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Chuku CC, Silva MF, Lee JS, Reid R, Lazarus K, Carrico AW, Dale SK. A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV. AIDS Care 2024; 36:1410-1423. [PMID: 38958126 DOI: 10.1080/09540121.2024.2372714] [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: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.
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Affiliation(s)
- Chika Christle Chuku
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Maria F Silva
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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2
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Liu J, Feaster DJ, Shahid N, Lazarus K, Boga DJ, Willie P, Juste RS, Silva MF, Adeojo L, Wright M, Reid R, Gonzalez S, Madhu A, Warman C, Bolden R, Pan Y, Nelson CM, Hlaing W, Rodriguez A, Alcaide ML, Ironson G, Safren S, Wright I, Dale SK. Testing for Measurement Invariance (MI): Do the Structures of Microaggression, Discrimination, and Resilience Among Black Women Living with HIV Remain the Same Across Time? J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02087-w. [PMID: 39102174 DOI: 10.1007/s40615-024-02087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
Assessing measurement invariance and the interplay of discrimination, microaggressions, and resilience among Black women living with HIV (BWLWH) across time utilizing latent class and repeated measure analysis may provide novel insights. A total of 151 BWLWH in a southeastern U.S. city completed surveys focused on multiple forms of microaggressions and discrimination (race, gender, sexual orientation, or HIV-related) and resilience factors (social support, self-efficacy, post-traumatic growth) at baseline, 3 months, and 6 months. To capture the psychosocial domains of discrimination, microaggressions, and resilience, three latent factors were developed and measured across three time points. Latent class analysis was also conducted to identify and compare meaningful subgroups based on varying levels of discrimination, microaggressions, and resilience reported. Three latent classes were created. MI testing suggested that measurement invariance was partially met (established metric invariance and scalar invariance), and it is possible to compare factor means of discrimination, microaggressions, and resilience across time. Latent factor mean scores of microaggressions and discrimination decreased after 3 and 6 months and increased for resilience after 6 months and varied over time across the three latent classes identified. The subgroup with the lowest level of discrimination and microaggressions and the highest level of resilience reported at baseline, experienced increases in resilience after months 3 and 6. Clinical interventions, research, and policies aimed at promoting resilience and reducing structural and social barriers linked to racism, sexism, HIV stigma, and classism are needed to improve the health and well-being of BWLWH.
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Affiliation(s)
- Jingxin Liu
- 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
| | - Naysha Shahid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Devina J Boga
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Peyton Willie
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Reyanna St Juste
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Layomi Adeojo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mya Wright
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Aarti Madhu
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Chelsie Warman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Roxana Bolden
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - WayWay Hlaing
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan Rodriguez
- Department of Medicine (Infectious Diseases), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Ian Wright
- Department of Economics, University of Miami School of Business, Coral Gables, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
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Dale SK, Wright IA, Madhu A, Reid R, Shahid NN, Wright M, Sanders J, Phillips A, Rodriguez A, Safren SA. A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV. AIDS Behav 2024:10.1007/s10461-024-04408-w. [PMID: 39012452 DOI: 10.1007/s10461-024-04408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Ian A Wright
- Department of Economics, Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Aarti Madhu
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Naysha N Shahid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Mya Wright
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Allan Rodriguez
- Clinical Immunology, Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
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Kacanek D, Yee LM, Yao TJ, Lee J, Chadwick EG, Williams PL, Barr EA, Berman CA, Davtyan M, DiPerna A, Flores A, Green J, Haddad LB, Hyzy L, Jacobson DL, James-Todd T, Jao J, Khadraoui A, Malee KM, Moscicki AB, Patel K, Robinson LG, Salomon L, Sanders K, Siminski S, Smith RA, Wolbach T, Powis KM. Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study protocol: a prospective observational cohort study of reproductive-aged women living with HIV. BMJ Open 2024; 14:e084835. [PMID: 38969382 PMCID: PMC11228391 DOI: 10.1136/bmjopen-2024-084835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Over 265 000 women are living with HIV in the USA, but limited research has investigated the physical, mental and behavioural health outcomes among women living with HIV of reproductive age. Health status during the reproductive years before, during and after pregnancy affects pregnancy outcomes and long-term health. Understanding health outcomes among women living with HIV of reproductive age is of substantial public health importance, regardless of whether they experience pregnancy. The Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study is a prospective observational cohort study designed to investigate physical and mental health outcomes of young women living with HIV as they age, including HIV disease course, engagement in care, reproductive health and choices and cardiometabolic health. We describe the HOPE study design, and characteristics of the first 437 participants enrolled as of 1 January 2024. METHODS AND ANALYSIS The HOPE study seeks to enrol and follow 1630 women living with HIV of reproductive age, including those with perinatally-acquired HIV, at 12 clinical sites across 9 US states and Puerto Rico. HOPE studies multilevel dynamic determinants influencing physical, mental and social well-being and behaviours of women living with HIV across the reproductive life course (preconception, pregnancy, post partum, not or never-pregnant), informed by the socioecological model. Key research areas include the clinical course of HIV, relationship of HIV and antiretroviral medications to reproductive health, pregnancy outcomes and comorbidities and the influence of racism and social determinants of health. HOPE began enrolling in April 2022. ETHICS AND DISSEMINATION The HOPE study received approval from the Harvard Longwood Campus Institutional Review Board, the single institutional review board of record for all HOPE sites. Results will be disseminated through conference presentations, peer-reviewed journals and lay summaries.
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Affiliation(s)
- Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Lee
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paige L Williams
- Departments of Epidemiology and Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily A Barr
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, Texas, USA
| | - Claire A Berman
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mariam Davtyan
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alex DiPerna
- Frontier Science Foundation, Amherst, New York, USA
| | - Amanda Flores
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lisa B Haddad
- Population Council Center for Biomedical Research, New York City, New York, USA
| | - Laurie Hyzy
- Frontier Science Foundation, Amherst, New York, USA
| | - Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamarra James-Todd
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anisa Khadraoui
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kathleen M Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kunjal Patel
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa-Gaye Robinson
- Broward Health, Children's Diagnostic and Treatment Center, Fort Lauderdale, Florida, USA
| | - Liz Salomon
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Renee A Smith
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Kathleen M Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Qiao S, Zhang J, Liang C, Li X. Using All of Us data to examine the mental health change during COVID-19 pandemic among people living with HIV: A longitudinal study protocol. BMJ Open 2023; 13:e071285. [PMID: 37788923 PMCID: PMC10551941 DOI: 10.1136/bmjopen-2022-071285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has negatively affected people's mental health around the globe. Such effects may be especially compounded among some vulnerable populations such as people living with HIV (PLWH). However, large-scale data on mental health outcomes among PLWH are limited. Few studies have also identified potential protective factors for mental health outcomes. METHODS AND ANALYSIS Guided by theories of resilience and socioecology, we will leverage multiple datasets from National Institutes of Health's Cloud-based All of Us Programme including electronic health records (EHRs), a series of COVID-19 Participant Experience (COPE) Surveys conducted from May 2020 to February 2021, and other self-reported survey data to achieve two specific aims: (1) to examine the mental health outcome changes during COVID-19 pandemic among PLWH by employing both EHR data (2018-2022) and survey data (2020-2021) in the All of Us Programme; and (2) to identify potential protective factors based on COPE Survey data for mental health outcomes at multiple socioecological levels including individual level (eg, coping strategy), interpersonal level (eg, social support) and health institutional level (eg, health service accessibility), adjusting for pre-existing health conditions including psychiatric disorders and other relevant factors (eg, COVID-19 infection). Interaction terms will be included in the multivariable analysis to identify different socially disadvantaged or stigmatised subgroups. ETHICS AND DISSEMINATION The study has been approved by the institutional review board at the University of South Carolina (Pro00124044). Study findings will be disseminated through presentations at academic conferences and publications in peer-reviewed journals.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Chen Liang
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
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Woods-Giscombe CL, Williams KP, Conklin J, Dodd A, Bravo L, Anderson AM, Frazier T, Bey G, Robinson MN, Warren BJ, Wight KD, Felix AS, Anderson CM, Hood DB. A scoping review of the concept of resilience among African American women. Arch Psychiatr Nurs 2023; 46:107-120. [PMID: 37813493 DOI: 10.1016/j.apnu.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 02/19/2023] [Accepted: 04/23/2023] [Indexed: 10/17/2023]
Abstract
Resilience, thriving in the face of adversity, is a critical component of well-being in African American women. However, traditional definitions and approaches to operationalize resilience may not capture race- and gender-related resilience experiences of African American women. A more complete conceptualization of resilience may help facilitate future investigation of the mechanisms through which resilience influences health in this group. Our team conducted a scoping review of the literature published during twenty years, between 2000 and 2019, on resilience and health in African American women. We included a multidisciplinary set of databases (PubMed, CINAHL, PsycINFO, Scopus, Social Work Abstracts, Sociological Abstracts, Academic Search Premier). Using Covidence software a multi-step review process was conducted; 904 abstracts were initially screened for eligibility, 219 full-text studies were screened in stage two, and 22 remaining studies were reviewed for extraction. The studies reviewed revealed limitations of unidimensional approaches to conceptualizing/operationalizing resilience in African American women. The review highlighted culturally-relevant components of resilience including spirituality/religion, strength, survival, active coping, and social support. Findings highlight the importance of operationalizing resilience as a multidimensional construct so it can be optimally included in research designed to investigate the quality of life, cardiovascular risk, and other health outcomes in African American women.
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Affiliation(s)
| | | | - Jamie Conklin
- The University of North Carolina at Chapel Hill, United States of America
| | - Adam Dodd
- The University of North Carolina at Chapel Hill, United States of America
| | - Lilian Bravo
- The University of North Carolina at Chapel Hill, United States of America
| | | | - Taleah Frazier
- The University of North Carolina at Chapel Hill, United States of America
| | - Ganga Bey
- The University of North Carolina at Chapel Hill, United States of America
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Reid R, Dale SK. Structural equation modeling of microaggressions, religious and racism-related coping, medication adherence, and viral load among Black women living with HIV. J Behav Med 2023; 46:837-848. [PMID: 36997766 DOI: 10.1007/s10865-023-00403-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/21/2023] [Indexed: 04/01/2023]
Abstract
Despite the disproportionate impact of HIV, microaggressions, and discrimination among Black women living with HIV (BWLWH), BWLWH have demonstrated resilience by mobilizing religious and other coping strategies. The current study sought to examine whether racism-related or religious coping moderates the relationship between latent gendered racial microaggressions (GRMs), antiretroviral therapy (ART) adherence and viral load (VL) among 119 BWLWH. Data was collected via self-report measures of GRMs and coping. ART adherence was measured via self-report and electronic monitoring and VL was measured via blood specimens. Structural equation modeling showed significant main effects of religious coping on adherence and VL. Furthermore, GRMs × racism-related coping and GRMs × religious coping significantly predicted adherence and VL. Our findings indicate the unique and culturally salient role of religious and racism-related coping among BWLWH in the context of GRMs. Such findings may be optimized in the development of culturally relevant multilevel interventions for BWLWH.
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Affiliation(s)
- Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
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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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9
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Alexander KA, Mpundu G, Duroseau B, Osian N, Chambers S, McCree D, Tobin KE, Willie TC. Intervention Approaches to Address Intimate Partner Violence and HIV: a Scoping Review of Recent Research. Curr HIV/AIDS Rep 2023; 20:296-311. [PMID: 37768511 DOI: 10.1007/s11904-023-00668-8] [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: 08/31/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Intimate partner violence (IPV) remains a critical challenge to HIV prevention and treatment efforts across the globe. We examined recently published (January 9, 2017-January 9, 2023) integrated behavioral interventions designed to address IPV and HIV across the care continuum. RECENT FINDINGS Fifteen studies (involving n = 10,947 participants) met the inclusion criteria for this review. Majority (n = 13) of studies focused on IPV and HIV prevention whereas two studies addressed IPV and HIV care engagement among women living with HIV. Ten studies were conducted on the African continent representing 5 countries. Most interventions (n = 11) focused on individual-level outcomes among cisgender women although two involved male partners. About half of the interventions reviewed (n = 8) showed effectiveness on both IPV and HIV outcomes compared to control groups. Integrated HIV/IPV interventions are needed to address the synergistic nature of these epidemics among marginalized populations. Future studies should focus on developing and implementing strength-based interventions among people living with HIV, men, transgender people, and Black women in the USA. Additionally, researchers and program managers should consider addressing structural and internalized stigma as potential behavioral mechanisms for improving health among people simultaneously experiencing or at-risk for HIV and IPV.
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Affiliation(s)
- Kamila A Alexander
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA.
| | - Gloria Mpundu
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Brenice Duroseau
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Nkemakolem Osian
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shadae Chambers
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - DaJaneil McCree
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, N430G, Baltimore, MD, 21213, USA
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Chang HY, Johnson V, Conyers LM. Exploring the Impact of an Integrated Trauma-Informed HIV and Vocational Intervention for Black/African American Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6649. [PMID: 37681789 PMCID: PMC10487101 DOI: 10.3390/ijerph20176649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
Given the increased recognition of the role of social determinants of health on the prevalence of HIV in the United States, interventions that incorporate and address social determinants of HIV are essential. In response to the health disparities facing Black/African American women living with HIV, HIV activists and mental health specialists developed an innovative integrated HIV prevention and vocational development intervention, Common Threads, that underscores and addresses key economic and other social determinants of health experienced by Black/African American women within a trauma-informed care (TIC) framework. This research study applied grounded theory methods to conduct a qualitative study of Common Threads based on interviews with 21 women who participated in the Common Threads intervention. Participants shared several critical aspects of program components that reflected the TIC principles, endorsing a safe environment, trust building, and a sense of belonging. These components also encouraged transparency and promoted autonomy. Additionally, participants shared perceived program outcomes, including changes of knowledge and skills in four considering work domains (i.e., medical, psychosocial financial/legal resources, and vocational) that facilitate health and vocational development.
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Affiliation(s)
- Hsiao-Ying Chang
- Yang-Tan Institute on Employment and Disability, Cornell University, Ithaca, NY 14850, USA
| | - Vanessa Johnson
- Ribbon, Suite 200, 1300 Mercantile Lane, Largo, MD 20774, USA;
| | - Liza Marie Conyers
- Educational Psychology, Counseling, and Special Education, Pennsylvania State University, University Park, PA 16802, USA;
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Sommer S, Barroso J. A qualitative metasynthesis of stigma in women living with HIV in the United States. Int J Equity Health 2023; 22:158. [PMID: 37605194 PMCID: PMC10441719 DOI: 10.1186/s12939-023-01969-5] [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: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Our goal was to synthesize qualitative studies on HIV-related stigma as experienced by women living with HIV (WLWH) in the U.S. Qualitative metasynthesis techniques as developed by Sandelowski et al. (Res Nurs Health 30(1):99-111, 2007) were used to integrate and update findings on stigma in WLWH in the U.S. in 43 reports of qualitative studies conducted between 2004 and 2023 with 1118 participants. Developed themes explored a collective narrative of women first surviving the intersectionality of multiple sources of stigma, discovering non-linear pathways to transcend their stigma, and finally experiencing resilience through their transcendence of stigma. While this metasynthesis revealed similarities to an earlier metasynthesis in the ubiquity and persistence of stigma, they differ primarily in women's abilities to find agency in managing and opposing their stigma. This cognitive reframing of their stigma helped women to redefine stigma as ignorance and move towards a more positive assessment of the self. In doing so, they separated themselves from their stigma and the damaging effects of it. Findings from this metasynthesis may serve as a useful tool for the development of stigma reduction interventions specific to the needs and experiences of WLWH in the U.S.
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Affiliation(s)
- Sadie Sommer
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA.
| | - Julie Barroso
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA
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12
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Qiao S, Wilcox S, Olatosi B, Li X. COVID-19 challenges, responses, and resilience among rural Black women: a study protocol. Front Public Health 2023; 11:1156717. [PMID: 37333566 PMCID: PMC10275362 DOI: 10.3389/fpubh.2023.1156717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Prevention Research Center, University of South Carolina, Columbia, SC, United States
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
- Department of Health System Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, United States
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13
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Rajabiun S, Heath C, Walter AW, Scott JC, Downes A, Jennings E, Cabral HJ, Flores-Rodriguez C, Sprague Martinez L. The Black women first initiative: using implementation science to examine bundled interventions to improve care and treatment coordination for Black women with HIV. BMC Health Serv Res 2023; 23:551. [PMID: 37237372 DOI: 10.1186/s12913-023-09446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Black cisgender and transgender women are disproportionately affected by the HIV epidemic compared to women of other racial and ethnic identities. Twelve demonstration sites across the United States are adapting, implementing and evaluating a comprehensive bundle of two or more evidence informed interventions to improve health and outcomes and quality of life for Black women with HIV. METHODS Guided by Greenhalgh's Conceptual Model of Diffusion of Innovations in Health Service Organizations and Proctor's model for use of implementation strategies and evaluating implementation, service and client outcomes, this mixed methods study documents outcomes at the client, organization, and system level. Participant eligibility for the bundled interventions includes: individuals who are 18 years or older, identify as Black or African-American, identify as cisgender or transgender female and have a diagnosis of HIV. Qualitative data are collected systematically through a series of annual site visits and a standardized monthly call form to assess the barriers and facilitators to the implementation process and the key determinants impacting the intervention uptake and implementation strategies. Quantitative data collection for the implementation, service and client outcomes is conducted through a pre-post prospective study to examine the impact on Black women's health and well-being. Implementation outcomes include: the reach to Black women with HIV, adoption of interventions across the sites and their community; the fidelity to the components of the bundled interventions; the costs of the intervention; and the sustainability of the intervention in the organization and community. Primary service and client outcomes are improved linkage to and retention in HIV care and treatment, increased and sustained viral suppression, improved quality of life and resilience, and stigma reduction. DISCUSSION The study protocol presented is specifically designed to advance the evidence for adopting culturally responsive and relevant care into clinic and public health settings to improve the health and well-being for Black women with HIV. In addition the study may advance the implementation science field by furthering what is known about the ways in which bundled interventions can address barriers to care and facilitate the uptake of organizational practices to improve health.
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Affiliation(s)
| | - Corliss Heath
- Health Resources and Services Administration, Division of Policy and Data, HIV/AIDS Bureau, Rockville, USA
| | | | | | | | | | | | | | - Linda Sprague Martinez
- Boston University School of Social Work, Center for Emerging Infectious Disease Policy and Research and Clinical Translational Science Institute Community Engagement Program, Boston, USA
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Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, Bolden R, Adeojo L, Patrick J, Wallen C, Liu J, Ironson G, Alcaide ML, Safren S, Feaster D. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol 2023; 42:299-313. [PMID: 37141016 PMCID: PMC10167554 DOI: 10.1037/hea0001275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health. METHOD 151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated. RESULTS Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms. CONCLUSION Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Ian A. Wright
- Department of Economics, University of Miami School of Business
| | | | | | | | | | | | | | | | | | | | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), OB/GYN and Public Health, University of Miami Miller School of Medicine
| | | | - Daniel Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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15
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Etowa EB, Wong JPH, Omorodion F, Etowa J, Luginaah I. Addressing HIV Misconceptions among Heterosexual Black Men and Communities in Ontario. Healthcare (Basel) 2023; 11:healthcare11070997. [PMID: 37046924 PMCID: PMC10094559 DOI: 10.3390/healthcare11070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background. Black males accounted for 19.7% of all the new HIV diagnoses in Canada in 2020, yet Black people make up only 4.26% of the population. Persistent misconceptions about modes of HIV transmission need to be addressed to reduce the relatively high HIV prevalence among Black men. We described the HIV misconceptions held by some HBM in Ontario. We also identified the social determinants that are protective versus risk factors for HIV misconceptions among heterosexual Black men (HBM) in Ontario with a view to building evidence-based strategies for strengthening HIV prevention and stigma reduction among HBM and their communities in Ontario. Methods. We report quantitative findings of the weSpeak study carried out among HBM in four cities (Ottawa, Toronto, London, and Windsor) in Ontario. Sample size was 866 and sub-samples were: Ottawa (n = 210), Toronto (n = 343), London (n = 157), and Windsor (n = 156). Data were collected with survey questionnaire. The outcome variable, HIV misconception score ranging from 1 to 18, was measured by the number of statements on the HIV Knowledge Questionnaire with incorrect answers. We included three categories of independent variables in the analysis based on a stepwise and forward model selection approach. The variable categories include (i) sociodemographic background; (ii) personalised psychosocial attributes (levels of HIV misconceptions, negative condom attitude, age at sexual debut, and resilience); and (iii) socially ascribed psychosocial experiences (everyday discrimination and pro-community attitudes). After preliminary univariate and bivariate analyses, we used a hierarchical linear regression model (HLM) to predict levels of HIV misconceptions while controlling for the effect of the city of residence. Results. More than 50% of participants in all study sites were aged 20–49 years, married, and have undergone a college or university undergraduate education. Yet, a significant proportion (27.2%) held varying levels of misconceptions about HIV. In those with misconceptions, the two most common misconceptions were: (i) people are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV (40.1%); and (ii) taking a test for HIV one week after having sex will tell a person if she or he has HIV (31.6%). Discrimination (β = 0.23, p < 0.05, 95% CI = 0.01, 0.46), negative condom attitudes (β = 0.07, p < 0.05, 95% CI = 0.01, 0.12), and sexual debut at an older age (β = 0.06, p < 0.05, 95% CI = 0.01, 1) were associated with more HIV misconceptions. Being born in Canada (β = −0.96, p < 0.05, 95% CI = −1.8, −0.12), higher education (β = −0.37, p < 0.05, 95% CI = −0.52, −0.21), and being more resilient (β = −0.04, p < 0.05, 95% CI = −0.08, −0.01) were associated with fewer HIV misconceptions. Conclusion and recommendations. HIV misconceptions are still common, especially among HBM. These misconceptions are associated with structural and behavioural factors. We recommend structural and policy-driven interventions that promote more accessible and equity-driven healthcare, education, and social integration of HBM in Ontario. We also recommend building capacity for collective resilience and critical health and racial literacy as well as creating culturally safe spaces for intergenerational dialogues among HBM in their communities.
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Affiliation(s)
- Egbe B. Etowa
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Correspondence:
| | - Josephine Pui-Hing Wong
- Daphne Cockwell Health Sciences Complex, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON N9B 3P4, Canada
| | - Josephine Etowa
- School of Nursing, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON N6A 3K7, Canada
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16
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Samuels S, Dale SK. Self-esteem, adverse life events, and mental health diagnoses among Black women living with HIV. ETHNICITY & HEALTH 2023; 28:170-181. [PMID: 35200044 PMCID: PMC10097460 DOI: 10.1080/13557858.2022.2035690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Black women in the U.S. are disproportionately impacted by HIV and adverse life events (ALE). High self-esteem has been noted as a protective factor and low self-esteem has been linked to mental health diagnoses. However, the existing literature is limited in the examination of how self-esteem may buffer relationships between ALE and mental health diagnoses among Black women living with HIV (BWLWH). METHODS One hundred and nineteen BWLWH completed self-report measures on self-esteem (Rosenberg Self-Esteem Scale) and ALE (Life Events Checklist for DSM-5) (e.g. sexual assault, physical assault, accidents, natural disaster) as well as a clinical interview (via Mini-International Neuropsychiatric Inventory) to diagnose current depression, PTSD, and suicidality. RESULTS Multivariable logistic regressions indicated that higher self-esteem was associated with lower likelihood of current depression (OR = .894, p < .01), PTSD (OR = .838, p < .001) and suicidality (OR = .889, p < .05). Interactions between self-esteem and total ALE significantly predicted current depression (OR = .000003, p < .05) and PTSD (OR = 2.7182 × 10-9, p < .001); and higher total ALE related to higher likelihood of current PTSD only among BWLWH reporting lower self-esteem (OR = 1.21, p < .05). CONCLUSION Interventions addressing mental health diagnoses among BWLWH should incorporate strategies to enhance self-esteem.
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Affiliation(s)
- Sherene Samuels
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Miami, FL, USA
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17
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Stubin CA. Steps toward a resilient future nurse workforce. Int J Nurs Educ Scholarsh 2023; 20:ijnes-2022-0057. [PMID: 37053471 DOI: 10.1515/ijnes-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/18/2022] [Indexed: 04/15/2023]
Abstract
INTRODUCTION The psychosocial needs of nursing students are a pressing matter as mental health disorders may affect nursing students' journeys as professional nurses. LITERATURE REVIEW Psychological distress and burnout in nurses are threats to worldwide health care, as the stress associated with the COVID-19 pandemic could lead to an unstable future global nurse workforce. DISCUSSION Resiliency training can positively impact nurse stress, mindfulness, and resilience, as resilient nurses are better able to manage their response to stress and adversity which will contribute to positive patient outcomes. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE Educating faculty on resilience will aid nurse educators to create new student instructional approaches to improve mental health wellness. CONCLUSIONS Supportive faculty behaviors, self-care techniques, and resilience-building infused throughout the nursing curriculum may promote the effective transitioning of students into practice, providing the necessary foundation for improving workplace stress management and increasing longevity and satisfaction in the profession.
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Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2023; 39:1-12. [PMID: 36322713 PMCID: PMC9889016 DOI: 10.1089/aid.2022.0079] [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: 11/30/2022] Open
Abstract
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Darren J. Baker
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - George A. Kuchel
- UConn Center on Aging, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kathryn E. Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Bruce Brew
- Department of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
- Department of Neurology, Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Department of Neurology, University of New South Wales Sydney, Sydney, Australia
- University of Notre Dame Australia, Sydney, Australia
| | - Lucette A. Cysique
- Faculty of Science, Department of Psychology, School of Psychology, University of New South Wales Sydney, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Neuroscience Unit, St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Chelsie Wallen
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joseph B. Margolick
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Divisions of Infectious Diseases, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
- Divisions of Geriatric Medicine, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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Reid R, Dale SK. Moderating effects of social support on the relationship between substance use disorders and HIV viral load and medication adherence among Black women living with HIV in the United States. AIDS Care 2022; 34:1219-1228. [PMID: 34783618 PMCID: PMC9453849 DOI: 10.1080/09540121.2021.2001415] [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: 05/12/2020] [Accepted: 10/28/2021] [Indexed: 01/26/2023]
Abstract
Substance use may predict lower rates of antiretroviral therapy (ART) adherence and viral suppression among Black Women Living with HIV (BWLWH). We assessed how perceived social support (PSS) moderates the relationship between substance use disorder (SUD) and viral load (VL) and ART adherence. 119 BWLWH provided information on PSS, SUD, alcohol use disorder (AUD) and adherence (via Wisepill). Higher PSS from friends (β = -.263, p = .008) and significant others (β = -.219, p = .025) predicted lower VL. SUD predicted low Wisepill adherence (a) in the past week (β = -.273, p = .035) and past two weeks (β = -.273, p = .033) only for women low in PSS from friends, and (b) in the past two weeks only for women low in total PSS (β = -.294, p = .024). Ironically, for women high in total PSS, SUD predicted higher adherence in the past four weeks (β = .360, p = .006). Adherence and VL may be bolstered by understanding the role of various forms of PSS and SUDs.
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Boga DJ, Dale SK. Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health. AIDS Patient Care STDS 2022; 36:364-374. [PMID: 36040393 PMCID: PMC9514596 DOI: 10.1089/apc.2022.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing. Clinical Trial Registration number NCT02764853.
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Affiliation(s)
- Devina J. Boga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida, USA
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22
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Dulin AJ, Fava JL, Earnshaw VA, Dale SK, Carey MP, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Agil D, Howe CJ. Development of Long and Short Forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. AIDS Behav 2022; 26:2469-2484. [PMID: 35092536 PMCID: PMC10782857 DOI: 10.1007/s10461-022-03579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/15/2023]
Abstract
Understanding resilience in relation to HIV-related outcomes may help address racial/ethnic disparities, however, significant gaps in its measurement preclude in-depth study. Thus, this research aims to develop and evaluate the psychometric properties of long and short forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. To develop the items, we conducted a mixed methods study (N = 48) and reviewed published resilience measures. We completed content validity index analyses to ensure the items reflected the resilience construct. Next, we conducted 20 cognitive interviews and a field survey (N = 400). The long and short forms demonstrated acceptable to excellent psychometric properties based on factorial validity, internal consistency and convergent validity and on measurement invariance (conducted for the short form only). These measures provide a comprehensive framework to examine resilience and HIV-related outcomes and can inform resilience-building interventions to reduce racial and ethnic health disparities.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Marta Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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23
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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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24
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Randolph SD, Johnson R, McGee K, A Adimora A, Ramirez C, Bailey DE, Holt L, Koch A, McMillian-Bohler JM, Ritchwood T, Relf MV. Adaptive leadership in clinical encounters with women living with HIV. BMC Womens Health 2022; 22:217. [PMID: 35681158 PMCID: PMC9185975 DOI: 10.1186/s12905-022-01810-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV (WLWH) report low engagement in health care, missed office visits, and less engagement in the clinical encounter. Strengthening the clinical encounter for WLWH may improve health outcomes and quality of life. The Adaptive Leadership Framework for Chronic Illness offers specific adaptive leadership strategies for providers to improve patient-provider interactions. The purpose of this study was to examine adaptive leadership behaviors that contribute to the development of effective patient-provider communication from the perspectives of WLWH. METHODS The descriptive, cross-sectional and qualitative study conducted interviews with 22 WLWH to assess perceptions of the clinical encounter related to HIV-related stigma, engagement in care, medical distrust, and experiences with discrimination and quality of life. Members of the study team using a set of a priori codes analyzed data using NVivo 12.0. RESULTS Participants described two primary themes and subthemes of each for adaptive leadership behaviors. The primary theme for adaptive leadership of providers was "my provider cares about me"; subthemes were communication, trust building takes time, and supportive providers are trusted. The primary theme for adaptive leadership of WLWH themselves was "I care about me; subthemes were self-advocacy and self-empowerment. CONCLUSIONS Providers can use adaptive leadership behaviors during clinical encounters to support WLWH, improve patient-provider communication, enhance trust, and improve patient outcomes.
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Affiliation(s)
| | | | - Kara McGee
- Duke University School of Nursing, Durham, NC, USA
| | - Adaora A Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, Department of Epidemiology, School of Medicine, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catalina Ramirez
- School of Medicine and the Project Director for the Women's Interagency HIV Study at the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lauren Holt
- Duke University School of Nursing, Durham, NC, USA
| | - Amie Koch
- Duke University School of Nursing, Durham, NC, USA
| | | | - Tiarney Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Michael V Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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25
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Huang YJ, Acquati C, Cheung M. Family communication and coping among racial-ethnic minority cancer patients: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e605-e620. [PMID: 34716631 DOI: 10.1111/hsc.13623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.
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Affiliation(s)
- Yu-Ju Huang
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
- Department of Health Disparities Research, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Monit Cheung
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
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26
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Li X, Qiao S, Yang X, Harrison SE, Tam CC, Shen Z, Zhou Y. A Resilience-Based Intervention to Mitigate the Effect of HIV-Related Stigma: Protocol for a Stepped Wedge Cluster Randomized Trial. Front Public Health 2022; 10:857635. [PMID: 35425746 PMCID: PMC9001957 DOI: 10.3389/fpubh.2022.857635] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite decades of global efforts to tackle HIV-related stigma, previous interventions designed to reduce stigma have had limited effects that were typically in the small- to-moderate range. The knowledge gaps and challenges for combating HIV-related stigma are rooted both in the complexity of the stigma and in the limitations of current conceptualizations of stigma reduction efforts. Recent research has shown the promise of resilience-based approaches that focus on the development of strengths, competencies, resources, and capacities of people living with HIV (PLWH) and their key supporting systems (e.g., family members and healthcare providers) to prevent, reduce, and mitigate the negative effects of stigma. However, the resilience-based approach, while hypothesized, has rarely been empirically tested in large intervention trials, especially in resource-limited settings. Methods In this study, we propose to develop, implement, and evaluate a theory-guided, multilevel, multimodal resilience-based intervention via a stepped wedge cluster randomized trial among 800 PLWH and their biological or surrogate family members, as well as 320 healthcare providers in Guangxi, China with a longitudinal follow-up period of 36 months at 6-month intervals. The primary outcome will be viral suppression and the intermediate outcomes will include perceived stress and medication adherence of PLWH as well as resilience measures at the level of the individual, the family, and the healthcare system. Discussion The proposed study will be one of the first large scale efforts to examine whether resilience among PLWH can be fostered and sustained through a multilevel and multi-component HIV-related stigma intervention and whether a resilience-based intervention can improve clinical outcomes and quality of HIV care among PLWH in a low-resource setting. If efficacious, the intervention components could be tailored to other groups of PLWH and adapted for other low- and middle-income countries. Trial Registration This trial is registered at ClinicalTrials.gov, registration number NCT05174936, registered 13 December 2021. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=3&cx=-jg9qo2.
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Affiliation(s)
- Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sayward E Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
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27
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Silverman ME, Sami TJ, Kangwa TS, Burgos L, Stern TA. Socioeconomic Disparity in Birth Rates During the COVID-19 Pandemic in New York City. J Womens Health (Larchmt) 2022; 31:1113-1119. [PMID: 35404128 DOI: 10.1089/jwh.2021.0571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: The differential impact of the coronavirus disease 2019 (COVID-19) pandemic across race, ethnicity, and socioeconomic status remains poorly understood. While recent explorations into birthrates during the pandemic have revealed significant declines, how birthrates may have differed between racial and socioeconomic subgroups during the pandemic remains to be detailed. Methods: Using electronic health records from a large hospital network in New York serving a racially and socioeconomically diverse population, we explored birthrates associated with conceptions that occurred during the COVID-19 pandemic lockdown for demographic and obstetric differences. Results: Two thousand five hundred twenty-three unique patient deliveries corresponded with conceptions that occurred during the COVID-19 pandemic lockdown in New York. Compared to the same period the previous year, there was a 22.85% decrease in births. Explorations into differences in birthrates by socioeconomic status revealed that much of the decline could be explained by fewer births among individuals living in higher socioeconomic status as opposed to individuals living in urban economic poverty [χ2(n = 5588) = 18.35, p < 0.01]. Conclusion: On March 22, 2020, New York instituted a prohibition of all nonessential social gatherings and the closure of all nonessential businesses. Although the full impact of the COVID-19 pandemic on reproductive health and outcomes remains largely unknown, the decreased birthrate associated with the initial COVID-19 wave in New York was not entirely unexpected. While the mechanisms that drive health disparities are complex and multifactorial, most of the decrease occurred among those living in higher socioeconomic status. This finding has important implications for understanding health behaviors and disparities among minorities living in low socioeconomic status.
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Affiliation(s)
- Michael E Silverman
- Department of Psychiatry and Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Tanya J Sami
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Thandiwe S Kangwa
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Laudy Burgos
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Toni A Stern
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
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28
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Newman AK, Thorn BE. Intersectional identity approach to chronic pain disparities using latent class analysis. Pain 2022; 163:e547-e556. [PMID: 34252906 DOI: 10.1097/j.pain.0000000000002407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Research on intersectionality and chronic pain disparities is very limited. Intersectionality explores the interconnections between multiple aspects of identity and provides a more accurate image of disparities. This study applied a relatively novel statistical approach (ie, Latent Class Analysis) to examine chronic pain disparities with an intersectional identity approach. Cross-sectional data were analyzed using pretreatment data from the Learning About My Pain trial, a randomized comparative effectiveness study of group-based psychosocial interventions (Patient-Centered Outcomes Research Institute Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. Latent Class Analysis results suggested a 5-class model. To easily identify each class, the following labels were created: older adults, younger adults, severe disparity, older Black or African American, and Working Women. The latent disparity classes varied by pretreatment chronic pain functioning. Overall, the severe disparity group had the lowest levels of functioning, and the Working Women group had the highest levels of functioning. Although younger and with higher literacy levels, the younger adults group had similar levels of pain interference and depressive symptoms to the severe disparity group (P's < 0.05). The younger adults group also had higher pain catastrophizing than the older adults group (P < 0.005). Results highlighted the importance of the interactions between the multiple factors of socioeconomic status, age, and race in the experience of chronic pain. The intersectional identity theory approach through Latent Class Analysis provided an integrated image of chronic pain disparities in a highly understudied and underserved population.
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Affiliation(s)
- Andrea K Newman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Beverly E Thorn
- Department of Psychology, University of Alabama, Tuscaloosa, AL, United States
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29
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Koch A, Ritchwood TD, Bailey DE, Caiola CE, Adimora AA, Ramirez C, Holt L, Johnson R, McGee K, McMillian-Bohler JM, Randolph SD, Relf MV. Exploring Resilience Among Black Women Living With HIV in the Southern United States: Findings From a Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:224-234. [PMID: 35195613 PMCID: PMC9188835 DOI: 10.1097/jnc.0000000000000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black women living with HIV (WLWH) face individual and sociostructural challenges. Despite these challenges, many exemplify remarkable levels of resilience and coping. Yet, research on resilience and coping in this population is limited. Twenty Black WLWH in the Southern United States completed semi-structured interviews that explored challenges facing WLWH. We identified six themes related to resilience and coping: self-acceptance, disclosure, self-compassion, social support, will to live, and service. Of these, social support was a driving protective element and an essential component to building and sustaining resilience and coping. Women who experienced positive support often expressed a will to live as well as a desire to support other WLWH. Resilience and social support were characterized by patterns of reciprocity, in that they were mutually sustaining, stabilizing, and strengthening.
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Affiliation(s)
- Amie Koch
- Duke University School of Nursing, and a Palliative Care and Hospice Family Nurse Practitioner at Transitions LifeCare, and is a COVID Nurse Practitioner, Lincoln Community Health Clinic, Durham, North Carolina, USA
| | - Tiarney D. Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Adaora A. Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, School of Medicine and a Professor of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- School of Medicine, and is a Project Director for the Women’s Interagency HIV Study, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, SA
| | - Lauren Holt
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Kara McGee
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | | | - Michael V. Relf
- Associate Dean for Global and Community Health Affairs, Duke University School of Nursing and Associate Research Professor, Duke Global Health Institute, Durham, North Carolina, USA
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30
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Duthely LM, Sanchez-Covarrubias AP, Brown MR, Thomas TE, Montgomerie EK, Dale S, Safren SA, Potter JE. Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter. Front Public Health 2021; 9:667331. [PMID: 34235129 PMCID: PMC8255796 DOI: 10.3389/fpubh.2021.667331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH). Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence. Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups. Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = −0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)—a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04). Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.
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Affiliation(s)
- Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alex P Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Megan R Brown
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tanya E Thomas
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emily K Montgomerie
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sannisha Dale
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - JoNell E Potter
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
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31
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Dale SK, Reid R, Safren SA. Factors associated with resilience among Black women living with HIV and histories of trauma. J Health Psychol 2021; 26:758-766. [PMID: 30957560 PMCID: PMC6783333 DOI: 10.1177/1359105319840690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States, Black women living with HIV face various individual (e.g. trauma) and structural (e.g. racism) adversities. However, resilience is understudied among Black women living with HIV. A total of 100 Black women living with HIV in the United States completed measures of resilience, general self-efficacy, self-esteem, post-traumatic growth, trauma symptoms, trauma-related cognitions, and depressive symptoms. Regressions controlling for age and education indicated that higher resilience was associated with higher general self-efficacy (β = .39, p < .001), higher self-esteem (β = .48, p < .001), higher post-traumatic growth (β = .34, p < .01), lower post-traumatic cognitions (β = -.36, p < .001), lower trauma symptoms (β = -.29, p < .01), and lower depressive symptoms (β = -.38, p < .001). Our findings suggest potential targets for interventions.
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Affiliation(s)
- Sannisha K Dale
- University of Miami, USA
- Massachusetts General Hospital, USA
- Harvard Medical School, USA
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32
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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33
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Fletcher FE, Sherwood NR, Rice WS, Yigit I, Ross SN, Wilson TE, Weiser SD, Johnson MO, Kempf MC, Konkle-Parker D, Wingood G, Turan JM, Turan B. Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis. AIDS Patient Care STDS 2020; 34:356-366. [PMID: 32757978 DOI: 10.1089/apc.2019.0309] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.
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Affiliation(s)
- Faith E. Fletcher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas R. Sherwood
- The Jimmy & Rosalynn Carter School for Peace and Conflict Resolution, George Mason University, Fairfax, Virginia, USA
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ibrahim Yigit
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shericia N. Ross
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP. J Racial Ethn Health Disparities 2020; 7:913-927. [PMID: 32078743 DOI: 10.1007/s40615-020-00715-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.
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35
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Silverman ME, Medeiros C, Burgos L. Early pregnancy mood before and during COVID-19 community restrictions among women of low socioeconomic status in New York City: a preliminary study. Arch Womens Ment Health 2020; 23:779-782. [PMID: 32844329 PMCID: PMC7447087 DOI: 10.1007/s00737-020-01061-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/18/2020] [Indexed: 11/03/2022]
Abstract
To explore the mental health consequences of COVID-19-related social restrictions on pregnant women living in low socioeconomic status. Prenatal women appearing at the Mount Sinai Hospital Ambulatory Practice were screened for mood symptomatology from February 2, 2020, through June 12, 2020. An improvement in prenatal mood was observed following social restrictions compared to before the pandemic. The impact of COVID-19 remains largely unknown and may be useful towards understanding the needs of pregnant women living in poverty.
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Affiliation(s)
- Michael E. Silverman
- grid.416167.3Department of Psychiatry, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY USA
| | - Cathryn Medeiros
- grid.416167.3Department of Social Work Services, The Mount Sinai Hospital, New York, NY USA
| | - Laudy Burgos
- grid.416167.3Department of Social Work Services, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY USA
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36
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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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