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Foroozanfar Z, Hooshyar D, Joulaei H. Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran. Qual Life Res 2024; 33:1063-1073. [PMID: 38231437 DOI: 10.1007/s11136-023-03586-9] [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: 12/09/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV). METHODS This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT. RESULTS Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL. CONCLUSION Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.
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Affiliation(s)
- Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Hooshyar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran.
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Malama K, Logie CH, Sokolovic N, Skeritt L, O'Brien N, Cardinal C, Gagnier B, Loutfy M, Kaida A, de Pokomandy A. Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings. J Acquir Immune Defic Syndr 2023; 94:116-123. [PMID: 37368938 DOI: 10.1097/qai.0000000000003241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/21/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. SETTING Ontario, British Columbia, and Quebec, Canada. METHODS We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. RESULTS There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. CONCLUSION Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Nina Sokolovic
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Lashanda Skeritt
- Centre for Outcomes Research and Evaluation, McGill University, Montréal, Canada
| | - Nadia O'Brien
- Department of Family Medicine, McGill University, Montréal, Canada
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King EM, Carter A, Loutfy M, Webster K, Muchenje M, Murray MCM, de Pokomandy A, Ding E, Li J, Kaida A. Sexual Satisfaction of Midlife Women Living With HIV in Canada: A Prospective Cohort Analysis. J Acquir Immune Defic Syndr 2023; 93:272-281. [PMID: 37019076 DOI: 10.1097/qai.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Although sexual activity and function decline in older women living with HIV, positive dimensions of sexual health, such as satisfaction, are relatively unexplored. We evaluated the prevalence of sexual satisfaction for midlife women with HIV and assessed its relation to women's physical, mental, and sociostructural experiences. SETTING We studied women in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) over 3 survey waves (2013-2018). METHODS We included women living with HIV aged ≥45 years who reported ever having consensual sex. Sexual satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women and was dichotomized into satisfactory ("completely/very/reasonably satisfactory") and not satisfactory ("not very/not at all satisfactory"). Probable depression was based on CES-D ≥10. Multivariable logistic regression and fixed effects models determined correlates of sexual satisfaction. Reasons for sexual inactivity and alternate forms of sexual expression were also explored. RESULTS Among 508 midlife women, 61% were satisfied with their sexual lives at baseline. Women with probable depression had lower odds of sexual satisfaction than those without (aOR: 0.44; 95% CI: 0.27 to 0.71) and worsening depressive symptoms over time were associated with poorer sexual satisfaction ( P = 0.001). Increased sexual activity was associated with higher sexual satisfaction (aOR: 2.75; 95% CI: 1.54 to 4.91); however, 51% of women reporting sexual satisfaction were sexually inactive. Sexually inactive women engaged in alternate forms of sexual expression such as self-pleasure (37%) and intimate relationships without sex (13%). CONCLUSION Midlife women with HIV have high rates of sexual satisfaction, even in the absence of sexual activity. Depressive symptoms were closely associated with sexual dissatisfaction, alerting providers to the importance of screening for depression and sexual health together.
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Affiliation(s)
- Elizabeth M King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law, UNSW Sydney, Sydney, Australia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- McGill University Health Center, Montreal, Quebec, Canada; and
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Marvelous Muchenje
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law, UNSW Sydney, Sydney, Australia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- McGill University Health Center, Montreal, Quebec, Canada; and
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | | | - Erin Ding
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jenny Li
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
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Wang P, Gao JY, Zhou HJ, Wu J, Wang Y. Health-related quality of life of Chinese AIDS patients: a multi-region study. Qual Life Res 2022; 32:1005-1014. [PMID: 36417088 DOI: 10.1007/s11136-022-03299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the health-related quality of life (HRQOL) of Chinese AIDS patients in three regions (Shanghai, Zhejiang, and Henan) and to examine the relationship between region and the HRQOL. METHOD A cross-sectional study was conducted from 2017 to 2018. Multistage stratified sampling was employed to recruit 1,273 AIDS patients from local Centers for Disease Control and Prevention. Data were collected by means of face-to-face interview using a structured questionnaire including the SF-12 and various rating scales. The multivariate linear and logistic regression models were performed to analyze the relationship of region and a variety of factors with the HRQOL and health utility. RESULTS The three most affected dimensions were mental health, general health, and vitality as 18.2%, 18.0%, and 16.4% of the patients reported problems respectively. The mean (SD) scores of physical component summary (PCS) and mental component summary (MCS), were 48.19 (8.02) and 46.74 (10.71) respectively. The mean (SD) health utility score was 0.75 (0.13) assessed by the SF-6D derived from the SF-12. Region, age, employment status, individual income, government assistance and stigma significantly affected the patients' HRQOL (P < 0.01). BMI, opportunistic infection, treatment compliance and time of treatment were also found to be significant factors of the HRQOL. CONCLUSION This study comprehensively estimated the HRQOL and health utility for the AIDS population in China, their HRQOL was mainly deteriorated in psychological dimensions, and geographical area may be closely related. Hence, close attention needs to be paid on the regional differences in HRQOL and the psychological problems of the patients.
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Gao RC, Wu L, Shi PL, Sang N, Hao M, Wu GC. The impact of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with systemic lupus erythematosus. Front Psychiatry 2022; 13:893235. [PMID: 35990077 PMCID: PMC9385970 DOI: 10.3389/fpsyt.2022.893235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
The evidence on the relationship between social support and quality of life in female systemic lupus erythematosus (SLE) patients is complex. The purpose of this study was to explore the impacts of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with SLE. A cross-sectional study was conducted, and 237 samples were obtained. Measures included demographic characteristics, Lupus Quality of Life (LupusQoL), social support rate scale (SSRS), distress disclosure index (DDI), and self-rating anxiety scale (SAS). Descriptive statistics, correlation analysis, and moderated mediating effect analysis were carried out. The LupusQoL was negatively correlated with age, systemic lupus erythematosus disease activity index (SLEDAI), DDI, and SAS. SSRS had a positive predictive effect on the LupusQoL, while SLEDAI and DDI had the opposite effect. SAS had a negative predictive effect on the LupusQoL. There were interactive effects of SAS and DDI on LupusQoL. In the moderated mediation model, SAS played moderating effect in the role of DDI on LupusQoL; the DDI of female patients with SLE played a partial mediator role, the mediation effect was 0.19, and the mediation effect ratio was 33.3%. In conclusion, to pay attention to the QOL, we should consider the mediator role of distress disclosure and the moderating role of anxiety.
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Affiliation(s)
- Rui-Chen Gao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Li Wu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Pei-Li Shi
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ni Sang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Min Hao
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, China
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Safreed-Harmon K, Fuster-RuizdeApodaca MJ, Pastor de la Cal M, Lazarus JV. Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool. Health Qual Life Outcomes 2022; 20:84. [PMID: 35614470 PMCID: PMC9131550 DOI: 10.1186/s12955-022-01978-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background In settings with high antiretroviral therapy coverage, numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). As part of a larger study to develop and validate a new patient-reported outcome measure for use in HIV clinical care in Spain, we sought to identify the most burdensome health-related issues experienced by PLHIV in order to determine which issues should be addressed in the new instrument. Methods We conducted a literature review and a qualitative study based on four focus group discussions (FGDs) with key informants in Spain. Participants were selected via purposive sampling. Two FGDs convened 16 expert HIV service providers, and two convened 15 PLHIV with diverse epidemiological profiles. FGDs followed semi-structured interview scripts and incorporated an exercise to prioritise the most critical health-related issues among those named in the discussions. Content analysis was conducted using MAXQDA 12. Results The analysis of FGD data identified several broad categories of issues that were perceived to negatively affect PLHIV. The most frequently named issues fell within the categories of social problems; physical symptoms; psychological problems; and sexuality-related problems. Regarding social problems, stigma/discrimination was by far the issue raised the most frequently. In the prioritisation exercise, stigma/discrimination was also ranked as the most burdensome issue by both service providers and PLHIV. Within the physical symptoms category, the issues named most frequently were sleep-related problems, fatigue, physical pain and body fat changes. Regarding psychological problems, FGD participants most commonly spoke of emotional distress in general terms, and also called attention to depression and anxiety. In the prioritisation exercise, both service providers and PLHIV ranked psychological well-being as the second-most important issue following stigma. Sexuality-related problems that were reported included sexually transmitted infections, hormonal problems, lack of libido, and general sexual dissatisfaction. Conclusions PLHIV are negatively affected by a wide range of health-related issues. HIV-related stigma and psychological well-being remain major challenges. Identifying and addressing these and other issues in routine clinical care supports healthy aging and may ultimately contribute to better health and HRQoL outcomes in this population.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Maria J Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Bizkaisida, Bilbao, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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King EM, Kaida A, Prior J, Albert A, Frank P, Abdul-Noor R, Kwaramba G, Gormley R, de Pokomandy A, Loutfy M, Murray MCM. Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV. Menopause 2022; 29:430-439. [PMID: 35357366 DOI: 10.1097/gme.0000000000001926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women living with HIV (WLWH) are commonly symptomatic during perimenopause and menopause (≥1 y without menstruation), however, little is known of risks for symptoms and their timing. We analyzed these unwanted experiences to inform care. METHODS WLWH (≥40 y) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study rated midlife experiences for seven symptoms and a symptom composite (from 0 to 21). Timing was categorized into four phases: i) perimenopause (flow in the last year), ii) 1-2 years from final menstrual period (FMP), iii) 2-5 years post-FMP; and iv) >5 years post-FMP. Resilience (standardized out of 100) was assessed based on Wagnild's Resilience Scale. Univariable/multivariable mixed effects linear regression assessed correlates of symptom intensity by composite score. RESULTS Among 457 peri-/menopausal women mean age 54.7 (±6.6) over two time points (703 observations), 88% experienced ≥1 mild symptom; 75% were of moderate and 55% severe intensity. The most frequently reported symptoms were joint/muscle stiffness (67%), depressed mood (67%), and hot flashes (57%). After adjusting for reproductive phase, we found that women with greater resilience had fewer/lower intensity symptoms (symptom score 1.37 [2.30 to 0.44] lower; P = 0.004); those with depressive symptoms and recreational drug use (respectively) had more/higher intensity symptoms (scores 1.71 [0.61 to 2.82] [P = 0.002]; 2.89 [2.09 to 3.77] [P<0.001] higher). Symptoms were most intense in perimenopause and declined with increasing menopausal years (P = 0.03). CONCLUSIONS WLWH experiences a high burden of midlife symptoms, decreased by resilience and most intense during perimenopause. Unwanted experiences were linked to psychosocial and behavioral factors. These data encourage HIV providers to adopt a bio-psychosocial approach to midlife management.
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Affiliation(s)
- Elizabeth M King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Angela Kaida
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Jerilynn Prior
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Rebecca Gormley
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Melanie C M Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Menstrual Cycle and Ovulation Research, UBC, Vancouver, BC, Canada
- Department of Medicine, Division of Endocrinology, UBC, Vancouver, BC, Canada
- School of Population and Public Health, UBC, Vancouver, BC, Canada
- Independent Researcher
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
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Kaida A, Cameron B, Conway T, Cotnam J, Danforth J, de Pokomandy A, Gagnier B, Godoy S, Gormley R, Greene S, Habanyama M, Kazemi M, Logie CH, Loutfy M, MacGillivray J, Masching R, Money D, Nicholson V, Osborne Z, Pick N, Sanchez M, Tharao W, Watt S, Narasimhan M. Key recommendations for developing a national action plan to advance the sexual and reproductive health and rights of women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455057221090829. [PMID: 35435062 PMCID: PMC9019372 DOI: 10.1177/17455057221090829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Action on the World Health Organization Consolidated guideline on sexual and reproductive health and rights of women living with HIV requires evidence-based, equity-oriented, and regionally specific strategies centred on priorities of women living with HIV. Through community–academic partnership, we identified recommendations for developing a national action plan focused on enabling environments that shape sexual and reproductive health and rights by, with, and for women living with HIV in Canada. Between 2017 and 2019, leading Canadian women’s HIV community, research, and clinical organizations partnered with the World Health Organization to convene a webinar series to describe the World Health Organization Consolidated guideline, define sexual and reproductive health and rights priorities in Canada, disseminate Canadian research and best practices in sexual and reproductive health and rights, and demonstrate the importance of community–academic partnerships and meaningful engagement of women living with HIV. Four webinar topics were pursued: (1) Trauma and Violence-Aware Care/Practice; (2) Supporting Safer HIV Disclosure; (3) Reproductive Health, Rights, and Justice; and (4) Resilience, Self-efficacy, and Peer Support. Subsequent in-person (2018) and online (2018–2021) consultation with > 130 key stakeholders further clarified priorities. Consultations yielded five cross-cutting key recommendations: 1. Meaningfully engage women living with HIV across research, policy, and practice aimed at advancing sexual and reproductive health and rights by, with, and for all women. 2. Centre Indigenous women’s priorities, voices, and perspectives. 3. Use language that is actively de-stigmatizing, inclusive, and reflective of women’s strengths and experiences. 4. Strengthen Knowledge Translation efforts to support access to and uptake of contemporary sexual and reproductive health and rights information for all stakeholders. 5. Catalyse reciprocal relationships between evidence and action such that action is guided by research evidence, and research is guided by what is needed for effective action. Topic-specific sexual and reproductive health and rights recommendations were also identified. Guided by community engagement, recommendations for a national action plan on sexual and reproductive health and rights encourage Canada to enact global leadership by creating enabling environments for the health and healthcare of women living with HIV. Implementation is being pursued through consultations with provincial and national government representatives and policy-makers.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Brittany Cameron
- PARN-Community Based HIV/STBBI Programs, Peterborough, ON, Canada
- International Community of Women Living with HV–North America (ICW-NA), Washington, DC, USA
| | - Tracey Conway
- Canadian Positive People Network (CPPN)/Réseau canadien de personnes séropositives (RCPS), Dunrobin, ON, Canada
| | - Jasmine Cotnam
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | | | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Brenda Gagnier
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Sandra Godoy
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Muluba Habanyama
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jay MacGillivray
- Positive Pregnancy Program (P3), St. Michael’s Hospital, Toronto, ON, Canada
| | - Renee Masching
- Canadian Aboriginal AIDS Network (CAAN), Dartmouth, NS, Canada
| | - Deborah Money
- Women’s Health Research Institute (WHRI), Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Zoë Osborne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA women, a network by and for women living with HIV, Vancouver, BC, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, ON, Canada
| | - Sarah Watt
- BC Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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9
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Fuster-RuizdeApodaca MJ, Safreed-Harmon K, Pastor de la Cal M, Laguia A, Naniche D, Lazarus JV. Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain. Front Psychol 2021; 12:681058. [PMID: 34177734 PMCID: PMC8219862 DOI: 10.3389/fpsyg.2021.681058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain. METHODS We used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct. RESULTS We identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument's eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL. CONCLUSION The CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV.
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Affiliation(s)
- Maria José Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Bizkaisida, Bilbao, Spain
| | - Ana Laguia
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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10
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Loutfy M, Tharao W, Kazemi M, Logie CH, Underhill A, O’Brien N, Pick N, Kestler M, H.Yudin M, Rana J, MacGillivray J, Kennedy VL, Jaworsky D, Carvalhal A, Conway T, Webster K, Lee M, Islam S, Nicholson V, Ndung’u M, Proulx-Boucher K, Carter A, Gormley R, Narasimhan M, Welbourn A, de Pokomandy A, Kaida A. Development of the Canadian Women-Centred HIV Care Model Using the Knowledge-to-Action Framework. J Int Assoc Provid AIDS Care 2021; 20:2325958221995612. [PMID: 33845677 PMCID: PMC8047935 DOI: 10.1177/2325958221995612] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
In Canada, women make up 25% of the prevalent HIV cases and represent an important population of those living with HIV, as a high proportion are racialized and systemically marginalized; furthermore, many have unmet healthcare needs. Using the knowledge-to-action framework as an implementation science methodology, we developed the "Women-Centred HIV Care" (WCHC) Model to address the needs of women living with HIV. The WCHC Model is depicted in the shape of a house with trauma- and violence-aware care as the "foundation". Person-centred care with attention with attention to social determinants of health and family make up the "first" floor. Women's health (including sexual and reproductive health and rights) and mental and addiction health care are integrated with HIV care, forming the "second" floor. Peer support, leadership, and capacity building make up the "roof". To address the priorities of women living with HIV in all their diversity and across their life course, the WCHC Model should be flexible in its delivery (e.g., single provider, interdisciplinary clinic or multiple providers) and implementation settings (e.g., urban, rural).
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Affiliation(s)
- Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Carmen H. Logie
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Angela Underhill
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Mark H.Yudin
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - Jesleen Rana
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, St. Michael’s Hospital, Toronto, Canada
| | - V. Logan Kennedy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Denise Jaworsky
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Northern Medical Program, University of Northern British Columbia, Prince George, Canada
| | | | - Tracey Conway
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shaz Islam
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mary Ndung’u
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Kirby Institute, UNSW Sydney, Australia
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Alice Welbourn
- Salamander Trust, United Kingdom lead coordinator of the Global Values and Preferences Survey
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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11
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Suarez EB, Logie C, Arocha JF, Sanchez H, Shokirova T. Contesting everyday violence: Resilience pathways of gay and transgender youth in Peru. Glob Public Health 2020; 16:706-728. [DOI: 10.1080/17441692.2020.1856397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Eliana Barrios Suarez
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener,Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Jose F. Arocha
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | | | - Takhmina Shokirova
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener,Canada
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12
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Kteily-Hawa R, Warren L, Kazemi M, Logie CH, Islam S, Kaida A, Conway T, Persad Y, de Pokomandy A, Loutfy M. Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach. J Int Assoc Provid AIDS Care 2020; 18:2325958219871289. [PMID: 31552790 PMCID: PMC6900626 DOI: 10.1177/2325958219871289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: We examined how multiple, nested, and interacting systems impact the protective process
of resilience for women living with HIV (WLWH). Methods: Using data from a Cohort Study, we conducted univariate analyses, multivariable
logistic regression, and a 2-step structural equation modeling for the outcome, high
resilience (N = 1422). Results: Participants reported high overall resilience scores with a mean of 62.2 (standard
deviation = 8.1) and median of 64 (interquartile range = 59-69). The odds of having high
resilience were greater for those residing in Quebec compared to Ontario (adjusted odds
ratio [aOR] = 2.1 [1.6, 2.9]) and British Columbia (aOR = 1.8 [1.3, 2.5]). Transgender
women had increased odds of high resilience than cisgender women (aOR = 1.9 [1.0, 3.6]).
There were higher odds of resilience for those without mental health diagnoses (aOR =
2.4 [1.9, 3.0]), non-binge drinkers (aOR=1.5 [1.1, 2.1]), and not currently versus
previously injecting drugs (aOR = 3.6 [2.1, 5.9]). Structural equation modeling
confirmed that factors influencing resilience lie at multiple levels: micro, meso, exo,
and macro systems of influence. Conclusion: There is a need to consider resilience as the interaction between the person and their
environments, informing the development of multilevel interventions to support
resilience among WLWH.
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Affiliation(s)
- Roula Kteily-Hawa
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Faculty of Education, Queen's University, Kingston, Ontario, Canada
| | - Laura Warren
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Shazia Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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13
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Kteily-Hawa R, Andany N, Wang Y, Logie CH, Tharao W, Conway T, Webster K, de Pokomandy A, Kaida A, Hogg R, Loutfy M. Quality of life of older women living with HIV: comparative assessment of physical and mental health-related markers using a large Canadian Sexual and Reproductive Health Cohort Study. HIV Res Clin Pract 2020; 20:35-47. [PMID: 31303141 DOI: 10.1080/15284336.2018.1554373] [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: 02/04/2023]
Abstract
Objective: This study assessed and compared physical and mental health components of quality of life (QoL) for older and younger women living with HIV (WLWH). Method: Using survey data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study, demographic, well-being, and physical and mental health-related QoL (HR-QoL) variables were compared between older (≥50 years) and younger (<50 years) WLWH. As the only significantly different QoL component, bivariate analyses and linear regression were used to assess factors associated with physical HR-QoL of older women. Results: The sample frame comprised 1,422 women (28.0% older women). Younger WLWH's mean age was 37.8 years (SD = 7.4) compared to older WLWH (55.8 years, SD = 5.3). Compared to younger WLWH, older WLWH had poorer physical HR-QoL (40.0 vs. 50.7; p < 0.001) but similar mental HR-QoL (42.7 vs. 42.1; p > 0.001). Older WLWH had lower social support (p < 0.001) with no significant differences in depressive symptoms or resilience. Resilience was associated with improved physical HR-QOL. Food insecurity, poorer mental HR-QoL and depressive symptoms were associated with poorer physical health. Discussion: Compared to younger WLWH, older WLWH had poorer physical HR-QoL, which was associated with resilience, food insecurity and mental health factors, highlighting the complex interactions of health-related social-ecological factors impacting aging WLWH.
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Affiliation(s)
- Roula Kteily-Hawa
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,b Faculty of Education , Queen's University , Kingston , Ontario , Canada
| | - Nisha Andany
- c Division of Infectious Diseases , Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Ying Wang
- e Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Carmen H Logie
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,e Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Wangari Tharao
- f Women's Health in Women's Hands , Toronto , Ontario , Canada
| | - Tracey Conway
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,g Canadian Positive People Network , Dunrobin , Ontario , Canada
| | - Kath Webster
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Alexandra de Pokomandy
- i Department of Family Medicine , McGill University , Montreal , Québec , Canada.,j Chronic Viral Illness Service , McGill University Health Centre , Montreal , Québec , Canada
| | - Angela Kaida
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Robert Hogg
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada.,k BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Mona Loutfy
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
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14
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Logie CH, Lacombe-Duncan A, Wang Y, Levermore K, Jones N, Ellis T, Bryan N, Grace D. Adapting the psychological mediation framework for cisgender and transgender sexual minorities in Jamaica: Implications from latent versus observed variable approaches to sexual stigma. Soc Sci Med 2019; 245:112663. [PMID: 31734480 DOI: 10.1016/j.socscimed.2019.112663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE Sexual minorities' mental health disparities are produced in larger contexts of sexual stigma. There is limited understanding of pathways between sexual stigma dimensions (e.g., enacted, perceived, internalized), psychological processes, and depression. OBJECTIVE We aimed to test the psychological mediation framework among transgender and cisgender sexual minorities in Kingston, Montego Bay, and Ocho Rios, Jamaica. METHODS We conducted structural equation modeling using maximum likelihood estimation to examine direct and indirect pathways from sexual stigma to recent (past 2-week) depressive symptoms via mediators of resilient coping, social support quantity, and empowerment, and the moderation effect of social support quality. RESULTS Model 1 used a latent sexual stigma construct (indicators: enacted, perceived, and internalized stigma dimensions). Model 2 examined sexual stigma dimensions (enacted, perceived, internalized) as observed variables. Among participants (n=871; mean age: 25.5, SD: 5.4), 90.82% reported recent depressive symptoms. Both models fit the data well. In Model 1, the sexual stigma latent construct had a significant direct effect on depressive symptoms; social support quantity and resilient coping were partial mediators. In Model 2, enacted sexual stigma had a significant direct effect on depressive symptoms. Internalized sexual stigma had a significant indirect effect via social support quantity, resilient coping, and empowerment. Perceived sexual stigma had an indirect effect on depressive symptoms via empowerment. Social support quality moderated the relationship between: internalized stigma and empowerment, empowerment and resilient coping, social support quantity and resilient coping, and resilient coping and depressive symptoms. CONCLUSION Findings suggest the importance of considering the synergistic effect of multiple sexual stigma dimensions on depression; exploring different sexual stigma dimensions to inform tailored stigma reduction and stigma coping interventions; andaddressing coping (e.g., resilience), social isolation (e.g., social support quantity/quality), and cognitive (e.g., empowerment) factors to mitigate the impacts of sexual stigma on depression among sexual minorities.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, 6th Floor, Toronto, Ontario, M5G 1N8, Canada.
| | - Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, United States
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada
| | - Kandasi Levermore
- Jamaica AIDS Support for Life, 3 Hendon Drive, Kingston 20, Kingston, Jamaica
| | - Nicolette Jones
- Jamaica AIDS Support for Life, 3 Hendon Drive, Kingston 20, Kingston, Jamaica
| | - Tyrone Ellis
- Jamaica AIDS Support for Life, 3 Hendon Drive, Kingston 20, Kingston, Jamaica
| | - Nicolette Bryan
- Jamaica AIDS Support for Life, 3 Hendon Drive, Kingston 20, Kingston, Jamaica; WE-Change, PO Box 1152, Kingston 8, Kingston, Jamaica
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Canada
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15
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Harrison S, Li X. Rebooting resilience: shifts toward dynamic, multi-level, and technology-based approaches for people living with HIV. AIDS Care 2019; 30:S1-S5. [PMID: 30678476 DOI: 10.1080/09540121.2018.1557592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Resilience research has often been characterized by a static conceptualization of resilience that focuses on individual-level factors that help people living with HIV (PLHIV) adapt to HIV-related challenges and overcome other life adversities. Early conceptualizations often depicted resilience as a static, stable construct, with limited attention paid to the social context and broader systems that may foster or discourage resilient adaptation across time and place. This special issue seeks to challenge these conventional views by highlighting innovative HIV resilience research across the globe. Far from ignoring socio-cultural contexts, studies presented in this issue directly address systemic stigma and discrimination against PLHIV, as well as sexual and gender minority individuals, and identify unique opportunities to promote resilience through building strong "villages" (i.e., social networks), reducing structural inequities, and enhancing HIV treatment and care systems. In addition, papers included in this issue address the promise and challenges of utilizing mobile Heath (mHealth) technology to build resilience for PLHIV through improving psychosocial and clinical outcomes.
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Affiliation(s)
- Sayward Harrison
- a SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Xiaoming Li
- a SC SmartState Center for Healthcare Quality, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
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