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Rice WS, Ellison CK, Bruno B, Hussen SA, Chavez M, Nápoles TM, Walcott M, Batchelder AW, Turan B, Kempf MC, Wingood GM, Konkle-Parker DJ, Wilson TE, Johnson MO, Weiser SD, Logie CH, Turan JM, Piper K. Exploring the role of motherhood in healthcare engagement for women living with HIV in the USA. CULTURE, HEALTH & SEXUALITY 2024:1-15. [PMID: 39041302 DOI: 10.1080/13691058.2024.2380765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
Mothers living with HIV are faced with managing their own complex healthcare and wellness needs while caring for their children. Understanding the lived experiences of mothers living with HIV, including grandmothers and mothers with older children - who are less explicitly represented in existing literature, may guide the development of interventions that best support them and their families. This study sought to explore the role of motherhood and related social/structural factors on engagement with HIV care, treatment-seeking behaviour, and overall HIV management among mothers living with HIV in the USA to inform such efforts. Semi-structured interviews were conducted between June and December 2015 with 52 mothers living with HIV, recruited from the Women's Interagency HIV Study (WIHS) sites in four US cities. Five broad themes were identified from the interviews: children as a motivation for optimal HIV management; children as providing logistical support for HIV care and treatment; the importance of social support for mothers; stressors tied to responsibilities of motherhood; and stigma about being a mother living with HIV. Findings underscore the importance of considering the demands of motherhood when developing more effective strategies to support mothers in managing HIV and promoting the overall health and well-being of their families.
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Affiliation(s)
- Whitney S Rice
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Celeste K Ellison
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Beverly Bruno
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Max Chavez
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
| | - Tessa M Nápoles
- Department of Social and Behavioral Sciences, University of CA, San Francisco, CA, USA
| | - Melonie Walcott
- Lindsley F. Kimball Research Institute, NY Blood Center, New York, NY, USA
| | - Abigail W Batchelder
- Department of Psychiatry, MA General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of AL at Birmingham, Birmingham, AL, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Deborah J Konkle-Parker
- Medicine and Population Health Sciences, University of MS Medical Center Schools of Nursing, Jackson, MS, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, SUNY Downstate Health Sciences University School of Public Health, New York, NY, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, School of Medicine, San Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California, School of Medicine, San Francisco, CA, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health, Atlanta, GA, USA
| | - Kendra Piper
- Population Health Innovation Lab, Public Health Institute, Oakland, CA, USA
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Nuño N, Martínez A, Martínez S, Cobos M, Hernández JS, Polo R. Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study. PLoS One 2024; 19:e0301335. [PMID: 38713682 DOI: 10.1371/journal.pone.0301335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/14/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain. METHODS We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates. RESULTS The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (β: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (β: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (β: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (β: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (β: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009). CONCLUSION The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.
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Affiliation(s)
- Néstor Nuño
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Alberto Martínez
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Susana Martínez
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | - Marta Cobos
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
| | | | - Rosa Polo
- Division for Control of HIV, STIs, Viral Hepatitis and Tuberculosis, Spanish Ministry of Health, Madrid, Spain
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Atkins K, Bruce J, Kay ES, Musgrove K, Kellar P, MacCarthy S. Transactional sex among adults accessing sexual health services in Alabama, 2008-2022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis. Ann Epidemiol 2024; 92:35-39. [PMID: 38360156 DOI: 10.1016/j.annepidem.2024.02.004] [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: 10/11/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The U.S. Deep South bears a disproportionate burden of HIV and other STIs. Transactional sex may influence these epidemics, but few studies have estimated its prevalence or correlates in the Deep South. METHODS We estimated the history of transactional sex among adults accessing an Alabama AIDS Service Organization from 2008-2022, using chi-square tests to examine its sociodemographic and behavioral correlates. We used modified Poisson regression with cluster-robust standard errors to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) for the associations between transactional sex and new HIV, hepatitis C (HCV), and STI diagnoses. RESULTS Transactional sex was reported at 944/20,013 visits (4.7 %) and associated with older age, being a cisgender woman or gender minority, identifying as white, diverse drug use, and sharing of drug equipment. Compared to others, clients reporting transactional sex had increased prevalence of syphilis (apR 3.60, 95 % CI 1.16-11.19) and HCV (aPR 1.53, 95 % CI 1.24-1.88). CONCLUSION Using 14 years of community-based data, this study is the first to estimate the relationship between transactional sex and HIV, HCV, and STIs in Alabama and highlights the need address STI burden and diverse drug use among people who transact sex in the Deep South.
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Affiliation(s)
- Kaitlyn Atkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, AL, USA
| | - Emma Sophia Kay
- Birmingham AIDS Outreach, Birmingham, AL, USA; Department of Acute, Chronic, and Continuing Care University of Alabama at Birmingham School of Nursing Birmingham, AL, USA
| | | | | | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [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] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Dorshimer M, Hirshfield S, Mayer J, Aidala AA. Examining Concordance Between Self-Report and Biomedical HIV Viral Load Data: A Scoping Review. AIDS Behav 2024; 28:93-104. [PMID: 37493931 DOI: 10.1007/s10461-023-04136-7] [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] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
Assessment of HIV viral load based on laboratory results is the gold standard in HIV care and research. However, blood assay or accessing medical records is not always possible due to research or service contexts and constraints. Self-report of viral load test results expands data resources, is a convenient method of collecting data in both research and service settings, and is useful for HIV surveillance. The purpose of this scoping review was to identify existing literature on the validity of self-reported viral load data compared to blood assay or medical record review. We found that the existing literature is limited, with varied data collection methods, self-report measures, and study designs, as well as predictors of accuracy. Concordance between self-reported viral load and biomedical data varied across studies but appeared to be more consistent among samples recruited from clinical populations that reported engagement in HIV care. While it is difficult to draw definitive conclusions about the validity of self-reported viral load across existing studies, there is a need for a standardized measure and method of collection that can be utilized across diverse populations living with HIV.
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Affiliation(s)
- Molly Dorshimer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1240, Brooklyn, NY, 11203-2012, USA.
| | - Joseph Mayer
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, United States, 11203, New York
| | - Angela A Aidala
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [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] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Small LA, Godoy SM, Lau C. Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA. CULTURE, HEALTH & SEXUALITY 2023; 25:1295-1309. [PMID: 36571392 PMCID: PMC10558086 DOI: 10.1080/13691058.2022.2155706] [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: 04/19/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.
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Affiliation(s)
- Latoya A. Small
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Sarah M. Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Lau
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
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Raiford JL, Yuan X, Carree T, Beer L. Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States - Medical Monitoring Project, United States, 2015-2019. J Acquir Immune Defic Syndr 2023; 93:413-421. [PMID: 37129907 PMCID: PMC10524626 DOI: 10.1097/qai.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Racial and ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) have been documented among women with HIV. We examined factors that may account for these racial/ethnic differences among women to inform interventions that increase health equity. METHODS We used data from the 2015-2019 cycles of the Medical Monitoring Project, a probability sample of U.S. adults with diagnosed HIV. Using logistic regression with predicted marginal means, we calculated weighted prevalence differences (PDs) of ART adherence and SVS among Black, Hispanic/Latina, and White women taking ART. Using modeling with forward stepwise selection, we adjusted PDs for selected variables, including social and structural determinants of health (SDOH) factors, to examine whether magnitude of PDs was attenuated by their inclusion. We assessed relative changes between unadjusted and adjusted PDs. RESULTS After adjusting for poverty, transportation needs, health literacy, and gap in health insurance/coverage, the Black-White PD in adherence decreased by 11% (-16.0% to -14.2%). After adjusting for adherence, poverty, type of health insurance, and gap in health insurance/coverage, the Black-White PD in SVS reduced 37% (-7.9% to -5.0%) and was no longer statistically different. The Hispanic/Latina-White PD in adherence reduced 24% (-12.7% to -9.6%) after adjusting for poverty, health literacy, and transportation needs. The unadjusted Hispanic/Latina-White PD in SVS was not significantly different. CONCLUSION Racial/ethnic disparities in HIV outcomes among women taking ART were substantially reduced after accounting for SDOH and other factors although differences remained. Structural interventions to improve SDOH are needed to improve health equity for women with HIV.
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Affiliation(s)
- Jerris L Raiford
- Centers for Disease Control and Prevention, Division of HIV Prevention, HIV Research Branch Atlanta, GA
| | - Xin Yuan
- DLH Corporation Atlanta, GA; and
| | | | - Linda Beer
- Centers for Disease Control and Prevention, Division of HIV Prevention, Behavioral Clinical Surveillance Branch Atlanta, GA
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Wien S, Guest JL, Luisi N, Taussig J, Kramer MR, Stephenson R, Millett G, del Rio C, Sullivan PS. Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective. AIDS Care 2023; 35:1154-1163. [PMID: 36878481 PMCID: PMC10426396 DOI: 10.1080/09540121.2023.2182871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.
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Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Greg Millett
- American Foundation for AIDS Research, Washington DC, USA
| | - Carlos del Rio
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Song W, Mulatu MS. Factors Associated With Rapid Linkage to HIV Medical Care Among Persons Newly Diagnosed With HIV Infection in the United States, 2019 to 2020. Sex Transm Dis 2023; 50:439-445. [PMID: 36881443 DOI: 10.1097/olq.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rapid linkage to HIV medical care, ideally within 7 days of a person's diagnosis with HIV infection, is a vital strategy of the Ending the HIV Epidemic initiative in the United States. We analyzed HIV testing data to evaluate the prevalence of and factors associated with rapid linkage to HIV medical care. METHODS We used HIV testing data reported by Centers for Disease Control and Prevention-funded 60 state and local health departments and 29 community-based organizations from 2019 to 2020. Variables analyzed include rapid linkage to HIV medical care (within 7 days of diagnosis), demographic/population characteristics, geographic region, test site type, and test year. Multivariable Poisson regression analysis was conducted to evaluate the characteristics associated with rapid linkage to HIV medical care. RESULTS A total of 3,678,070 HIV tests were conducted, and 11,337 persons were newly diagnosed with HIV infection. Only 4710 persons (41.5%) received rapid linkage to HIV medical care, which was more likely among men who have sex with men or persons who were diagnosed in Phase I Ending the HIV Epidemic jurisdictions and less likely among persons diagnosed in sexually transmitted disease clinics or the South region. CONCLUSIONS Less than one-half of persons newly diagnosed with HIV infection in Centers for Disease Control and Prevention-funded HIV testing programs were linked to HIV medical care within 7 days of diagnosis. Rapid linkage to care varied significantly by population characteristics and setting. Identifying and removing potential individual, social, or structural barriers to rapid linkage to care can help improve HIV-related health equity and contribute to the national goal of ending the HIV epidemic.
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Affiliation(s)
- Wei Song
- From the Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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TÉCLESSOU JN, AKAKPO AS, DOKLA AK, AMOUSSOU DK, DEKU K, LIMAIE CA, Palokinam PITCHÉ V. [Stigmatization of people living with HIV in health care services in Togo]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i2.2023.260. [PMID: 37525681 PMCID: PMC10387313 DOI: 10.48327/mtsi.v3i2.2023.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/01/2023] [Indexed: 08/02/2023]
Abstract
Introduction The elimination of AIDS as a threat to public health implies comprehensive care for those tested in all health facilities and without discrimination/stigmatization. The aim of this study is to evaluate the problems of stigmatization and discrimination of people living with HIV (PLHIV) in health care facilities and their implications for access to care for PLHIV. Methodology This is a descriptive cross-sectional study in the 6 health regions of Togo targeting people aged 18 years and over, living with HIV. A hybrid sampling method combining a limited chain referral and a sampling based on the mapping of meeting places/activities was used. Data were collected using the digitized version 2.0 of the PLHIV Stigma Index questionnaire. Results A total of 1 119 PLHIV with a mean age of 39 years were included. The sex-ratio was 0.5, and 43.4% had known their HIV status for 1 to 4 years. In the last 12 months, the experiences of stigmatization reported by the PLHIV from health personnel were: gossip (13%), disclosure of status without consent (10%) or avoidance of physical contact (2.6%). In terms of reproductive health, 2.1% of respondents had been advised not to become fathers/mothers and 1.4% had their access to antiretroviral drugs (ARV) conditioned by the use of a contraceptive method. 28.4% of those on ARV had missed one dose of treatment in the last 12 months for fear that someone would find out they were HIV positive. Also, 39.5% of the respondents who were not on ARV justified this by the fear that health workers would treat them badly or reveal their HIV status without their consent. Conclusion In health care settings, this phenomenon of HIV-related stigma is multifaceted and deserves to be documented so that it can be taken into account in order to improve the quality of services offered to beneficiary populations.
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Affiliation(s)
| | - Abla Séfako AKAKPO
- Faculté des sciences de la santé, Université de Lomé, 08 B.P. 8615 Lomé, Togo
| | | | | | - Kodzo DEKU
- Conseil national de lutte contre le sida et les IST du Togo (CNLS-IST), Lomé, Togo
| | - Charles Abalo LIMAIE
- Conseil national de lutte contre le sida et les IST du Togo (CNLS-IST), Lomé, Togo
| | - Vincent Palokinam PITCHÉ
- Faculté des sciences de la santé, Université de Lomé, 08 B.P. 8615 Lomé, Togo
- Conseil national de lutte contre le sida et les IST du Togo (CNLS-IST), Lomé, Togo
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Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Page KR, Celentano DD, Smith KC, Kerrigan D. Exploring the dynamics of the quality of HIV care experienced by female sex workers living in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001479. [PMID: 37115734 PMCID: PMC10146439 DOI: 10.1371/journal.pgph.0001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
Abstract
Despite increased attention and efforts to improve HIV care among female sex workers (FSWs), they continue to have suboptimal HIV outcomes. Exploring the socio-structural dynamics related to the quality of HIV care received by FSWs is critical to further strengthen interventions to improve their HIV care continuum outcomes. In this study, we conducted two rounds of qualitative in-depth interviews with 20 FSWs living with HIV in the Dominican Republic to explore how healthcare experiences contributed to their quality of HIV care. Data was analyzed using a thematic analytic approach exploring diverse structural and relational aspects of the quality of HIV care affecting FSWs as they navigate the clinic environment. Results indicated that quality of HIV care was influenced by both structural and relational factors within clinics. At the structural level, insufficient stock of antiretroviral therapy and the financial burden created by HIV care related costs hindered FSWs' satisfaction with their current HIV care and presented a barrier in FSWs' ability to access HIV care services. Quality of care was also closely linked to relational aspects of the HIV care environment, including FSWs' relationship and communication with their clinical providers, as FSWs often expressed their satisfaction with HIV care experiences based on these interpersonal factors. Lastly, personal agency emerged as an important factor contributing to the quality of HIV care, specifically as FSWs' treatment literacy resulted in greater advocacy and demands for quality care. Programmatic efforts should be directed to improving the quality of HIV care experiences of FSWs in the clinic environment. These include addressing resource shortages, promoting positive and effective patient-provider relationships, and facilitating HIV treatment education opportunities for FSWs.
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Affiliation(s)
- Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Yeycy Donastorg
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Kathleen R. Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - David D. Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, United States of America
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Implementation of a Novel Clinic/Community Partnership Addressing Food Insecurity Among Adults With HIV in the Southern United States: A Program Brief. J Assoc Nurses AIDS Care 2023; 34:307-315. [PMID: 36897568 DOI: 10.1097/jnc.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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Alenezi A. Stigmatization and discrimination towards human immunodeficiency virus seropositive patients in psychiatric and mental health facilities. Int J Ment Health Nurs 2022; 31:1198-1212. [PMID: 35678330 DOI: 10.1111/inm.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Stigmatization and discriminatory attitudes of nurses towards human immunodeficiency (HIV) patients have been reported in many countries. The current study was undertaken to assess the knowledge, attitudes and factors associated with stigmatizing attitudes and discrimination among psychiatric and mental health nurses and nurse interns towards patients diagnosed with the human immunodeficiency virus; utilizing a single-centre hospital-based survey design. Primary data were collected using a previously validated questionnaire in a large mental health care hospital in Riyadh, Saudi Arabia. Knowledge, attitudes, acts of discrimination and associated factors on the part of mental health nurses towards those diagnosed with the HIV were identified. The study described herein is in accordance with the STROBE guideline. A total of 241 psychiatric and mental health nurses completed the questionnaire, yielding a completion rate of 74.4%. Overall, more than half of the nurses demonstrated gaps in knowledge and reported higher stigmatizing attitudes and acts of discrimination. Factors associated with stigmatization and/or discrimination include higher exposure to seropositive patients, no formal HIV training, lower religiousness, lower awareness of HIV testing policy and lower level of knowledge about HIV infection. There is an urgent need to implement a training program that will help to reduce stigma among nurses caring for people diagnosed with this illness.
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Affiliation(s)
- Atallah Alenezi
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
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15
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Bleasdale J, Leone LA, Morse GD, Liu Y, Taylor S, Przybyla SM. Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States. Trop Med Infect Dis 2022; 7:259. [PMID: 36288000 PMCID: PMC9607497 DOI: 10.3390/tropicalmed7100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 08/22/2023] Open
Abstract
Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive-deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Shelby Taylor
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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Fernandez SB, Lopez C, Ibarra C, Sheehan DM, Ladner RA, Trepka MJ. Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11484. [PMID: 36141757 PMCID: PMC9517674 DOI: 10.3390/ijerph191811484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.
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Affiliation(s)
- Sofia B. Fernandez
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cindy Lopez
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
| | - Diana M. Sheehan
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL 33199, USA
| | | | - Mary Jo Trepka
- Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL 33199, USA
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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Mohd Salleh NA, Ahmad A, Vicknasingam B, Kamarulzaman A, Yahya 'A. Material Security Scale as a Measurement of Poverty among Key Populations At-Risk for HIV/AIDS in Malaysia: An Implication for People who Use Drugs and Transgender People during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158997. [PMID: 35897368 PMCID: PMC9331958 DOI: 10.3390/ijerph19158997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
The HIV epidemic is fueled by poverty; yet, methods to measure poverty remain scarce among populations at risk for HIV infection and disease progression to AIDS in Malaysia. Between August and November 2020, using data from a cross-sectional study of people who use drugs, (PWUD), transgender people, sex workers and men who have sex with men, this study examined the reliability and validity of a material security scale as a measurement of poverty. Additionally, we assessed factors associated with material security scores. We performed confirmatory factor analysis (CFA) for 268 study participants included in the analysis. A revised nine-item three-factor structure of the material security scale demonstrated an excellent fit in CFA. The revised material security score displayed good reliability, with Cronbach’s alpha of 0.843, 0.826 and 0.818 for housing, economic resources and basic needs factors, respectively. In a subsequent analysis, PWUD and transgender people were less likely to present good material security scores during the pandemic, compared to their counterparts. The revised nine-item scale is a useful tool to assess poverty among key populations at-risk for HIV/AIDS with the potential to be extrapolated in similar income settings.
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Affiliation(s)
- Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
| | - Ahsan Ahmad
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
- Yale School of Medicine, Yale University, New Heven, CT 06510, USA
| | | | - Adeeba Kamarulzaman
- Centre of Excellence of Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (A.A.); (A.K.)
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - 'Abqariyah Yahya
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
- Correspondence: ; Tel.: +603-7967-4756
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18
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Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. Intersecting alcohol use and depression impedes HIV treatment in the rural South, USA. Behav Med 2022; 48:190-197. [PMID: 34024263 DOI: 10.1080/08964289.2020.1809336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study tested the hypothesis that the co-occurrence of alcohol use and depressive symptoms predicts HIV suppression and antiretroviral therapy (ART) adherence among people living with HIV. Baseline cross-sectional results showed a significant interaction between depressive symptoms and alcohol use in predicting HIV suppression; individuals who drank more alcohol and had higher depressive symptoms demonstrated poorer HIV suppression relative to those who had fewer depressive symptoms. In a one-year longitudinal analysis of ART adherence, alcohol use and depressive symptoms measured in daily text-message assessments demonstrated that neither alcohol use nor depressive symptoms alone predicted ART adherence. However, the intersection of alcohol use on days when experiencing depressive symptoms did significantly predict ART non-adherence, for both moderate and heavy alcohol drinkers. Findings suggest that the co-occurrence of alcohol use and depressive symptoms is a robust predictor of poor HIV treatment outcomes.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut
| | - Harold Katner
- Department of Medicine, Mercer University Medical School
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut
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Lapham J, Martinson ML. The intersection of welfare stigma, state contexts and health among mothers receiving public assistance benefits. SSM Popul Health 2022; 18:101117. [PMID: 35620484 PMCID: PMC9127679 DOI: 10.1016/j.ssmph.2022.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022] Open
Abstract
The stigmatizing nature of the US welfare system is of particular importance not only because it has shown to deter eligible applicants from participating in public assistance programs despite facing economic hardship, but also because stigma is an important fundamental cause of health inequities. Although scholars agree stigma is shaped by individual and contextual dimensions, the role of context is often overlooked. Given the heterogeneous nature of US state welfare environments, it may be critical to consider the ways in which state policy, social and economic contexts condition the relationship between welfare stigma and health. Using a multilevel lens, this study first examined the impact of experienced and perceived welfare stigma on self-reported health among female public assistance recipients with children. Second, we assessed the moderating effect of uneven state TANF policies, income inequality, and negative public welfare attitudes in shaping these associations. Using data from the Fragile Families and Child Wellbeing Study merged with state-level economic and social measures, we employed a series of multilevel logit models with random effects. Findings show experiences and perceptions of welfare stigma are significantly linked to poor health regardless of state contexts, and outcomes vary markedly by race, ethnicity and education. States with strong anti-welfare attitudes amplified the relationship between experienced welfare stigma and poor health for Black and Hispanic mothers, and state economic contexts modified the relationship between experienced welfare stigma and poor health for mothers with less than a high school education. TANF generosity had no moderating effect on health suggesting state policy environments have limited ability to protect welfare recipients against the stigmatizing effects of the US welfare system. Results have implications for explaining stigma related disparities in health within the context of U.S. welfare environments and informing policies that may be key levers for reducing health inequities.
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Affiliation(s)
- Jessica Lapham
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
| | - Melissa L. Martinson
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
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20
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Roland KB, Carey JW, Bessler PA, Langer Tesfaye C, Randall LA, Betley V, Schoua-Glusberg A, Frew PM. "Take care of their hierarchy of needs first": strategies used by data-to-care staff to address barriers to HIV care engagement. AIDS Care 2022; 35:764-771. [PMID: 35611755 DOI: 10.1080/09540121.2022.2077296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Data-to-Care (D2C) is a public health strategy designed to engage out-of-care (OOC) persons with HIV (PWH) in HIV care. OOC PWH are identified through review of state and local HIV data and engaged in care through individualized efforts that address barriers to HIV care. Perspectives of D2C program staff can contribute to D2C program development and sustainability. We conducted semi-structured interviews in 2017 with 20 D2C program staff from Louisiana (n = 10) and Virginia (n = 10), states with distinct D2C programs. We used content and thematic analysis to analyze interview transcripts. In both states, common barriers to care for OOC PWH include limited transportation, stigma, substance use, poverty, homelessness, and mental illness. To address these barriers and engage OOC clients in HIV care, staff and programs provided transportation vouchers and housing assistance, integrated substance use and mental health services into care engagement processes, provided empathy and compassion, and assessed and addressed basic unmet needs. Identifying and addressing social and structural barriers to HIV care is a critical and often a necessary first step in engaging OOC clients in HIV care. These findings can be used for D2C program design and implementation, facilitating engagement in HIV care for OOC PWH.
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Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | - James W Carey
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | - Patricia A Bessler
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
| | | | - Laura A Randall
- School of Medicine & Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Paula M Frew
- School of Medicine & Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ingram MV, Amodei N, Perez VV, German V. Factors predicting 12-month retention in care for minority women living with HIV. Ther Adv Infect Dis 2022; 9:20499361221089815. [PMID: 35450384 PMCID: PMC9016542 DOI: 10.1177/20499361221089815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Retention in HIV medical care is associated with improved clinical outcomes
and reduced mortality. The present study was conducted to identify
significant predictors of 1-year retention in care for a sample of minority
women whose engagement in HIV care at baseline varied along the care
continuum from newly diagnosed to lost-to-care. Methods: One hundred sixty-five cisgender and transgender women living with HIV in a
southern US state were offered a multicomponent retention intervention that
included outreach, medical case management (MCM), patient navigation
services (PN), and a group intervention for stigma. Multilevel logistic
regression analysis was performed to identify baseline and intervention
predictors of retention in care at 12 months following enrollment. Results: Multilevel logistic regression analysis revealed that baseline
characteristics such as working significantly reduced the odds of being
retained as did increasing CD4 counts. However, greater amounts of patient
navigation and medical case management services received increased the odds
of being retained. Conclusion: MCM services designed to accelerate coordination and linkage or re-linkage to
primary care and PN services to help navigate the complex system of HIV
offered in the present study are particularly effective for minority women
who lack health insurance, have low CD4 counts, and are unemployed.
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Affiliation(s)
- Mercedes V. Ingram
- Community Initiatives and Population Health, University Health System, 4502 Medical Dr., MS 82-2, San Antonio, TX 78229, USA
| | - Nancy Amodei
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Veronica Villela Perez
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
| | - Victor German
- Community Initiatives and Population Health, University Health System, San Antonio, TX, USA
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The impact of regional socioeconomic deprivation on the timing of HIV diagnosis: a cross-sectional study in Germany. BMC Infect Dis 2022; 22:258. [PMID: 35296239 PMCID: PMC8928640 DOI: 10.1186/s12879-022-07168-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background HIV infections which are diagnosed at advanced stages are associated with significantly poorer health outcomes. In Germany, the proportion of persons living with HIV who are diagnosed at later stages has remained continuously high. This study examined the impact of regional socioeconomic deprivation on the timing of HIV diagnosis. Methods We used data from the national statutory notification of newly diagnosed HIV infections between 2011 and 2018 with further information on the timing of diagnosis determined by the BED-Capture-ELISA test (BED-CEIA) and diagnosing physicians. Data on regional socioeconomic deprivation were derived from the German Index of Socioeconomic Deprivation (GISD). Outcome measures were a non-recent infection based on the BED-CEIA result or an infection at the stage of AIDS. The effect of socioeconomic deprivation on the timing of diagnosis was analysed using multivariable Poisson regression models with cluster-robust error variance. Results Overall, 67.5% (n = 10,810) of the persons were diagnosed with a non-recent infection and 15.2% (n = 2746) with AIDS. The proportions were higher among persons with heterosexual contact compared to men who have sex with men (MSM) (76.8% non-recent and 14.9% AIDS vs. 61.7% non-recent and 11.4% AIDS). MSM living in highly deprived regions in the countryside (< 100 k residents) were more likely to have a non-recent infection (aPR: 1.16, 95% CI: 1.05–1.28) as well as AIDS (aPR: 1.41, 95% CI: 1.08–1.85) at the time of diagnosis compared to MSM in less deprived regions in the countryside. No differences were observed among MSM from towns (100 k ≤ 1 million residents) or major cities (≥ 1 million residents), and no differences overall in the heterosexual transmission group. Conclusions An effect of socioeconomic deprivation on the timing of HIV diagnosis was found only in MSM from countryside regions. We suggest that efforts in promoting HIV awareness and regular HIV testing are increased for heterosexual persons irrespective of socioeconomic background, and for MSM with a focus on those living in deprived regions in the countryside. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07168-x.
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Mirzazadeh A, Eshun-Wilson I, Thompson RR, Bonyani A, Kahn JG, Baral SD, Schwartz S, Rutherford G, Geng EH. Interventions to reengage people living with HIV who are lost to follow-up from HIV treatment programs: A systematic review and meta-analysis. PLoS Med 2022; 19:e1003940. [PMID: 35290369 PMCID: PMC8923443 DOI: 10.1371/journal.pmed.1003940] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimizing services to facilitate engagement and retention in care of people living with HIV (PLWH) on antiretroviral therapies (ARTs) is critical to decrease HIV-related morbidity and mortality and HIV transmission. We systematically reviewed the literature for the effectiveness of implementation strategies to reestablish and subsequently retain clinical contact, improve viral load suppression, and reduce mortality among patients who had been lost to follow-up (LTFU) from HIV services. METHODS AND FINDINGS We searched 7 databases (PubMed, Cochrane, ERIC, PsycINFO, EMBASE, Web of Science, and the WHO regional databases) and 3 conference abstract archives (CROI, IAC, and IAS) to find randomized trials and observational studies published through 13 April 2020. Eligible studies included those involving children and adults who were diagnosed with HIV, had initiated ART, and were subsequently lost to care and that reported at least one review outcome (return to care, retention, viral suppression, or mortality). Data were extracted by 2 reviewers, with discrepancies resolved by a third. We characterized reengagement strategies according to how, where, and by whom tracing was conducted. We explored effects, first, among all categorized as LTFU from the HIV program (reengagement program effect) and second among those found to be alive and out of care (reengagement contact outcome). We used random-effect models for meta-analysis and conducted subgroup analyses to explore heterogeneity. Searches yielded 4,244 titles, resulting in 37 included studies (6 randomized trials and 31 observational studies). In low- and middle-income countries (LMICs) (N = 16), tracing most frequently involved identification of LTFU from the electronic medical record (EMR) and paper records followed by a combination of telephone calls and field tracing (including home visits), by a team of outreach workers within 3 months of becoming LTFU (N = 7), with few incorporating additional strategies to support reengagement beyond contact (N = 2). In high-income countries (HICs) (N = 21 studies), LTFU were similarly identified through EMR systems, at times matched with other public health records (N = 4), followed by telephone calls and letters sent by mail or email and conducted by outreach specialist teams. Home visits were less common (N = 7) than in LMICs, and additional reengagement support was similarly infrequent (N = 5). Overall, reengagement programs were able to return 39% (95% CI: 31% to 47%) of all patients who were characterized as LTFU (n = 29). Reengagement contact resulted in 58% (95% CI: 51% to 65%) return among those found to be alive and out of care (N = 17). In 9 studies that had a control condition, the return was higher among those in the reengagement intervention group than the standard of care group (RR: 1.20 (95% CI: 1.08 to 1.32, P < 0.001). There were insufficient data to generate pooled estimates of retention, viral suppression, or mortality after the return. CONCLUSIONS While the types of interventions are markedly heterogeneity, reengagement interventions increase return to care. HIV programs should consider investing in systems to better characterize LTFU to identify those who are alive and out of care, and further research on the optimum time to initiate reengagement efforts after missed visits and how to best support sustained reengagement could improve efficiency and effectiveness.
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Affiliation(s)
- Ali Mirzazadeh
- Division of Infectious Disease and Global Epidemiology, Department of Epidemiology and Biostatistics, and Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, School of Medicine, Washington University at St Louis, St Louis, Missouri, United States of America
| | - Ryan R. Thompson
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | | | - James G. Kahn
- University of California San Francisco, San Francisco, California, United States of America
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George Rutherford
- Division of Infectious Disease and Global Epidemiology, Department of Epidemiology and Biostatistics, and Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, School of Medicine, Washington University at St Louis, St Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St Louis, Missouri, United States of America
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Durable Viral Suppression Among People with HIV and Problem Substance Use in the Era of Universal Antiretroviral Treatment. AIDS Behav 2022; 26:385-396. [PMID: 34331177 PMCID: PMC8800950 DOI: 10.1007/s10461-021-03392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 02/03/2023]
Abstract
This study explored factors associated with durable viral suppression (DVS) among two groups of people living with HIV (PLWH) and problem substance use in the context of universal antiretroviral treatment initiation. Participants (N = 99) were recruited between 2014-2017 from public sexual health clinics [SHC] and a hospital detoxification unit [detox]). DVS (NYC HIV surveillance registry) was defined as two consecutive viral load tests ≤ 200 copies/mL, ≤ 90 days apart, with all other viral loads suppressed over 12 or 18 months. Detox participants were significantly older, with more unstable housing/employment, substance use severity, and longer-term HIV vs. SHC participants. Older age, opioid and stimulant use disorder were significantly associated with lower odds of DVS, while fulltime employment and stable housing were significantly associated with higher odds of DVS at 12-month follow-up. Patterns held at 18-month follow-up. Co-located substance use and HIV services, funding for supportive housing, and collaborative patient-provider relationships could improve DVS among populations with the syndemic of problem substance use, poverty, and long-term HIV.
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Ndirangu JW, Gichane MW, Browne FA, Bonner CP, Zule WA, Cox EN, Smith KM, Carney T, Wechsberg WM. ‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa. Health Expect 2022; 25:754-763. [PMID: 35060260 PMCID: PMC8957738 DOI: 10.1111/hex.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Methods Results Conclusion Patient or Public Contribution
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Affiliation(s)
- Jacqueline W. Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Margaret W. Gichane
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Courtney P. Bonner
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Erin N. Cox
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
| | - Kevin M. Smith
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Tygerberg South Africa
- Department of Psychiatry and Mental Health University of Cape Town Rondebosch Cape Town South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA
- Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Department of Psychology North Carolina State University Raleigh North Carolina USA
- Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
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26
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Herron LM, Mutch A, Lui CW, Kruizinga L, Howard C, Fitzgerald L. Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 2021; 43:313-344. [PMID: 34534051 DOI: 10.1080/07399332.2021.1959589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.
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Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lara Kruizinga
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Lee Y, Walton R, Jackson L, Batey DS. Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis. J Assoc Nurses AIDS Care 2021; 32:589-598. [PMID: 33009174 DOI: 10.1097/jnc.0000000000000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.
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Affiliation(s)
- Yookyong Lee
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Walton
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsey Jackson
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rajabiun S, Lennon-Dearing R, Hirschi M, Davis B, Williams B, Sprague Martinez L, Campos M. Ending the HIV Epidemic: One Southern Community Speaks. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:647-664. [PMID: 34251984 PMCID: PMC8429130 DOI: 10.1080/19371918.2021.1947929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Memphis, Tennessee and its surrounding counties have been profoundly affected by the HIV epidemic. Using a participatory research approach this study identified from a community perspective: 1) the barriers and facilitators for providing support to achieve viral suppression to the most at-risk groups living with HIV in the Memphis Transitional Grant Area and 2) opportunities to strengthen the health care system through the use of community health workers (CHWs) to do outreach and engage with people living with HIV. Themes of barriers include intersectional stigma, HIV criminal laws, abstinence-only sex education, housing, transportation, and limited access to HIV case management and mental health services. Strategies to address these barriers included HIV education to youth in schools and community-wide campaigns, more testing sites, involving faith leaders, funding for housing options, innovative transportation services, rapid start of culturally appropriate HIV medical treatment, intensive case management services, and mental health counseling. Two opportunities to utilize CHWs to address the barriers identified in this geographic area are as policy advocates and as an integrated member of the HIV primary care team. The findings of this study can inform a strategy to build the CHW workforce which may have widespread implications for ending the HIV epidemic in this geographic area and across the United States.
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Affiliation(s)
- Serena Rajabiun
- Lowell Zuckerberg College of Health Sciences, University of Massachusetts
| | | | | | | | | | | | - Maria Campos
- School of Social Work, Boston University, Boston, Massachusetts, USA
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Kalichman SC, Katner H, Eaton LA, Banas E, Hill M, Kalichman MO. Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting. Transl Behav Med 2021; 11:852-862. [PMID: 33200772 DOI: 10.1093/tbm/ibaa109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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30
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D'Angelo AB, Davis Ewart LN, Koken J, Bimbi D, Brown JT, Grov C. Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model. J Assoc Nurses AIDS Care 2021; 32:481-494. [PMID: 34171885 DOI: 10.1097/jnc.0000000000000241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.
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Affiliation(s)
- Alexa B D'Angelo
- Alexa B. D'Angelo, MPH, is a Project Coordinator and PhD Student, CUNY Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA. Leah N. Davis Ewart, MPH, CHES, is a PhD Student, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA. Juline Koken, PhD, is an Associate Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. David Bimbi, PhD, is a Professor, Department of Health Sciences, LaGuardia Community College of CUNY, Long Island City, New York, USA. Justin T. Brown, PhD, MPH, is an Assistant Professor and Executive Director, Department of Health Sciences, The Center for LGBTQ Studies (CLAGS), LaGuardia Community College of CUNY, Long Island City, New York, USA. Christian Grov, PhD, MPH, is a Professor, Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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31
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Fauk NK, Ward PR, Hawke K, Mwanri L. HIV Stigma and Discrimination: Perspectives and Personal Experiences of Healthcare Providers in Yogyakarta and Belu, Indonesia. Front Med (Lausanne) 2021; 8:625787. [PMID: 34055824 PMCID: PMC8149745 DOI: 10.3389/fmed.2021.625787] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/12/2021] [Indexed: 11/20/2022] Open
Abstract
Stigma and discrimination are major challenges facing People Living with HIV/AIDS (PLWHA) globally due to their HIV status. As part of a larger qualitative study in Yogyakarta and Belu, Indonesia, using in-depth interviews with 92 PLWHA (52 women, 40 men) and 20 healthcare providers, this paper describes perspectives and personal experiences of the 20 healthcare providers, relating to HIV stigma and discrimination toward PLWHA in both study settings. The healthcare providers were recruited from healthcare facilities providing HIV-related healthcare services, using a snowball sampling technique. A qualitative framework analysis was used to guide data analysis. Health stigma and discrimination framework guided the conceptualisation and discussion of the findings. The findings presented the views and perspectives of healthcare providers that HIV stigma and discrimination toward PLWHA still occurred within families, communities and healthcare settings. These were reflected in negative labelling, separation of personal belongings, avoidance, denial of treatment and rejection of PLWHA by healthcare providers, family and community members. Some healthcare providers reported that they had personally stigmatised and discriminated against PLWHA. A lack of knowledge about HIV, fear of contracting HIV, personal values, religious thoughts and sociocultural values and norms, were reported as drivers or facilitators behind this HIV-related stigma and discrimination. The findings indicate the importance of continued HIV/AIDS education for families, community members and healthcare providers, to raise awareness and to ensure that healthy and professional support systems are in place for PLWHA. The findings indicate the need to enhance improvement within the healthcare or HIV care system to adequately address the needs of PLWHA, which may facilitate their early initiation of HIV treatment and better treatment adherence and retention to increase Cluster of Differentiation 4 (CD4) count and suppress viral load. Future studies are also needed to explore the role that government and non-government institutions can play in improving health service delivery for people newly diagnosed with HIV and those living with HIV/AIDS.
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Affiliation(s)
- Nelsensius Klau Fauk
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Institute of Resource Governance and Social Change, Kupang, Indonesia
| | - Paul Russell Ward
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Karen Hawke
- Infectious Disease - Aboriginal Health, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Mehraeen M, Heydari M, Lankarani KB, Joulaei H, Faghih M. Investigating the contributing factors to HIV/AIDS infection from the perspective of HIV-infected patients. BMC Psychol 2021; 9:13. [PMID: 33494819 PMCID: PMC7836197 DOI: 10.1186/s40359-021-00513-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background People with HIV have always faced stigma and discrimination. Given the numerous papers that have addressed the psychological and social risk factors in spreading HIV, a pressing question is whether individuals’ mere careless and behavioural flaws can still account for the spread of HIV. Barriers and opposing politic made a hard position for HIV and sex education in Iran. Methods The present study investigated the causes of contracting HIV/AIDS from the perspective of HIV-infected patients. To accomplish this, 150 patients referring to the voluntary counseling and testing Center, Shiraz were convenient selected based on the convenient sampling method and responded to a researcher-made questionnaire From June to August 2019. The data were analyzed through descriptive statistics (mean, SD, frequency tables) and inferential statistics (chi-square). Results Results revealed that the main cause of HIV infection amongst males was the injection of narcotics, and in the females it was sexual intercourse with an infected individual. Meanwhile, 57% of the females and 66% of the males blamed themselves for contracting and transmitting the disease. The patients stated that if they could return to pre-infection period, they would use one of the following ways to prevent the disease: (a) they would pay attention to hygienic/sanitary principles; (b) they would not get married; and (c) they would prevent drug addiction. Also only 44% of the individuals had successful siblings (those who were neither addicts nor HIV/AIDS-infected individuals), which was an observation that emphasizes on the epidemic of high-risk behaviors in the patients’ families. Conclusions According to participants' statements collected in our study, weakness in governmental public health education, along with family-related and individual factors, are important causes of HIV spread
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Affiliation(s)
- Morteza Mehraeen
- Shiraz HIV/AIDS Research Center (SHARC), Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Mohammadreza Heydari
- Shiraz HIV/AIDS Research Center (SHARC), Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Kamran B Lankarani
- Health Policy Research Centre, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Hassan Joulaei
- Shiraz HIV/AIDS Research Center (SHARC), Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Marjan Faghih
- Department of Biostatistics, School of Medicine, Arak University of Medical Sciences, Faculties Building, Payambar A'zam, University Campus, Baseej Square, Sardasht, Islamic Republic of Iran.
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Parish CL, Feaster DJ, Pereyra MR, Alcaide ML, Weber KM, Cohen MH, Levin S, Gustafson D, Merenstein D, Aouizerat BE, Donohue J, Webster-Cyriaque J, Wingood G, Kempf MC, Metsch LR. Women's HIV disclosure to the dentist: Does frequent contact matter? J Public Health Dent 2020; 81:65-76. [PMID: 33049081 DOI: 10.1111/jphd.12403] [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: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.
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Affiliation(s)
- Carrigan L Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Daniel J Feaster
- Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Maria L Alcaide
- Miller School of Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge H Cohen
- Cook County Bureau of Health Services, Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | | | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Services University, Brooklyn, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, USA
| | - Bradley E Aouizerat
- College of Dentistry Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University, New York, NY, USA
| | - Jessica Donohue
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Webster-Cyriaque
- Department of Dental Ecology, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa R Metsch
- School of General Studies and Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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Chandran A, Edmonds A, Benning L, Wentz E, Adedimeji A, Wilson TE, Blair-Spence A, Palar K, Cohen M, Adimora A. Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS. AIDS Behav 2020; 24:2811-2818. [PMID: 32170507 PMCID: PMC7483905 DOI: 10.1007/s10461-020-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amanda Blair-Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Mardge Cohen
- Cook County Health and Hospital System, Chicago, IL, USA
| | - Adaora Adimora
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Exploring HIV-Related Stigma as a Determinant of Engagement in HIV Care by African American Women. J Assoc Nurses AIDS Care 2020; 31:167-175. [PMID: 31725104 DOI: 10.1097/jnc.0000000000000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Engagement in HIV care reduces HIV-related health disparities that persist across racial/ethnic and gender lines; yet, African American (AA) women face multiple challenges to remaining engaged in care, including HIV-related stigma. We analyzed longitudinal data from 239 participants in the Unity Health Study to estimate associations between HIV-related stigma and engagement in care among AA women linked to HIV care. In adjusted Poisson regression analyses, engagement in care was not associated with HIV-related stigma but was associated with older age (incidence rate ratio [IRR] = 1.01, 95% confidence interval [CI] = [1.00-1.01], p = .01), higher levels of education (IRR = 1.18, 95% CI = [1.02-1.35], p = .03), and higher levels of social support (IRR = 1.05, 95% CI = [1.01-1.09], p = .04). Our findings suggest the need for targeted interventions to enhance engagement in care and to incorporate social support into health promotion programming for AA women living with HIV.
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Norberg A, Nelson J, Holly C, Jewell ST, Lieggi M, Salmond S. Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices that influence engagement in US primary healthcare settings: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:1154-1228. [PMID: 30994499 DOI: 10.11124/jbisrir-2017-003756] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem that has claimed the lives of more than 34 million people worldwide. The health of people living with HIV (PLWH) is optimized by ongoing engagement in HIV care, yet many people living with HIV either do not enter or fall out of care. Access to care and ongoing engagement in care for antiretroviral (ARV) medication adherence and psychoeducational support are critical to achieving the desired outcomes of reducing the risk of further HIV transmission and HIV related morbidity and mortality, and managing other commonly co-occurring health, social and behavioral conditions, thereby maximizing wellness. OBJECTIVE The objective of the review was to identify, evaluate and synthesize existing qualitative evidence on the experiences of HIV-infected adults with healthcare systems/practices/processes, and the experiences of healthcare providers with healthcare systems/practices/processes that impact engagement in primary healthcare settings in the United States (US). INCLUSION CRITERIA The review included studies reporting on the qualitative experiences of HIV-infected adults, aged 18-65 years, with healthcare systems, practices and processes and their healthcare providers (physicians, nurses and others providing care to these patients in the primary care healthcare setting). Qualitative studies including but not limited to designs such as phenomenology, ethnography, grounded theory, action research and qualitative descriptive were included. Studies published in languages other than English and conducted outside of the US were excluded. METHODS Using a three-step search strategy, databases of published and unpublished articles were searched from 1997 to 2017. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Findings were rated according to their level of credibility, categorized based on similarity in meaning and subjected to a meta-synthesis. RESULTS A total of 1038 qualitative articles were identified of which 41 were included after critical appraisal. Meta-synthesis generated four synthesized findings: i) What I want from my provider: to be a respectful, empathetic and holistic partner in my care; ii) I cannot do it alone: the critical importance of actively guiding and assisting patients during transitions and securing the needed resources; iii) Help me to understand my illness and care needs; iv) One-stop care that is de-stigmatizing and welcoming to diverse cultures keeps clients in care. These synthesized findings were derived from 243 study findings that were subsequently aggregated into 19 categories. Of the 243 study findings, 240 were rated unequivocal and three were rated credible. The overall ConQual for each of the four synthesized findings was moderate due to common dependability issues across the included studies. A total of 1597 participants were included. Only two studies were included from 1997 to 2000. The majority of included studies were published from 2005 to 2017. CONCLUSIONS The synthesized findings illustrate clear quality indicators for primary care practice, emphasizing the patient-provider-care team partnership and shared decision making that is holistic, takes into account a patient's whole life, responsibilities and stressors, and reframes HIV associated misperceptions/myths. The review also highlights the importance of helping patients navigate and interact with the healthcare system by offering one-stop services that assist with multiple medical care needs and "wraparound" services that provide the needed care coordination to assist with critical quality of life needs such as food, housing, transportation, and assistance with applying for health insurance and medication.
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Affiliation(s)
- Andrea Norberg
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - John Nelson
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - Cheryl Holly
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
| | - Sarah T Jewell
- George F. Smith Library of the Health Sciences, Rutgers, The State University of New Jersey, Newark, USA
| | - Michelle Lieggi
- Fishbon Library, University of California San Francisco Medical Center, San Francisco, USA
| | - Susan Salmond
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
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Kalichman S, Shkembi B, Hernandez D, Katner H, Thorson KR. Income Inequality, HIV Stigma, and Preventing HIV Disease Progression in Rural Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:1066-1073. [PMID: 30955136 DOI: 10.1007/s11121-019-01013-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings.
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Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Bruno Shkembi
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Dominica Hernandez
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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Summers NA, Colasanti JA, Feaster DJ, Armstrong WS, Rodriguez A, Jain MK, Jacobs P, Metsch LR, del Rio C. Predictors for Poor Linkage to Care Among Hospitalized Persons Living with HIV and Co-Occurring Substance Use Disorder. AIDS Res Hum Retroviruses 2020; 36:406-414. [PMID: 31914790 DOI: 10.1089/aid.2019.0153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Persons living with HIV (PLWH) with substance use disorders (SUD) remain a population difficult to engage in HIV care. Project HOPE (Hospital Visits as an Opportunity for Prevention and Engagement), a randomized controlled trial testing patient navigation with/without contingency management for PLWH with SUD, aimed to address this disparity. PLWH with SUD who were out of care were recruited from 11 hospitals across the United States from 2012 to 2014. Baseline socioeconomic factors, medical mistrust scores, and perceived discrimination surveys were collected at enrollment and evaluated for effects on linkage to care at the 6-month follow-up assessment. Linkage to care (attending an outpatient visit for HIV care), early linkage to care (attending first visit within 30 days of enrollment), and engagement in care (two HIV visits within the 6-month period) were determined by medical record abstraction, supplemented by self-report. Among 801 participants enrolled in the study (mean age 45 years, 33% women, and 73% African American), those who did not complete high school and with severe food insecurity had lower odds of being linked to care at 6 months. Those with high levels of medical mistrust, recent drug use, and who did not complete high school had lower odds of early linkage to care. Early linkage was associated with higher odds of engagement at 6 months and was mitigated by both patient navigator interventions (all p < .05). Addressing social determinants of health is critical to correct the disparity seen in HIV outcomes among PLWH with SUD. Identifying factors that alter the effect of interventions could help identify patients who would benefit most.
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Affiliation(s)
- Nathan A. Summers
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Daniel J. Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mamta K. Jain
- Division of Infectious Diseases, Department of Medicine, UT Southwestern, Dallas, Texas, USA
| | - Petra Jacobs
- National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Lisa R. Metsch
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia, USA
- Department of Sociomedical Sciences, Columbia Millner School of Public Health, New York City, New York, USA
| | - Carlos del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory Center for AIDS Research, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Kates J, Millett G, Dawson L, Honermann B, Jones A, Sherwood J, Garcia ZI, Kuenzle K. The Broader Context of "Ending the HIV Epidemic: A Plan for America" Initiative. Am J Public Health 2020; 110:58-60. [PMID: 31800281 DOI: 10.2105/ajph.2019.305429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennifer Kates
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Gregorio Millett
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Lindsey Dawson
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Brian Honermann
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Austin Jones
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Jennifer Sherwood
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Zulema Iboa Garcia
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
| | - Katherine Kuenzle
- Jennifer Kates and Lindsey Dawson are with the Kaiser Family Foundation, Washington, DC. Gregorio Millett, Brian Honermann, Austin Jones, Jennifer Sherwood, Zulema Iboa Garcia, and Katherine Kuenzle are with amfAR, The Foundation for AIDS Research, Washington, DC
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40
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Kalichman SC, Katner H, Hill M, Kalichman MO, Hernandez D. Alcohol-Related Intentional Antiretroviral Nonadherence among People Living with HIV: Test of an Interactive Toxicity Beliefs Process Model. J Int Assoc Provid AIDS Care 2020; 18:2325958219826612. [PMID: 30782051 PMCID: PMC6748551 DOI: 10.1177/2325958219826612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Beliefs that it is harmful to mix medications with alcohol (ie, interactive toxicity beliefs) are a known source of intentional antiretroviral therapy (ART) nonadherence. This study examined a serial process model of alcohol-ART interactive toxicity beliefs, alcohol-ART avoidance behaviors, and ART adherence in the association between alcohol use and HIV viral load. Participants were 198 patients receiving ART from a community clinic in the southeastern United States; 125 reported current alcohol use. Results showed that current alcohol use was associated with detectable HIV viral load, partially accounted for by alcohol-ART interactive toxicity beliefs, alcohol-ART avoidance behaviors, and ART adherence. There was a significant indirect effect of the serial chain of interactive toxicity beliefs-avoidance behaviors-adherence, indicating the 3 intermediating variables partially accounted for the relationship between alcohol use and HIV viral load. Addressing alcohol use as a barrier to ART adherence requires multipronged approaches that address intentional nonadherence.
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Affiliation(s)
- Seth Charles Kalichman
- 1 Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- 2 Department of Internal Medicine, Mercer University, School of Medicine, Macon, GA, USA
| | - Marnie Hill
- 2 Department of Internal Medicine, Mercer University, School of Medicine, Macon, GA, USA
| | - Moira O'Connor Kalichman
- 1 Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Dominica Hernandez
- 1 Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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41
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Anderson AN, Higgins CM, Haardörfer R, Holstad MM, Nguyen MLT, Waldrop-Valverde D. Disparities in Retention in Care Among Adults Living with HIV/AIDS: A Systematic Review. AIDS Behav 2020; 24:985-997. [PMID: 31555931 DOI: 10.1007/s10461-019-02679-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As national HIV prevention goals aim to increase the proportion of persons living with HIV, determining existing disparities in retention in care will allow for targeted intervention. The purpose of this systematic review was to identify existing disparities in retention in care. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guided this systematic review. Electronic databases, including PubMed/MEDLINE, CINAHL, Sociological Collection, PsychInfo, and Cab Direct/Global Health, were systematically searched and twenty studies were included. This review identified disparities in retention in care that have been documented by race, gender, age, HIV exposure, incarceration history, place of birth, and U.S. geographic location. Research is necessary to further identify existing disparities in retention in care and to better understand determinants of health disparities. Additionally, interventions must be tailored to meet the needs of health disparate populations and should be assessed to determine their effectiveness in reducing health disparities.
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42
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Harrington P, Onwubiko U, Qi M, Holland DP, Wortley P, Chamberlain AT. Factors Associated with HIV Seroconversion Among Women Attending an Urban Health Clinic in the South: A Matched Case-Control Study. AIDS Patient Care STDS 2020; 34:124-131. [PMID: 32109142 DOI: 10.1089/apc.2019.0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Compared to knowledge about HIV risk factors among men in the south, less is known about risk factors for women. We conducted an individually matched case-control study to identify factors associated with HIV seroconversion among women. Cases had a clinician-assisted visit (CAV) between 2011 and 2016 at an Atlanta-based public health clinic before HIV diagnosis. Controls were women who visited the clinic but remained HIV negative. Controls were matched to cases in a 2:1 ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a best-fitting model for characterizing HIV risk. Of 18,281 women who were HIV negative at their first visit, 110 (0.6%) seroconverted before 2019. Of these, 80 (73%) had a CAV before HIV diagnosis. Having multiple gonorrhea episodes, a syphilis episode, a greater number of sex partners in the past 2 months, anal sex, history of drug use, history of exchanging drugs or money for sex, and heterosexual sex with >1 sex partner in the last month were individually associated with HIV seroconversion. In multivariate analyses, having a syphilis episode [odds ratio (OR) = 4.7, 95% confidence interval (CI): 1.3-16.3], anal sex (OR = 2.8, 95% CI: 1.0-8.1), and injection drug or crack cocaine use (OR = 33.5, 95% CI: 3.6-313.3) remained associated with HIV. Women having all three risk factors were six times more likely to seroconvert compared to women without these factors. Our results offer insights into which women in a southern HIV "hotspot" may be at greatest risk for HIV.
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Affiliation(s)
- Pauline Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Udodirim Onwubiko
- Division of Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia
| | - Mingli Qi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - David P. Holland
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Pascale Wortley
- HIV Epidemiology Department, Georgia Department of Public Health, Atlanta, Georgia
| | - Allison T. Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Epidemiology, Fulton County Board of Health, Atlanta, Georgia
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Chen YN, Coker D, Kramer MR, Johnson BA, Wall KM, Ordóñez CE, McDaniel D, Edwards A, Hare AQ, Sunpath H, Marconi VC. The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa. AIDS Behav 2019; 23:2558-2575. [PMID: 31049812 DOI: 10.1007/s10461-019-02523-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Using a case-control study of patients receiving antiretroviral treatment (ART) in 2010-2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients' risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with socioeconomic status (SES) and geographic access to care. We then determined whether neighborhood-level poverty modifies the association between individual-level SES and VF. Automobile ownership for men and having non-spouse family members pay medical care for women remained independently associated with increased odds of VF for patients dwelling in moderately and severely poor neighborhoods. Closer geographic proximity to medical care was positively associated with VF among men, while higher neighborhood-level poverty was positively associated with VF among women. The programmatic implications of our findings include developing ART adherence interventions that address the role of gender in both the socioeconomic and geographical contexts.
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Affiliation(s)
- Yi-No Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Daniella Coker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Claudia E Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Darius McDaniel
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Q Hare
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Henry Sunpath
- Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vincent C Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
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Lipira L, Williams EC, Huh D, Kemp CG, Nevin PE, Greene P, Unger JM, Heagerty P, French AL, Cohn SE, Turan JM, Mugavero MJ, Simoni JM, Andrasik MP, Rao D. HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence. AIDS Behav 2019; 23:2025-2036. [PMID: 30343422 PMCID: PMC6815932 DOI: 10.1007/s10461-018-2301-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA.
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA.
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Joseph M Unger
- Department of Health Services, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Audrey L French
- Stroger Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele P Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
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Abstract
Great progress has been made in caring for persons with human immunodeficiency virus. However, a significant proportion of individuals still present to care with advanced disease and a low CD4 count. Careful considerations for selection of antiretroviral therapy as well as close monitoring for opportunistic infections and immune reconstitution inflammatory syndrome are vitally important in providing care for such individuals.
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Affiliation(s)
- Nathan A Summers
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 341 Ponce de Leon Avenue, Atlanta, GA 30308, USA
| | - Wendy S Armstrong
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 341 Ponce de Leon Avenue, Atlanta, GA 30308, USA.
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Sprague C, Brown SM, Simon S, McMahan LD, Kassiel I, Konkle-Parker D. Towards ending the US HIV epidemic by 2030: Understanding social determinants of health and HIV in Mississippi. Glob Public Health 2019; 15:31-51. [PMID: 31221026 DOI: 10.1080/17441692.2019.1631366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The disproportionate burden of HIV-related inequities borne by African Americans in the US South amplifies the role of social determinants of health (SDH) in shaping social patterning of illness. Despite some attention, SDH remain overlooked in a biomedically oriented, federal HIV policy. Mississippi is the poorest state with the worst HIV outcomes, nationally. Using qualitative methods, we investigated how primarily African American, HIV-positive Mississippians experienced SDH and health inequities in their daily lives. Employing grounded theory and in-depth interviews (n = 25) in an urban and rural site in 2015 yielded these findings: (1) absence of an enabling structural environment; (a) HIV-stigma constructed via social discourse; (b) lack of psycho-social support and HIV education; (c) insufficient economic and social support resources; and (2) presence of family support for coping. Due to stigma, being HIV-positive seemed to lead to further status loss; diminished social position; reduced life chances; and contractions in particular freedoms. Stigma further compounded existing inequalities - contributing to the moral, social experience of those living with HIV. Trump's plan to end HIV by 2030 creates the opportunity to rethink the biomedical-paradigm and fully engage SDH - using social science theory and methods that address multi-level social determinants in ways that are also policy-responsive.
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Affiliation(s)
- Courtenay Sprague
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.,Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,Center for Peace, Democracy & Development, University of Massachusetts Boston, Boston, MA, USA
| | - Shelley M Brown
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,Department of Health Sciences, Sargent College, Boston University, Boston, MA, USA
| | - Sara Simon
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,Center for Peace, Democracy & Development, University of Massachusetts Boston, Boston, MA, USA
| | - Lyndsey D McMahan
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,Center for Peace, Democracy & Development, University of Massachusetts Boston, Boston, MA, USA.,School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Ira Kassiel
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
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47
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De Jesus M, Williams DR. The Care and Prevention in the United States Demonstration Project: A Call for More Focus on the Social Determinants of HIV/AIDS. Public Health Rep 2019; 133:28S-33S. [PMID: 30457952 DOI: 10.1177/0033354918801353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Maria De Jesus
- 1 School of International Service and Center on Health, Risk, and Society, American University, Washington, DC, USA
| | - David R Williams
- 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,3 Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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48
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Fletcher FE, Rice WS, Ingram LA, Fisher CB. Ethical Challenges and Lessons Learned from Qualitative Research with Low-Income African American Women Living with HIV in the South. J Health Care Poor Underserved 2019; 30:116-129. [PMID: 31735725 PMCID: PMC7509837 DOI: 10.1353/hpu.2019.0122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
African American women living with HIV (WLWH) in the U.S. South encounter heightened marginalization due to the complex intersections of race, gender, poverty, and HIV status. Social vulnerabilities experienced by individuals and communities in daily life have the potential to sharpen ethical tensions in the context of research. Thus, conducting ethical research requires attention to the contextual challenges and concerns of diverse research populations to tailor participant protections to a particular sociocultural context. Using principles from the Belmont Report, the present report draws on data from a qualitative study with 42 African American WLWH in the South by highlighting the first author's accounts of ethical challenges that emerged during data collection. Findings suggest that engaging participants in their natural environments can inform the development of ethical research strategies germane to women's lived experiences. Study findings also contribute to empirical guidance for investigators engaging marginalized populations in scientific research.
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49
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Geter A, Herron AR, Sutton MY. HIV-Related Stigma by Healthcare Providers in the United States: A Systematic Review. AIDS Patient Care STDS 2018; 32:418-424. [PMID: 30277814 DOI: 10.1089/apc.2018.0114] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reducing HIV-related stigma may enhance the quality of HIV prevention and care services and is a national prevention goal. The objective of this systematic review was to identify studies of HIV-related stigma among healthcare providers. For studies published between 2010 and 2017, we: (1) searched databases using our keywords, (2) excluded nonpeer reviewed studies, (3) limited the findings to the provider perspective and studies conducted in the United States, (4) extracted and summarized the data, and (5) conducted a contextual review to identify common themes. Of 619 studies retrieved, 6 were included, with 3 themes identified: (1) attitudes, beliefs, and behaviors (n = 6), (2) quality of patient care (n = 3), and (3) education and training (n = 2). Factors associated with HIV-related stigma varied by gender, race, provider category, and clinical setting. Providers with limited recent HIV-stigma training were more likely to exhibit stigmatizing behaviors toward patients. Developing provider-centered stigma-reduction interventions may help advance national HIV prevention and care goals.
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Affiliation(s)
- Angelica Geter
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne R. Herron
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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50
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Hutson SP, Darlington CK, Hall JM, Heidel RE, Gaskins S. Stigma and Spiritual Well-being among People Living with HIV/AIDS in Southern Appalachia. Issues Ment Health Nurs 2018; 39:482-489. [PMID: 29446661 DOI: 10.1080/01612840.2017.1423426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Appalachian South is disproportionately affected by HIV/AIDS. Partly due to the negative connotation that this disease carries in religiously conservative areas, HIV-related stigma remains a critical barrier to HIV care in the South. However, spirituality is a well-documented, effective coping mechanism among persons living with HIV/AIDS (PLWH). The purpose of this study was to examine the relationship between HIV-related stigma and spiritual well-being among a sample of PLWH (n = 216) in Appalachian counties of Tennessee and Alabama using the HIV Stigma Scale and the Spiritual Well-being Scale. Overall, disclosure of HIV status was the most highly reported stigma concern. Women reported higher levels of stigma and religious well-being than men. While existential well-being was negatively correlated with stigma, no significant overall correlation was found between religious well-being and stigma. Our findings reveal the importance of defining theology and differentiating between cultural religious conditioning and internalized beliefs.
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Affiliation(s)
- Sadie P Hutson
- a College of Nursing, University of Tennessee , Knoxville , Tennessee , USA
| | | | - Joanne M Hall
- a College of Nursing, University of Tennessee , Knoxville , Tennessee , USA
| | - R Eric Heidel
- b University of Tennessee Graduate School of Medicine , Knoxville , Tennessee , USA
| | - Susan Gaskins
- c University of Alabama , Tuscaloosa , Alabama , USA
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