrolled WWH from Miami, FL, who reported heavy drinking. Bivariate logistic regression was done, mean age was 48 years ( n = 194; SD : 8.7), 40% had current drug use (other than alcohol), and 14% reported recent IPV. WWH who reported both IPV and drug use had the highest rate of suboptimal viral suppression (45%), but these differences were not statistically significant. The high rates of suboptimal viral suppression, drug use, and IPV suggest a need to include screening for IPV in clinical guidelines related to HIV care in women.
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Affiliation(s)
- Caroline Deaterly
- University of Florida College of Nursing and a pre-doctoral student with the Southern HIV and Alcohol Research Consortium, Gainesville, FL, USA
| | | | - Michael Weaver
- University of Florida College of Nursing, Gainesville, FL, USA
| | - Karina Villalba
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Deepthi Varma
- University of Florida Department of Epidemiology, Gainesville, FL, USA
| | - Isaac Payton
- University of Florida College of Nursing and a pre-doctoral student with the Southern HIV and Alcohol Research Consortium, Gainesville, FL, USA
| | - Robert Cook
- University of Florida Department of Epidemiology, Gainesville, FL, USA
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Shahid NN, Dale SK. Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach. AIDS Behav 2024; 28:1276-1290. [PMID: 37642823 DOI: 10.1007/s10461-023-04157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
To better understand factors that may contribute to HIV outcomes experienced by Black women living with HIV (BWLWH), the present study examined the relationships among gendered racial microaggressions (GRM; subtle daily insults due to racism and sexism), self-silencing, substance use, antiretroviral therapy (ART) medication adherence, and viral suppression using structural equation modeling and path analysis. Self-silencing and substance use were examined as potential mediators. Participants were 119 BWLWH residing in South Florida. Results of this study showed that GRM was directly and positively associated with self-silencing and indirectly and negatively associated with medication adherence via self-silencing. GRM was directly related to higher alcohol use disorder severity. Self-silencing was directly and negatively associated with medication adherence. Medication adherence was directly and negatively related to viral suppression. The model fit the data well. Identifying the negative consequences of GRM in conjunction with self-silencing and substance use may help inform prevention and intervention strategies to improve mental health and HIV-related outcomes among BWLWH.
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Affiliation(s)
- Naysha N Shahid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
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Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
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Wang L, Hong C, He N, Xavier Hall CD, Simoni JM, Wong FY. Depression as a mediator between intimate partner violence (IPV) and CD4 cell count among men who have sex with men (MSM) living with HIV in China. AIDS Care 2023; 35:1667-1676. [PMID: 37018752 DOI: 10.1080/09540121.2023.2195608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Intimate partner violence (IPV) is associated with adverse mental and physical outcomes among men who have sex with men (MSM) living with HIV. Few studies focus on psychological IPV, such as verbal threats. This study examined the associations between different forms of IPV and depression and CD4+ cell count, with depression as a mediator for the association between IPV and CD4+ cell count. Data for these analyses were derived from a larger cross-sectional study on HIV-HCV co-infection among MSM in Shanghai, China (N = 1623). We estimated the average causal mediation effects (ACME) and average direct effects (ADE) through three steps. About 16% of participants experienced IPV, with forced sex (7%), verbal threats (5%), and thrown objects (4%) being most common. Verbal threats showed the strongest link with depression and low CD4+ cell count. Depression fully mediated the relationship between verbal abuse and low CD4+ cell count, suggesting it as a potential pathway between psychological IPV and poorer HIV-related health outcomes. More research on psychological IPV is warranted to examine its health impacts. Mental health could be a potential focus of intervention to enhance HIV-related health outcomes among MSM with IPV experience.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Na He
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, WA, USA
| | - Frank Y Wong
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, FL, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
- John D. Bower School of Population Health, Department of Population Health Science, University Mississippi Medical Center, Jackson, MS, USA
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Quinn KG, Edwards T, Johnson A, Takahashi L, Dakin A, Bouacha N, Voisin D. Understanding the impact of police brutality on Black sexually minoritized men. Soc Sci Med 2023; 334:116191. [PMID: 37666095 PMCID: PMC10565611 DOI: 10.1016/j.socscimed.2023.116191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
Young Black gay, bisexual, and other sexually minoritized men (SMM) face high levels of police brutality and other negative, unwarranted encounters with the police. Such interactions have known health consequences. The purpose of this study was to understand the health, mental health, and social consequences of police brutality experienced by young Black SMM. We conducted in-depth interviews with 31 Black, cisgender men, ages of 16-30 and analyzed the data using thematic analysis. Our primary results are summarized in four themes: 1) Police brutality is built into the system and diminishes trust; 2) Videos and social media make visible violence that has long existed; 3) Police brutality contributes to anxiety and other psychosocial effects; and 4) Violence reduces feelings of safety and contributes to avoidance of police. Our results highlight the direct and vicarious police brutality participants are subjected to and sheds light on the effects of such violence on trust, perceived safety, anxiety, and trauma symptoms. Results from this study contribute to the needed public health conversation around police brutality against Black men, specifically shedding light on the experiences of Black SMM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Travonne Edwards
- School of Child and Youth Care, Toronto Metropolitan University, Canada
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Dexter Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Rony MKK, Rahman MM, Saki MAA, Parvin MR, Alamgir HM. Coping strategies adopted by frontline nurses in dealing with COVID-19 patients in a developing country during the pandemic: A qualitative study. Nurs Open 2023; 10:3646-3658. [PMID: 36719818 PMCID: PMC10170892 DOI: 10.1002/nop2.1614] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 02/01/2023] Open
Abstract
AIM This study aimed to explore the coping strategies adopted by frontline nurses in dealing with COVID-19 patients during the pandemic in Bangladesh. DESIGN A qualitative descriptive study. METHODS Purposive sampling was used to recruit seventeen frontline nurses from three COVID-19-specific hospitals in Dhaka City. In-depth online interviews and semi-structured questionnaires were used to collect data through the Google Meet platform. Interview sessions audio-video were recorded, interpreted, analysed, verbatim transcribed and quotes of the participants were verified by member checking. Thematic analysis was used in this research. The study's reporting guidelines were based on the consolidated criteria for reporting qualitative research. RESULTS Seven themes were identified after careful data analysis: (i) A positive attitude in dealing with challenging situation, (ii) Intimate partner's influence, (iii) Self-emotional regulation, (iv) The tendency to avoid negativity, (v) Motivated by professional obligations, (vi) Religious influence, (vii) Recreational activities. NO PATIENT OR PUBLIC CONTRIBUTION This study explored various coping strategies employed by frontline nurses in caring for COVID-19 patients. No patient or public contribution was investigated.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Master of Public HealthBangladesh Open UniversityDhakaBangladesh
- Institute of Social Welfare and ResearchUniversity of DhakaDhakaBangladesh
- Directorate General Nursing and MidwiferyDhakaBangladesh
| | | | | | - Mst. Rina Parvin
- Major at Bangladesh ArmyCombined Military HospitalDhakaBangladesh
| | - Hasnat M. Alamgir
- Professor of Public Health; Chair, Centre for Consultancy and Applied ResearchInternational University of Business Agriculture and TechnologyDhakaBangladesh
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11
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Koskela-Staples NC, Evans C, Turner EM, Black LV, Fedele DA. The Association Between Caregiver Coping and Youth Clinic Attendance and Health-related Quality of Life in Pediatric Sickle Cell Disease. J Pediatr Hematol Oncol 2023; 45:e433-e440. [PMID: 36898015 PMCID: PMC10121850 DOI: 10.1097/mph.0000000000002636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/11/2023] [Indexed: 03/12/2023]
Abstract
Caregivers of youth with sickle cell disease (SCD) influence the youth disease management and psychosocial outcomes. Effective caregiver coping is important for improving disease management and outcomes since caregivers often report high disease-related parenting stress. This study characterizes caregiver coping and examines its relation to youth clinic nonattendance and health-related quality of life (HRQOL). Participants were 63 youth with SCD and their caregivers. Caregivers completed the Responses to Stress Questionnaire-SCD module to assess primary control engagement (PCE; attempts to change stressors or reactions to stress), secondary control engagement (SCE; strategies to adapt to stress), and disengagement (avoidance) coping. Youth with SCD completed the Pediatric Quality of Life Inventory-SCD module. Medical records were reviewed for the hematology appointment nonattendance rates. Coping factors were significantly different ( F [1.837, 113.924]=86.071, P <0.001); caregivers reported more PCE ( M =2.75, SD =0.66) and SCE ( M =2.78, SD =0.66) than disengagement ( M =1.75, SD =0.54) coping. Responses to short-answer questions corroborated this pattern. Greater caregiver PCE coping was associated with lower youth nonattendance (β=-0.28, P =0.050), and greater caregiver SCE coping was related to higher youth HRQOL (β=0.28, P =0.045). Caregiver coping is related to improved clinic attendance and HRQOL in pediatric SCD. Providers should assess caregiver coping styles and consider encouraging engagement coping.
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Affiliation(s)
| | - Corinne Evans
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Elise M Turner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | | | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
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12
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Stoner MCD, Kelly NK, Gomez-Olive FX, Kahn K, Wagner D, Bhushan NL, Aiello AE, Pettifor AE. Relationships Between Stress-Responsive Biomarkers, ART Adherence, and Viral Suppression Among Adolescent Girls and Young Women Living With HIV in South Africa: An HPTN 068 Analysis. J Acquir Immune Defic Syndr 2023; 92:349-358. [PMID: 36729676 PMCID: PMC10006401 DOI: 10.1097/qai.0000000000003149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adolescent girls and young women (AGYW) living with HIV who have higher stress levels may be at risk of stress-related biological alterations, which could influence HIV progression and adherence to antiretroviral therapy (ART). SETTING We aimed to estimate associations among stress-responsive biomarkers, ART adherence, and viral suppression in AGYW living with HIV in South Africa. We also hypothesized that psychosocial stressors [eg, depression, food insecurity, low socioeconomic status (SES), and HSV-2] would be associated with higher biomarker levels. METHODS We used 2018/2019 data from the HIV Prevention Trials Network 068 cohort to assess associations between stress-responsive biomarkers and viral suppression (<1000 copies/mL) and ART adherence measured using dried blood spot cards. Stress-responsive biomarkers included C-reactive protein, herpes simplex virus type 1, and cytomegalovirus infection and reactivation. Associations were estimated using unadjusted log-binomial or ordinal logistic regression models. RESULTS In 166 AGYW living with HIV, there was no association between stress-responsive biomarkers and viral suppression or ART adherence. However, increased C-reactive protein levels were associated with higher HSV-2 infection [odds ratio (OR) 1.98; 95% confidence interval (CI) 1.11, 3.52], being a government grant recipient (OR 3.21; 95% CI: 1.30, 7.92), lower food insecurity (OR 0.34; 95% CI: 0.13, 0.90), and increased body mass index (OR 1.07; 95% CI: 1.01, 1.14). CONCLUSIONS High prevalence of psychosocial stressors and persistent herpesviruses in AGYW living with HIV has the potential to lead to poorer health outcomes. More research is needed to untangle relationships between economic stability, chronic disease, and chronic stress.
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Affiliation(s)
- Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Nicole K Kelly
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - F Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Nivedita L Bhushan
- Center for Communication Science, RTI International, Research Triangle Park, NC
| | - Allison E Aiello
- Department of Epidemiology, Robert N Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, USA
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
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13
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Nowotny KM, Valdez A, Cepeda A. Syndemic Profiles for HIV, Hepatitis C, and Sextually Transmitted Infections Among Mexican American Women Formerly Affiliated with Youth Street Gangs. AIDS Behav 2023; 27:388-399. [PMID: 35840855 PMCID: PMC9286305 DOI: 10.1007/s10461-022-03773-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
We examine syndemic profiles of intimate partner violence, mental health, drug use, incarceration, and infectious diseases (HIV, HCV, and STIs) among a sample of adult Mexican American women who were affiliated with youth street gangs during adolescence through their relationships to boys and men. Latent class analysis included multiple factors along the following dimensions: intimate partner violence, drug use, mental illness, and incarceration. Five unique syndemic profiles were found with varying associations to HIV, HCV, and STI: (1) no syndemic, (2) intimate partner violence, no syndemic, (3) drug use, mental health, and incarceration syndemic, (4) intimate partner violence, drug use (without injection drug use), and mental health syndemic, and (5) intimate partner violence, drug use with injection drug use, mental health, and incarceration syndemic. To successfully prevent HIV, HCV, and STI among gang-involved girls and women, it is necessary to address syndemic factors.
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Affiliation(s)
- Kathryn M Nowotny
- Department of Sociology and Criminology, University of Miami, 5202 University Dr., Merrick 120, FL, 33146, Coral Gables, USA.
| | - Avelardo Valdez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, CA, Los Angeles, USA
| | - Alice Cepeda
- Suzanne Dworak-Peck School of Social Work, University of Southern California, CA, Los Angeles, USA
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Closson K, Nicholson V, Lee M, McLinden T, Cassidy-Matthews C, G Card K, E Marziali M, Trigg J, Wang L, Parashar S, S G Montaner J, Gibbs A, Hart TA, Kaida A, Hogg RS. Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada. AIDS Care 2023; 35:296-305. [PMID: 36169492 DOI: 10.1080/09540121.2022.2126959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007-2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0-3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07-1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Megan E Marziali
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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15
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Harris RM, Xavier Hall CD, Mills JC, Pence BW, Bgneris J, Wong FY. Beyond Viral Suppression-The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients. J Acquir Immune Defic Syndr 2023; 92:59-66. [PMID: 36099083 PMCID: PMC11079852 DOI: 10.1097/qai.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV. DESIGN We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284). METHODS A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress. RESULTS The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001). CONCLUSIONS Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.
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Affiliation(s)
- Rachel M Harris
- Center for Population Sciences and Health Equity College of Social Work, Florida State University, FL
| | - Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Center for Population Sciences and Health Equity, Northwestern University, Florida State University, FL
| | - Jon C Mills
- College of Medicine, Center for Population Sciences and Health Equity, Florida State University, FL
| | - Brian W Pence
- Gillings School of Global Public Health, University of North Carolina, Chape Hill, NC
| | - Jessica Bgneris
- Center for Population Sciences and Health Equity, Graduate College of Social Work, Florida State University, University of Houston, TX; and
| | - Frankie Y Wong
- Center for Population Sciences and Health Equity, Florida State University, FL
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16
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Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
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Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
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17
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Folayan MO, Arije O, Enemo A, Sunday A, Muhammad A, Nyako HY, Abdullah RM, Okiwu H, Lamontagne E. Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria. AFRICAN JOURNAL OF AIDS RESEARCH 2022; 21:306-316. [DOI: 10.2989/16085906.2022.2118615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Nigeria Institute of Medical Research, Yaba, Nigeria
- Community Oral Health Department, Tehran University of Medical Sciences, Iran
- Faculty of Health Sciences, University of Zaragoza, Spain
| | - Olujide Arije
- Institute of Public Health, College of Health Sciences, Obafemi Awolowo University, Nigeria
| | - Amaka Enemo
- Nigeria Sex Workers Association, Kubwa, Nigeria
| | - Aaron Sunday
- African Network of Adolescent and Young Persons Development, Barnawa, Nigeria
| | - Amira Muhammad
- Northern Nigerian Transgender Initiative, Abuja, Nigeria
| | | | | | | | - Erik Lamontagne
- Joint United Nations Programme on HIV/AIDS, Strategic Information, Geneva, Switzerland
- Aix-Marseille University, School of Economics, Marseille, France
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18
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Stubbs A, Szoeke C. The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. TRAUMA, VIOLENCE & ABUSE 2022; 23:1157-1172. [PMID: 33541243 DOI: 10.1177/1524838020985541] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019. METHODS SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening. RESULTS IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes. CONCLUSION The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.
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Affiliation(s)
- Anita Stubbs
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne and Austin Health, Australia
| | - Cassandra Szoeke
- Centre for Medical Research (Royal Melbourne Hospital), Department of Medicine, 2281University of Melbourne, Australia
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19
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Ogbonnaya IN, Reed E, Wanyenze RK, Wagman JA, Silverman JG, Kiene SM. Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP17133-NP17156. [PMID: 34176367 PMCID: PMC9814921 DOI: 10.1177/08862605211028284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1-2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0-2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0-2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.
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Affiliation(s)
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | | | - Jennifer A. Wagman
- University of California Los Angeles Jonathan and Karin Fielding School of Public HealthLos Angeles, CA, USA
| | - Jay G. Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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20
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Sikkema KJ, Rabie S, King A, Watt MH, Mulawa MI, Andersen LS, Wilson PA, Marais A, Ndwandwa E, Majokweni S, Orrell C, Joska JA. ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial. Trials 2022; 23:680. [PMID: 35982485 PMCID: PMC9386207 DOI: 10.1186/s13063-022-06655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.
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Affiliation(s)
- K J Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - S Rabie
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M I Mulawa
- Duke University School of Nursing and Duke Global Health Institute, Durham, NC, USA
| | - L S Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Present Address, University of Copenhagen, Copenhagen, Denmark
| | - P A Wilson
- Department of Psychology, University of California, Los Angeles, USA
| | - A Marais
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - E Ndwandwa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - S Majokweni
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - C Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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21
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Jones DL, Zhang Y, Rodriguez VJ, Haberlen S, Ramirez C, Adimora AA, Merenstein D, Aouizerat B, Sharma A, Wilson T, Mimiaga MJ, Sheth AN, Plankey M, Cohen MH, Stosor V, Kempf MC, Friedman MR. Association of PTSD With Longitudinal COVID-19 Burden in a Mixed-Serostatus Cohort of Men and Women: Weathering the Storm. J Acquir Immune Defic Syndr 2022; 90:567-575. [PMID: 35585664 PMCID: PMC9283230 DOI: 10.1097/qai.0000000000003006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study of people with HIV (PWH) and those without HIV conducted during the COVID-19 pandemic in the United States in 2020 examines the impact of posttraumatic stress disorder (PTSD) on COVID-19 burden, defined as pandemic-related disruptions. METHODS Data consisted of survey responses on PTSD among participants (N = 2434) enrolled in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV (WIHS) cohorts. Unadjusted and adjusted regression models were used to examine the association of PTSD with COVID-19 burden (overall and domain-specific burdens). Quasi-Poisson regression models were used to assess associations with the COVID-19 burden score and 2 domain-specific burdens: (1) changes in resources and (2) interruptions in health care. Analyses was adjusted for age, race/ethnicity, HIV serostatus, current smoking status, number of comorbidities, education, and study regions. RESULTS Study participants were a median age of 58 (interquartile range, 52-65) years. In both bivariate and multivariable models, PTSD severity was associated with greater overall COVID-19 burden. PTSD severity was associated with the number of resource changes and number of interruptions in medical care. These findings were also consistent across cohorts (MACS/WIHS) and across HIV serostatus, suggesting a greater risk for COVID-19 burden with greater PTSD severity, which remained significant after controlling for covariates. CONCLUSIONS This study builds on emerging literature demonstrating the impact of mental health on the burden and disruption associated with the COVID-19 pandemic, providing context specific to PWH. The ongoing pandemic requires structural and social interventions to decrease disruption to resources and health resource needs among these vulnerable populations.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Psychology, University of Georgia, Athens, GA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catalina Ramirez
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Bradley Aouizerat
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York City, New York
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine
| | - Tracey Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago IL
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Evanston, IL
| | - Mirjam-Colette Kempf
- Department of Family, Community & Health Systems, Schools of Nursing, Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL; and
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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22
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Jeffers NK, Zemlak JL, Celius L, Willie TC, Kershaw T, Alexander KA. 'If the Partner Finds Out, then there's Trouble': Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV). AIDS Behav 2022; 26:2266-2278. [PMID: 35032282 PMCID: PMC9338767 DOI: 10.1007/s10461-021-03565-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 01/02/2023]
Abstract
Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners' interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.
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Affiliation(s)
- Noelene K Jeffers
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lourdes Celius
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kamila A Alexander
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
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23
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Papageorgiou V, Davies B, Cooper E, Singer A, Ward H. Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis. AIDS Behav 2022; 26:2026-2054. [PMID: 34894331 PMCID: PMC9046343 DOI: 10.1007/s10461-021-03551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/06/2022]
Abstract
Despite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.
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Affiliation(s)
- Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK.
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Emily Cooper
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ariana Singer
- School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
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24
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Conroy AA, Leddy AM, Darbes LA, Neilands TB, Mkandawire J, Stephenson R. Bidirectional Violence Is Associated with Poor Engagement in HIV Care and Treatment in Malawian Couples. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4258-NP4277. [PMID: 32946327 PMCID: PMC7969480 DOI: 10.1177/0886260520959632] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Growing evidence suggests that intimate partner violence (IPV) is a barrier to engagement in HIV care. Bidirectional IPV-being both a perpetrator and victim-may be the most common pattern of IPV, yet no research has examined its effect on engagement in care, which could identify couples in most need of interventions. Married couples (N = 211) with at least one partner on antiretroviral therapy were recruited from HIV clinic waiting rooms in Zomba, Malawi. Partners completed separate surveys on physical, sexual, and emotional IPV, medication adherence, and appointment attendance. We created categorical variables indicating no violence, perpetrator-only, victim-only, and bidirectional violence. Generalized estimating equation regression models tested for associations between IPV and engagement in care. The bidirectional pattern represented 25.4%, 35.5%, and 34.0% of all physical, sexual, and emotional IPV. Physical IPV victimization-only (adjusted odds ratio [AOR]: 0.28, 95% confidence interval [CI]: 0.08, 0.92) was associated with lower adherence, but the association was stronger for bidirectional physical IPV (AOR: 0.10, 95% CI: 0.02, 0.51). Bidirectional sexual IPV was also associated with lower adherence (AOR: 0.14, 95% CI: 0.02, 0.80). Bidirectional physical IPV (AOR: 4.04, 94% CI: 1.35, 12.14) and emotional IPV (AOR: 3.78, 95% CI: 1.78, 8.05) were associated with missing 1+ appointment. Interventions to address the health effects of bidirectional IPV, which may be greater than victim-only or perpetrator-only IPV, should intervene with both partners to break cycles of violence. Couple-based interventions may be a viable option by intervening on both partners' trauma and aggression simultaneously.
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Affiliation(s)
- Amy A. Conroy
- University of California San Francisco, San Francisco, CA, USA
| | - Anna M. Leddy
- University of California San Francisco, San Francisco, CA, USA
| | - Lynae A. Darbes
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
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25
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Merrill KG, Campbell JC, Kennedy CE, Burke VM, Miti S, Frimpong C, Decker MR, Abrams EA, Mwansa JK, Denison JA. 'So hurt and broken': A qualitative study of experiences of violence and HIV outcomes among Zambian youth living with HIV. Glob Public Health 2022; 17:444-456. [PMID: 33428559 PMCID: PMC8272734 DOI: 10.1080/17441692.2020.1864749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Emerging data show associations between violence victimisation and negative HIV outcomes among youth in sub-Saharan Africa. We conducted in-depth interviews with adolescents and young adults living with HIV (aged 15-24 years) in Ndola, Zambia, to better understand this relationship. We purposively selected 41 youth (24 females, 17 males) with varied experiences of violence and virologic results. Analysis used thematic coding. Two-thirds of participants said violence affected their medication adherence, clinic attendance, and/or virologic results. They focused on the negative effects of psychological abuse from family members in homes and peers at schools, which were the most salient forms of violence raised, and sexual violence against females. In contrast, they typically depicted physical violence from caregivers and teachers as a standard discipline practice, with few impacts. Youth wanted HIV clinic settings to address verbal abuse and emotional maltreatment, alongside physical and sexual violence, including through peer mentoring. Violence - especially verbal and emotional forms - must be recognised as a potential barrier to HIV self-management among youth living with HIV in the region. Further testing of clinic, home, and school-based interventions may be critical to reducing levels of violence and improving HIV outcomes in this vulnerable but resilient population.Trial registration: ClinicalTrials.gov identifier: NCT04115813.
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Affiliation(s)
- Katherine G. Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquelyn C. Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M. Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sam Miti
- Arthur Davison Children’s Hospital, Ndola, Zambia
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A. Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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26
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Merrill KG, Campbell JC, Decker MR, McGready J, Burke VM, Mwansa JK, Miti S, Frimpong C, Kennedy CE, Denison JA. Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults. AIDS Behav 2021; 25:1373-1383. [PMID: 32761474 PMCID: PMC8052241 DOI: 10.1007/s10461-020-02958-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15-24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14-11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26-8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05-4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37-4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05-4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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27
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Budd AS, Krentz HB, Rubin LH, Power C, Gill MJ, Fujiwara E. Long-term consequences of interpersonal violence experiences on treatment engagement and health status in people living with HIV. AIDS 2021; 35:801-809. [PMID: 33369906 DOI: 10.1097/qad.0000000000002798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort. DESIGN People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed. METHODS A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+ T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions. RESULTS At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (n = 224, 21%) or adulthood experiences (n = 161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+ cell counts below 200/μl, and 65% more likely to die compared with patients not reporting IPersV (P < 0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications. CONCLUSION IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
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Affiliation(s)
- Alexandra S Budd
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
| | - Hartmut B Krentz
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leah H Rubin
- Department of Neurology
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher Power
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton
| | - Michael J Gill
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Esther Fujiwara
- Department of Psychiatry
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton
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28
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Parcesepe AM, Cordoba E, Gallis JA, Headley J, Tchatchou B, Hembling J, Soffo C, Baumgartner JN. Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis. BMC Pregnancy Childbirth 2021; 21:178. [PMID: 33663428 PMCID: PMC7934543 DOI: 10.1186/s12884-021-03673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. METHODS This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. RESULTS Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. CONCLUSIONS Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.
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Affiliation(s)
- Angela M. Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC 27599 USA
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC USA
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - John A. Gallis
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC USA
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29
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Momplaisir FM, Fortune K, Nkwihoreze H, Groves AK, Aaron E, Jemmott JB. Outcome expectancies toward adherence to antiretroviral therapy for pregnant and postpartum women with HIV. WOMEN'S HEALTH 2021; 17:17455065211061094. [PMID: 34812095 PMCID: PMC8640315 DOI: 10.1177/17455065211061094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: Adherence to antiretroviral therapy and retention in care significantly drop for women with HIV during the postpartum period. We have a limited understanding of how outcome expectancies influence maternal adherence and retention in care. Methods: Women with HIV from an urban academic clinic completed in-depth interviews in the third trimester and at 3 to 9 months postpartum to evaluate outcome expectancies, facilitators, and barriers to antiretroviral therapy adherence and retention in care. Interviews were audio-recorded and analyzed for content. A codebook was created using deductive (based on the theory of reasoned action approach) and inductive (based on emergent themes) codes. Results: We conducted 21 interviews with 12 women during pregnancy and 9 women during postpartum period. Participants had a mean age of 31 (standard deviation = 5.7) and most were African American (75%). Outcome expectancies centered mostly around pediatric health to prevent perinatal transmission of HIV and to be healthy to raise their children. Other outcome expectancies included preventing transmission of HIV to their partners. Social support from partners served as a strong facilitator as they helped routinize pill-taking behaviors, provided reminders, and decreased social isolation. Barriers to antiretroviral therapy adherence included depression, the disruption of scheduling routines, and the physical demands associated with the postpartum period. These barriers were accentuated for women with multiple children. Conclusion: Women’s commitment to pediatric health was the primary motive for antiretroviral therapy adherence. Partners also served an important role. These findings suggest that interventions linking pediatric and maternal health, and partner support can improve maternal HIV treatment in the postpartum period.
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Affiliation(s)
- Florence M Momplaisir
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Hervette Nkwihoreze
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison K Groves
- Department of Community and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Erika Aaron
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - John B Jemmott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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30
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Mercy SK, Sebean M, Margaret M. Predictors of Non-Adherence to Combined Anti-Retroviral Therapy among Expectant and Breastfeeding Women Receiving Care through Test and Treat Model in Lusaka. Health (London) 2021. [DOI: 10.4236/health.2021.138067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Burton CW, Gilpin CE, Draughon Moret J. Structural violence: A concept analysis to inform nursing science and practice. Nurs Forum 2020; 56:382-388. [PMID: 33355920 DOI: 10.1111/nuf.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
This analysis is meant to elucidate the concept of structural violence and its implications for nursing science and practice. The concept of structural violence, also known as indirect violence, was first identified in the literature by peace researcher Johan Galtung. According to Galtung, structural violence broadly represents harm done to persons and groups through inequitable social, political, or economic structures. Such inequitable structures, such as systemic discrimination based on race, ethnicity, religion, gender, sexual orientation, etc. create conditions within society that directly disadvantage and oppress members of certain groups. This oppression can inflict profound physical, psychological, and socioeconomic harm on individuals, leading to disparate health outcomes. Using techniques for developing conceptual meaning as outlined in Chinn and Kramer (2018), our analysis seeks to specify meanings and applications of structural violence for application to nursing. This analysis draws on literature from clinical, historical, and other social sciences. Databases including CINAHL, PubMed, JSTOR, and PsychInfo were explored for references to structural violence. Structural violence is readily identified in specific contexts where individuals or groups are disadvantaged by socially constructed systems, such as those of race, gender, and economic privilege. Structural violence can result in health disparities and the development of conditions that predispose individuals to health risks. Nurses must be familiar with the concept to address these issues with patients.
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Affiliation(s)
- Candace W Burton
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Claire E Gilpin
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Jessica Draughon Moret
- Betty Irene Moore School of Nursing, University of California Davis, Davis, California, USA
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32
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Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
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33
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Closson K, Lee M, Gibbs A, Kaida A. When Home is Not a Safe Place: Impacts of Social Distancing Directives on Women Living with HIV. AIDS Behav 2020; 24:3017-3019. [PMID: 32488553 PMCID: PMC7266420 DOI: 10.1007/s10461-020-02941-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Melanie Lee
- Faculty of Health Sciences, Burnaby, Canada, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, 491 Peter Mokaba Ridge, Road, Overport, Durban, 4091, KZN, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa, George Campbell Building West Wing, UKZN Howard College Campus, Durban, 4001, KZN, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Burnaby, Canada, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
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34
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Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, Rodriguez AE, Safren SA. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med 2020; 44:147-158. [PMID: 33098541 DOI: 10.1007/s10865-020-00191-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL (N = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
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Geller RJ, Decker MR, Adedimeji AA, Weber KM, Kassaye S, Taylor TN, Cohen J, Adimora AA, Haddad LB, Fischl M, Cunningham S, Golub ET. A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018. J Womens Health (Larchmt) 2020; 29:1256-1267. [PMID: 32996812 DOI: 10.1089/jwh.2019.7972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.
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Affiliation(s)
- Ruth J Geller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Tonya N Taylor
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sarah Cunningham
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Overstreet NM, Cheeseborough T. Examining the Effect of Internalized HIV-Related Stigma on Perceptions of Research Participation among HIV-Positive African American Women. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2020; 6:223-234. [PMID: 34761075 PMCID: PMC8577417 DOI: 10.1037/tps0000271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
HIV-related stigma may influence ethical concerns in health disparity populations, particularly groups with histories of race, gender, and class oppression in medical research such as African American women. However, a dearth of research has examined how HIV-related stigma influences perceptions of the research process among African American women who participate in health research. The goal of the current study was to examine whether HIV-related stigma experienced on the micro-level, specifically internalized HIV-related stigma, is associated with reactions to research participation in 5 domains: attitudes toward participation, perceptions of research benefits, emotional reactions, perceived drawbacks of the research, and global evaluations of the research. We also examine whether internalized HIV-related stigma is associated with difficulty in answering questions related to sensitive topics. We found that women with higher levels of internalized HIV-related stigma reported more emotional reactions to research, perceived more drawbacks of the research, and expressed more difficulty in answering sensitive questions. Understanding how HIV-related stigma influences perceived risks and benefits of research participation may play an important role in guiding best practices for ethical engagement with HIV-positive African American women who participate in health research.
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Severe intimate partner violence is associated with all-cause mortality among women living with HIV. AIDS 2020; 34:1549-1558. [PMID: 32675565 DOI: 10.1097/qad.0000000000002581] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the independent association between intimate partner violence (IPV) severity and all-cause mortality among women living with HIV (WLHIV). DESIGN Cross-sectional questionnaire linked to longitudinal vital statistics data. METHODS We examined the lifetime prevalence of IPV and age-standardized all-cause mortality rates by IPV severity reported by WLHIV. Lifetime IPV (emotional/verbal, physical, or sexual) severity was assessed as a categorical variable: no history of any IPV (none); experienced one or two forms of IPV (moderate); or experienced all three forms of IPV (severe IPV). Two separate logistic regression models examined associations between any IPV (vs. none) as well as IPV severity (none vs. moderate, severe) and all-cause mortality. RESULTS At the time of interview (2007-2010), 260 participants self-identified as women with a median (Q1-Q3) age of 41 years (35-46). Of these women, the majority were unemployed (85%), 59% reported any IPV and 24% reported severe IPV. Of the 252 women followed until 31 December 2017, 25% (n = 63) died. Age-standardized all-cause mortality rates for WLHIV who experienced severe IPV were two-times higher than women with no history of IPV (44.7 per 1000 woman-years vs. 20.9 per 1000 woman-years). After adjustment for confounding, experiences of severe IPV (vs. none) were significantly associated with all-cause mortality (aOR = 2.42, 95% CI = 1.03-5.70). CONCLUSION Although we found that any lifetime experience of IPV was not associated with all-cause mortality, women ever experiencing severe IPV were significantly more likely to die during the study period. This may suggest a need for increased trauma- and violence-aware approaches.
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Alexander KA. Social determinants of HIV/AIDS and intimate partner violence: interrogating the role of race, ethnicity and skin color. Rev Lat Am Enfermagem 2020; 28:e3280. [PMID: 32520238 PMCID: PMC7282718 DOI: 10.1590/1518-8345.0000.3280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kamila A Alexander
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
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Torkashvand S, Pirdehghan A, Jiriaee N, Hoseini M, Ahmadpanah M. Sexual Violence in Women with HIV Positive Spouse and Their Mental Health. J Res Health Sci 2020; 20:e00472. [PMID: 32814692 PMCID: PMC7585757 DOI: 10.34172/jrhs.2020.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/19/2020] [Accepted: 02/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Sexual violence (SV) against women is one of the most important issues in women's health. We aimed to investigate the related variable for SV against women with HIV spouse and its relationship with mental problems in them.
Study design: A cross-sectional study.
Methods: This study was performed on 143 women referred to Hamadan and Malayer Risky Behavior Related Disease Clinic (Triangular Clinic), located in Comprehensive Health Service centers, Iran in 2019. SV and mental problems were assessed using standard questionnaires, based on interview. All analyses performed using SPSS. The significance level of all analyses was considered 0.05.
Results: Totally, 407 HIV+ patients were diagnosed from 1998 to 2018, in Hamadan and Malayer cities. We assessed the wives of survivors who allowed about SV. Mean of SV in women with HIV positive spouse was significantly higher than control group (P=0.004). Among all variables, unsafe sex, extramarital relationship, smoking, alcohol, multi-partner and suicide were significantly related to SV; but age, living area, educational status, income and job in both men and women had not statically significant relationship with SV.
Conclusion: SV besides its complications and mental problems in women with HIV positive spouses must be considered in interventional programs in order to improve sexual rights in this vulnerable group in the future.
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Affiliation(s)
- Saman Torkashvand
- Student Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azar Pirdehghan
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran .
| | - Nasrin Jiriaee
- Department of Community and Preventive Medicine, School of Medicine, Hamadan university of Medical Sciences, Hamadan, Iran
| | - Mahsan Hoseini
- Hamadan Province Health Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Behavioral disorders and substances abuse research center, Hamadan University of Medical Sciences, Hamadan, Iran
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Brief Report: Intimate Partner Violence and Antiretroviral Therapy Initiation Among Female Sex Workers Newly Diagnosed With HIV in Zambia: A Prospective Study. J Acquir Immune Defic Syndr 2019; 79:435-439. [PMID: 30142141 PMCID: PMC6203637 DOI: 10.1097/qai.0000000000001841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Intimate partner violence (IPV) is common among female sex workers (FSW) globally. Here, we prospectively assessed the relationship between IPV and engagement in HIV care in a cohort of FSW who had been newly diagnosed with HIV. Methods: Data arose from the Zambian Peer Educators for HIV Self-Testing study, a randomized controlled trial of HIV self-test distribution among FSW in 3 transit towns in Zambia. Participants were self-reported to be HIV-uninfected or unaware of their status at baseline. IPV in the previous 12 months was assessed at baseline. At 4 months, participants were asked the results of their last HIV test and those who reported testing positive were asked whether they had engaged in HIV-related care and started antiretroviral therapy (ART). Results: Of 964 participants, 234 (24.3%) reported that they were living with HIV at 4 months. Of these 234 participants, 142 (60.7%) reported a history of IPV (past 12 months) at baseline and at 4 months, 152 (65.0%) reported that they were in HIV-related care, and 132 (56.7%) reported that they had initiated ART. Participants who reported IPV had significantly reduced odds of engagement in care (adjusted odds ratio = 0.48, 95% confidence interval: 0.26 to 0.91) and ART initiation (adjusted odds ratio = 0.40, 95% confidence interval: 0.22 to 0.72). Conclusions: FSW living with HIV in Zambia reported very high rates of IPV. Structural and individual interventions for violence prevention are urgently needed to better protect this population. Given the strong negative relationship between IPV and engagement in HIV-related care, such interventions could also substantially improve HIV-related health outcomes.
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Riley ED, Vittinghoff E, Koss CA, Christopoulos KA, Clemenzi-Allen A, Dilworth SE, Carrico AW. Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco. AIDS Behav 2019; 23:2326-2336. [PMID: 31324996 PMCID: PMC7478361 DOI: 10.1007/s10461-019-02601-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine A Koss
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Katerina A Christopoulos
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
| | - Samantha E Dilworth
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Burton CW, Williams JR, Anderson J. Trauma-Informed Care Education in Baccalaureate Nursing Curricula in the United States: Applying the American Association of Colleges of Nursing Essentials. JOURNAL OF FORENSIC NURSING 2019; 15:214-221. [PMID: 31764525 DOI: 10.1097/jfn.0000000000000263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The practice of trauma-informed care (TIC) allows nurses in any setting to identify and intervene with traumatized individuals and to create a continuum of care when forensic nursing services are needed. The purpose of this article is to suggest ways to incorporate TIC content into baccalaureate nursing programs. We begin with an overview of baccalaureate nursing curricula and common types of traumatic experience important for students to understand. We then propose specific strategies for inclusion of TIC content in baccalaureate nursing education, using the American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice. With a solid foundation in TIC, baccalaureate-prepared nursing students can provide effective patient care and better support forensic nursing practice. This will increase the capacity of the nursing profession in general to meet the needs of those affected by trauma, violence, and abuse.
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Overstreet NM, Okuyan M, Fisher CB. Perceived Risks and Benefits in IPV and HIV Research: Listening to the Voices of HIV-Positive African American Women. J Empir Res Hum Res Ethics 2018; 13:511-524. [PMID: 30183457 DOI: 10.1177/1556264618797557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women living with HIV were asked to reflect on the perceived risks and benefits of research participation after completing a study examining socially sensitive issues in their lives, including intimate partner violence (IPV) and HIV. Administration of standardized quantitative instruments yielded positive responses to the research experience. However, qualitative assessments of perceived risks and benefits revealed more nuanced responses. For example, confidentiality concerns were more prominent in open-ended responses as was participants' positive attitudes toward monetary compensation. In addition, some women reported that study participation provided them with new insights about their experiences with IPV. Findings suggest that empirical studies on research protections involving potentially distressing and socially sensitive experiences with vulnerable populations require both quantitative and qualitative assessments of perceived risks and benefits. We discuss implications of our findings for ethics practices in trauma-related research among populations with multiple social vulnerabilities.
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Conducting Clinically Based Intimate Partner Violence Research: Safety Protocol Recommendations. Nurs Res 2017; 66:405-409. [PMID: 28858149 DOI: 10.1097/nnr.0000000000000235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maintaining safety is of utmost importance during research involving participants who have experienced intimate partner violence (IPV). Limited guidance on safety protocols to protect participants is available, particularly information related to technology-based approaches to informed consent, data collection, and contacting participants during the course of a study. PURPOSE The purpose of the article is to provide details on the safety protocol developed and utilized with women receiving care at an urban HIV clinic and who were taking part in an observational study of IPV, mental health symptoms, and substance abuse and their relationship to HIV treatment adherence. The protocol presents the technological strategies to promote safety and allow autonomy in participant decision-making throughout the research process, including Voice over Internet Protocol telephone numbers, and tablet-based eligibility screening and data collection. Protocols for management of participants at risk for suicide and/or intimate partner homicide that included automated high-risk messaging to participants and research staff and facilitated disclosure of risk to clinical staff based on participant preferences are discussed. DISCUSSION Use of technology and partnership with clinic staff helped to provide an environment where research regarding IPV could be conducted without undue burden or risk to participants. Utilizing tablet-based survey administration provided multiple practical and safety benefits for participants. Most women who screened into high-risk categories for suicide or intimate partner homicide did not choose to have their results shared with their healthcare providers, indicating the importance of allowing participants control over information sharing whenever possible.
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