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Istiko SN, Remata S, Ndayizeye A, Moreno MEV, Kirunda V, Hollingdrake O, Osborne R, Hou JZ, Abell B, Mullens AB, Gu Z, Debattista J, Vujcich D, Lobo R, Parma G, Howard C, Durham J. Developing critical HIV health literacy: insights from interviews with priority migrant communities in Queensland, Australia. CULTURE, HEALTH & SEXUALITY 2024; 26:936-951. [PMID: 37950430 DOI: 10.1080/13691058.2023.2265960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023]
Abstract
In Australia, surveillance data establish that there are higher rates of late HIV diagnoses among heterosexual migrants from Sub-Saharan Africa and new HIV diagnoses among gay and bisexual men (GBM) from Southeast and Northeast Asia and Latin America. Together, these groups are identified as priority migrant communities in current efforts to eliminate HIV transmissions. HIV health literacy is recognised as a key means of improving access to services and health outcomes. This qualitative paper explores critical HIV health literacy among priority migrant communities in Queensland, Australia. To foreground community voices, peer researchers from priority migrant communities participated in the project design, data collection and analysis, with 20 interviews completed. The findings demonstrate how participants' engagement with HIV health information and services is highly relational and situated within the framework of sexual health and wellbeing. Participants strategically selected where to seek information and who they trusted to help them appraise this information. They further demonstrated reflective capacities in identifying the contextual barriers that inhibit the development of their HIV health literacy. The findings highlight the need for HIV health promotion strategies that embrace a sex positive approach, promote cultural change, and involve collaboration with general practitioners (GPs).
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Affiliation(s)
- Satrio Nindyo Istiko
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Simeon Remata
- Queensland Positive People, Brisbane, Queensland, Australia
- ACON, Sydney, New South Wales, Australia
| | - Aimable Ndayizeye
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Miguel Eduardo Valencia Moreno
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Kirunda
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Olivia Hollingdrake
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Richard Osborne
- Department of Health and Medical Sciences, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jenny Zhengye Hou
- Faculty of Creative Industries, Education, and Social Justice, School of Communication/Digital Media Research Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bridget Abell
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amy B Mullens
- Centre for Health Research, School of Psychology and Wellbeing, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Zhihong Gu
- Ethnic Communities Council of Queensland, Brisbane, Queensland, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Daniel Vujcich
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Roanna Lobo
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gianna Parma
- True Relationships & Reproductive Health, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Jo Durham
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Belus JM, Hines AC, Magidson JF, Iwamoto D, Rose AL, Li A, Barnabas RV, van Heerden A. Development and Empirical Test of the Research-Informed South African Relationship Functioning Assessment (SARFA). PERSONAL RELATIONSHIPS 2024; 31:44-66. [PMID: 38708292 PMCID: PMC11068037 DOI: 10.1111/pere.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/15/2023] [Indexed: 05/07/2024]
Abstract
Intimate partners play an important role in chronic diseases. Despite the chronic disease burden increase in sub-Saharan Africa, very few culturally-relevant quantitative measures of intimate relationship functioning are available. We conducted an empirical investigation evaluating the psychometric properties of the South African Relationship Functioning Assessment (SARFA) assessing healthy relationship functioning in N = 150 community members (50% women; M age = 27.2 years) living in the Vulindlela area of KwaZulu-Natal, South Africa. Item development was based on prior qualitative research from two South African communities. All assessments were conducted in isiZulu, participants' primary language. An exploratory factor analysis was conducted on the initial 39-item measure. The best-fitting model consisted of one factor with 22 items. The SARFA's internal consistency was α = .94. Convergent validity was observed via significant positive associations (all rs ≥ .38, p < .001) between the SARFA's total score and measures of trust, emotional intimacy, constructive communication, sexual satisfaction, and relationship control (women only). Divergent validity was observed for women only. Encouraging initial psychometric properties of a culturally-relevant measure of relationship functioning in KwaZulu-Natal may have relevance to other communities and potential to be used in research involving couples and health in chronic disease-burdened communities.
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Affiliation(s)
- Jennifer M Belus
- University Hospital Basel, Department of Clinical Research, Basel, Switzerland
- University of Basel, Basel, Switzerland
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Abigail C Hines
- University of Maryland, Department of Psychology, College Park, MD, USA
| | | | - Derek Iwamoto
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Alexandra L Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Alison Li
- Orlando Regional Medical Center, Cardiovascular Intensive Care Unit, Orlando, FL, USA
| | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Gutin SA, Ruark A, Darbes LA, Neilands TB, Mkandawire J, Conroy AA. Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence. BMC Public Health 2023; 23:1878. [PMID: 37770885 PMCID: PMC10540419 DOI: 10.1186/s12889-023-16762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. METHODS Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. RESULTS Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. CONCLUSIONS Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.
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Affiliation(s)
- Sarah A Gutin
- Department Of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF), 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Allison Ruark
- Wheaton College, 501 College Avenue, Wheaton, IL, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
| | - James Mkandawire
- Invest in Knowledge, Old Naisi Road, P.O. Box 506, Zomba, Malawi
| | - Amy A Conroy
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
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Belus JM, Bradley VD, van Heerden A, Msimango LI, Barnabas RV, van Rooyen H. "I think it's communication and trust and sharing everything": Qualitative evidence for a model of healthy intimate relationships in Black women living with HIV and men in KwaZulu-Natal, South Africa. FAMILY PROCESS 2022; 61:1507-1524. [PMID: 34931703 PMCID: PMC10078736 DOI: 10.1111/famp.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
In South Africa, couple-based interventions (CBIs) have been used to increase HIV testing, reduce HIV transmission, and shift relationship dynamics. To understand local definitions of healthy relationships, this study sought to collect qualitative data on a model of healthy relationships in a semi-rural area of KwaZulu-Natal, South Africa. We conducted semi-structured qualitative interviews with HIV-positive women (n = 15) and men of mixed HIV status (n = 15) who were in heterosexual, monogamous relationships (not with each other). Thematic analyses guided coding. Three primary healthy relationship behaviour themes emerged, labelled open communication, couple-level problem-solving, and active relationship building, which were related to various relationship facets (trust, support, respect, commitment, and connection). We purposively explored contextual themes, namely the role of HIV, positive community involvement, and power dynamics, to better situate the healthy relationship behaviour themes. HIV was not central to relationship conceptualisations and three different power structures (shared power/flexible gender norms, shared power/traditional gender norms, male-dominated power/traditional gender norms) were described as being healthy. This model of healthy relationships is similar to observed definitions in other African countries and in high-income settings. Findings can inform HIV programming content for couples in KwaZulu-Natal, particularly the active relationship building component.
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Affiliation(s)
- Jennifer M. Belus
- Department of PsychologyUniversity of MarylandCollege ParkMarylandUSA
- Present address:
Swiss Tropical and Public Health Institute and the University of BaselBaselSwitzerland
| | | | - Alastair van Heerden
- Human and Social DevelopmentHuman Sciences Research CouncilPietermaritzburgSouth Africa
- MRC/WITS Developmental Pathways for Health Research Unit Department of PaediatricsFaculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lindani I. Msimango
- Human and Social DevelopmentHuman Sciences Research CouncilPietermaritzburgSouth Africa
- Present address:
Centre for AIDS Programme of Research in South Africa (CAPRISA)DurbanSouth Africa
| | | | - Heidi van Rooyen
- MRC/WITS Developmental Pathways for Health Research Unit Department of PaediatricsFaculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
- The Impact CentreHuman Sciences Research CouncilDurbanSouth Africa
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Jurinsky J, Perkins JM, Kakuhikire B, Nyakato VN, Baguma C, Rasmussen JD, Satinsky EN, Ahereza P, Kananura J, Audet CM, Bangsberg DR, Tsai AC. Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:343-352. [PMID: 34355265 PMCID: PMC8792190 DOI: 10.1007/s00127-021-02135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. METHODS We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. RESULTS Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007). CONCLUSION In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.
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Affiliation(s)
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,University of Witwatersrand, Johannesburg, South Africa
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Hickson W, Mayers PM. Understanding how young people become motivated to take their human immunodeficiency virus medication (antiretroviral therapy) and how the need for adherence is communicated. Health SA 2021; 25:1458. [PMID: 33391827 PMCID: PMC7756603 DOI: 10.4102/hsag.v25i0.1458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Antiretroviral therapy (ART), the only effective treatment for human immunodeficiency virus (HIV), requires excellent long-term compliance. Poor levels of adherence to ART, especially amongst adolescents and young adults in South Africa, have been reported. Aim This study aimed to explore how young people become motivated to take their HIV medication (ART) and how the need for adherence is communicated. Setting The study was conducted in a peri-urban township in the Western Cape, South Africa. Methods A qualitative grounded theory approach was employed. Eighty young people were purposively recruited. Participant observation, focus groups and semi-structured interviews were utilised to explore how effective ART adherence messages are in motivating adherence amongst young people and how they would like ART adherence to be communicated to them. All interviews and focus groups were transcribed and analysed by using cross-comparison analysis. Measures to ensure trustworthiness were established and ethical considerations were adhered to. Results Young people’s adherence motivation was an outcome of reconnecting to one or more trusted significant other(s) from within their belonging group, who accepted and supported them, which in turn affirmed their prior belonging identities of son, daughter, other family member or close friend. This facilitated reconnection to their present and future hopes, which in turn increased their motivation to live and to adhere to treatment. Conclusion The findings highlight the need for the development of more effective communication strategies, which facilitate and support young people’s reconnection to trusted members of their belonging groups, and also help belonging group members to accept, affirm and support adherence.
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Affiliation(s)
- Warren Hickson
- Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pat M Mayers
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Kajubi P, Ruark A, Hearst N, Ruteikara S, Green EC. Assessment of an HIV-prevention intervention for couples in peri-urban Uganda: pervasive challenges to relationship quality also challenge intervention effectiveness. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:249-262. [PMID: 33119459 DOI: 10.2989/16085906.2020.1811357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Reducing multiple and concurrent partnerships has been identified as a priority in generalised HIV epidemics, yet developing successful interventions to bring about such behaviour change has proven challenging. We offered a three-session intervention aimed to improve couple relationship quality and address HIV risk factors, particularly concurrent sexual partnerships (CSP), in a peri-urban community of Kampala, Uganda. Before launching the intervention, a different group of community members participated in eight single-gender focus group discussions (FGDs) which explored issues of couple relationship quality and satisfaction. Findings from the FGDs guided the intervention. All 162 couples invited to the intervention completed a survey pre- and post-intervention. In FGDs, women and men discussed challenges faced in their relationships, including pervasive dissatisfaction, financial constraints, deception and lack of trust, poor communication, lack of sexual satisfaction, and concurrent sexual partnerships. A difference-in-difference analysis showed no measurable impact of the intervention on relationship quality or sexual risk behaviours over a six-month follow-up among 183 individuals who participated in the intervention, although many stated in response to open-ended questions that they had experienced positive relationship changes. Qualitative findings suggest high demand for couple-focused interventions but also reveal many individual-, couple-, community- and structural-level factors which contribute to women and men seeking concurrent sexual partnerships. More intensive interventions may be needed to overcome these barriers to behaviour change and reduce HIV risk. These findings also raise questions about how to interpret divergent qualitative and quantitative data, a topic which has received little attention in the literature.
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Affiliation(s)
- Phoebe Kajubi
- The Uganda Academy for Health Innovation & Impact, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda; Currently at Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allison Ruark
- Department of Medicine, Brown University, Providence, USA; currently Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.,Ukwanda Centre for Rural Health, Stellenbosch University, South Africa
| | - Norman Hearst
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, USA
| | | | - Edward C Green
- Department of Anthropology, The George Washington University, Washington, DC, USA
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