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Nkinsi NT, Galagan SR, Benzekri NA, Govere S, Drain PK. Food Insecurity at HIV Diagnosis Associated with Subsequent Viremia Amongst Adults Living with HIV in an Urban Township of South Africa. AIDS Behav 2023; 27:3687-3694. [PMID: 37249804 DOI: 10.1007/s10461-023-04085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
We assessed the temporal impact of food insecurity on 12-month antiretroviral (ART) adherence, retention in care, hospitalization, and HIV viremia (> 1000 copies/mL) in ART naïve adults presenting for HIV testing in Umlazi, South Africa. At the time of HIV testing and prior to ART initiation, we determined each participants' food security status using the validated Household Food Insecurity Access Scale (HFIAS). Following HIV testing and ART initiation, we then assessed the above outcomes of each study participant at 3-month intervals for a total of 12 months. Among 2,383 participants with HIV in this study, 253 (10.6%) experienced food insecurity. We found that food insecurity is associated with 20% higher adjusted prevalence odd ratios (aPOR) of having HIV viremia (> 1000 copies/mL) at 12 months following initial diagnosis (aPOR 1.2, 95% CI 1.1-1.4). We found no significant differences in ART adherence, retention in care, and hospitalization occurrences between the food secure and food insecure cohorts.
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Affiliation(s)
- Naomi T Nkinsi
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
- Department of Global Health, University of Washington, Seattle, USA.
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Paul K Drain
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
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Mwangala PN, Wagner RG, Newton CR, Abubakar A. Navigating Life With HIV as an Older Adult on the Kenyan Coast: Perceived Health Challenges Seen Through the Biopsychosocial Model. Int J Public Health 2023; 68:1605916. [PMID: 37398632 PMCID: PMC10308997 DOI: 10.3389/ijph.2023.1605916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV-OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya. Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data. Results: Symptoms of common mental disorders, comorbidities, somatic symptoms, financial difficulties, stigma, and discrimination were viewed as common. There was also an overlap of perceived risk factors across the physical, mental, and psychosocial health domains, including family conflicts and poverty. Conclusion: OALWH at the Kenyan coast are perceived to be at risk of multiple physical, mental, and psychosocial challenges. Future research should quantify the burden of these challenges and examine the resources available to these adults.
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Affiliation(s)
- Patrick N. Mwangala
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles R. Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA,Corresponding author.. 1.949.480.4216, 1 University Drive, Aliso Viejo, CA, 92656, USA, (D. Denardo)
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa,Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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Knight L, Schatz E. Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11473. [PMID: 36141746 PMCID: PMC9517460 DOI: 10.3390/ijerph191811473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants' disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH's health outcomes.
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Affiliation(s)
- Lucia Knight
- Division of Social & Behavioural Sciences, School of Public Health, University of Cape Town, Rondebosch, Cape Town 7701, South Africa
| | - Enid Schatz
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA
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Kia H, Grace D, Strike C, Ferlatte O, Knight R, Salway T, Ross LE. "They Haven't Made a Slot for Us Yet": Conceptualizing the Health Care and Social Service Needs of Older Gay Men Living with HIV in Canada. JOURNAL OF HOMOSEXUALITY 2022; 69:332-355. [PMID: 32946344 DOI: 10.1080/00918369.2020.1819712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montreal, Canada
| | - Rod Knight
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Koyratty N, Jones AD, Schuster R, Kordas K, Li CS, Mbuya MNN, Boateng GO, Ntozini R, Chasekwa B, Humphrey JH, Smith LE. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6020. [PMID: 34205143 PMCID: PMC8199942 DOI: 10.3390/ijerph18116020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Background: With millions of people experiencing malnutrition and inadequate water access, FI and WI remain topics of vital importance to global health. Existing unidimensional FI and WI metrics do not all capture similar multidimensional aspects, thus restricting our ability to assess and address food- and water-related issues. Methods: Using the Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) trial data, our study conceptualizes household FI (N = 3551) and WI (N = 3311) separately in a way that captures their key dimensions. We developed measures of FI and WI for rural Zimbabwean households based on multiple correspondence analysis (MCA) for categorical data. Results: Three FI dimensions were retained: 'poor food access', 'household shocks' and 'low food quality and availability', as were three WI dimensions: 'poor water access', 'poor water quality', and 'low water reliability'. Internal validity of the multidimensional models was assessed using confirmatory factor analysis (CFA) with test samples at baseline and 18 months. The dimension scores were associated with a group of exogenous variables (SES, HIV-status, season, depression, perceived health, food aid, water collection), additionally indicating predictive, convergent and discriminant validities. Conclusions: FI and WI dimensions are sufficiently distinct to be characterized via separate indicators. These indicators are critical for identifying specific problematic insecurity aspects and for finding new targets to improve health and nutrition interventions.
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Affiliation(s)
- Nadia Koyratty
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85281, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA;
| | | | - Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
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Schatz E, Knight L, Mukumbang FC, Teti M, Myroniuk TW. 'You Have to Withstand That Because You Have Come for What You Have Come for': Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:624-641. [PMID: 33682928 DOI: 10.1111/1467-9566.13243] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing - stigma, finances and family dynamics - impact access to ART. Qualitative interviews with 23 persons aged 50-plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age-related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre-existing co-morbidities. Key age-related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, The Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh, University of Washington, Seattle, WA, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
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