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Dale SK, Wright IA, Madhu A, Reid R, Shahid NN, Wright M, Sanders J, Phillips A, Rodriguez A, Safren SA. A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV. AIDS Behav 2024:10.1007/s10461-024-04408-w. [PMID: 39012452 DOI: 10.1007/s10461-024-04408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR = .07, estimate = - 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Ian A Wright
- Department of Economics, Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Aarti Madhu
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Naysha N Shahid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Mya Wright
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Jasmyn Sanders
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Arnetta Phillips
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Allan Rodriguez
- Clinical Immunology, Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
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Gómez W, Schustack A, Carrico AW, Ramirez-Forcier J, Batchelder A. In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV. Int J Behav Med 2024; 31:315-324. [PMID: 37438561 DOI: 10.1007/s12529-023-10198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population. METHOD The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience. RESULTS Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis. CONCLUSION PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Sommer SB, Barroso JV, Bass SB, Congema MR, Schoemann AM, Caiola CE. Peer advice for women living with HIV in the Southern USA. CULTURE, HEALTH & SEXUALITY 2023:1-16. [PMID: 38047389 PMCID: PMC11147954 DOI: 10.1080/13691058.2023.2281371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
Peer advice can provide emotional, social and practical assistance for the sustained self-management of chronic conditions. For stigmatised diseases such as HIV, finding support can be challenging. Women living with HIV in the Southern USA are additionally impacted upon by region-specific barriers such as stigma, poverty and limited access to services. The effectiveness of peer advice has been studied, yet little is known about the advice shared amongst women living with HIV. Therefore, we aimed to qualitatively explore the context and content of the advice participants offered to other women. With the assistance of a Community Clinician Advisory Board, women were recruited from across the US Centers for Disease Control and Prevention South Census Region. In-depth interviews were conducted with (N = 40) participants, aged 23 to 72 years (M = 51.2). Qualitative inductive thematic analysis was used to explore both the solicited and unprompted advice shared during individual interviews. Analysis of interview transcripts revealed three advice themes: Consistency in disease management Practical, non-medical advice; and Emotional and social support. The findings are valuable in shaping future peer-delivered programmes and interventions to enhance HIV care engagement, medication adherence, and the well-being of women living with HIV in the Southern USA.
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Affiliation(s)
- Sadie B Sommer
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Julie V Barroso
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah B Bass
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Marianne R Congema
- College of Nursing, East Carolina University, Greenville, South Carolina, USA
| | | | - Courtney E Caiola
- College of Nursing, East Carolina University, Greenville, South Carolina, USA
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Amoatika DA, Brown MJ, Addo PNO, Kaur A. Coping strategies among older adults living with HIV/AIDS with history of childhood sexual abuse. Int J STD AIDS 2023; 34:687-693. [PMID: 37147925 DOI: 10.1177/09564624231173030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Background: Childhood sexual abuse (CSA) may be a risk factor for poor mental health in adulthood. Survivors may experience emotions detrimental to their social and mental wellbeing. Some of these emotions may include anger, fear, rage, helplessness, guilt, shame, which may impact their coping strategies. The aim of this study was to determine the association between CSA and coping among older adults living with HIV (OALH). Method: Data were obtained from 91 OALH via convenience sampling. The participants were recruited from an immunology clinic and were at least 50 years or older and living with HIV. CSA was operationalized using questions from the Adverse Childhood Experiences Questionnaire. Coping was assessed using the Brief COPE Inventory. Crude and adjusted linear regression models, controlling for age, sex, race, gender, and income were used to determine the association between CSA and each coping subscale. The analyses were conducted in SAS version 9.4. Results: Crude analyses showed statistically significant associations between CSA and specific coping strategies: humor (β = 1.244; p = 0.0018), religion (β = 1.122; p = 0.0291), Self-blame (β = 1.103; p = 0.0154), planning β = 1.197; p = 0.0196), venting (β = 1.218; p = 0.0063), substance use (β = 0.828; p = 0.0335) and instrumental support (β = 0.949; p = 0.0416) After adjusting for sociodemographic characteristics, there was a statistically significant association between CSA and humor (β = 1.321; p = 0.0048) and self-blame (β = 1.046; p = 0.0382). Conclusion: OALH with a history of CSA were more likely to use humor and self-blame as coping strategies. Trauma-informed interventions should be geared towards decreasing self-blame for OALH who are CSA survivors.
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Affiliation(s)
- Daniel A Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prince N O Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Randolph SD, Johnson R, McGee K, A Adimora A, Ramirez C, Bailey DE, Holt L, Koch A, McMillian-Bohler JM, Ritchwood T, Relf MV. Adaptive leadership in clinical encounters with women living with HIV. BMC Womens Health 2022; 22:217. [PMID: 35681158 PMCID: PMC9185975 DOI: 10.1186/s12905-022-01810-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women living with HIV (WLWH) report low engagement in health care, missed office visits, and less engagement in the clinical encounter. Strengthening the clinical encounter for WLWH may improve health outcomes and quality of life. The Adaptive Leadership Framework for Chronic Illness offers specific adaptive leadership strategies for providers to improve patient-provider interactions. The purpose of this study was to examine adaptive leadership behaviors that contribute to the development of effective patient-provider communication from the perspectives of WLWH. METHODS The descriptive, cross-sectional and qualitative study conducted interviews with 22 WLWH to assess perceptions of the clinical encounter related to HIV-related stigma, engagement in care, medical distrust, and experiences with discrimination and quality of life. Members of the study team using a set of a priori codes analyzed data using NVivo 12.0. RESULTS Participants described two primary themes and subthemes of each for adaptive leadership behaviors. The primary theme for adaptive leadership of providers was "my provider cares about me"; subthemes were communication, trust building takes time, and supportive providers are trusted. The primary theme for adaptive leadership of WLWH themselves was "I care about me; subthemes were self-advocacy and self-empowerment. CONCLUSIONS Providers can use adaptive leadership behaviors during clinical encounters to support WLWH, improve patient-provider communication, enhance trust, and improve patient outcomes.
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Affiliation(s)
| | | | - Kara McGee
- Duke University School of Nursing, Durham, NC, USA
| | - Adaora A Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, Department of Epidemiology, School of Medicine, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catalina Ramirez
- School of Medicine and the Project Director for the Women's Interagency HIV Study at the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lauren Holt
- Duke University School of Nursing, Durham, NC, USA
| | - Amie Koch
- Duke University School of Nursing, Durham, NC, USA
| | | | - Tiarney Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Michael V Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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6
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Kaur A, James TA, Brown MJ. Coping and ART adherence self-efficacy among people living with HIV in South Carolina. AIDS Care 2022; 35:989-994. [PMID: 35621305 DOI: 10.1080/09540121.2022.2079600] [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
In the US, more than 50% of new HIV infections are reported in southern states. Besides, the incidence rate of HIV in South Carolina is 17 per 100,000 population. Regardless of improved quality of life with the advent of ART, coping with stressors may influence ART adherence self-efficacy. This study assessed the association between coping strategies and ART adherence self-efficacy among people living with HIV (PLWH) in South Carolina. Cross-sectional data were obtained from 402 PLWH attending a large immunology center in South Carolina in 2018. Unadjusted and adjusted linear regression models were used to determine the association between coping strategies and ART adherence self-efficacy. Alcohol or drug use was negatively associated with ART adherence self-efficacy (b = -0.170, 95% CI [-0.255, -0.085], p = 0.0001). Religiosity was positively associated with ART adherence self-efficacy (b = 0.101, 95% CI [0.017, 0.185], p = 0.019). Overall coping and self-motivation were not significantly associated with ART adherence self-efficacy. Accentuating religiosity and attenuating alcohol or drug use as a means of coping may improve ART adherence self-efficacy among PLWH.
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Affiliation(s)
- Amandeep Kaur
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Titilayo A James
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Monique J Brown
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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7
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Koch A, Ritchwood TD, Bailey DE, Caiola CE, Adimora AA, Ramirez C, Holt L, Johnson R, McGee K, McMillian-Bohler JM, Randolph SD, Relf MV. Exploring Resilience Among Black Women Living With HIV in the Southern United States: Findings From a Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:224-234. [PMID: 35195613 PMCID: PMC9188835 DOI: 10.1097/jnc.0000000000000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black women living with HIV (WLWH) face individual and sociostructural challenges. Despite these challenges, many exemplify remarkable levels of resilience and coping. Yet, research on resilience and coping in this population is limited. Twenty Black WLWH in the Southern United States completed semi-structured interviews that explored challenges facing WLWH. We identified six themes related to resilience and coping: self-acceptance, disclosure, self-compassion, social support, will to live, and service. Of these, social support was a driving protective element and an essential component to building and sustaining resilience and coping. Women who experienced positive support often expressed a will to live as well as a desire to support other WLWH. Resilience and social support were characterized by patterns of reciprocity, in that they were mutually sustaining, stabilizing, and strengthening.
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Affiliation(s)
- Amie Koch
- Duke University School of Nursing, and a Palliative Care and Hospice Family Nurse Practitioner at Transitions LifeCare, and is a COVID Nurse Practitioner, Lincoln Community Health Clinic, Durham, North Carolina, USA
| | - Tiarney D. Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Adaora A. Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, School of Medicine and a Professor of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- School of Medicine, and is a Project Director for the Women’s Interagency HIV Study, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, SA
| | - Lauren Holt
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Kara McGee
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | | | - Michael V. Relf
- Associate Dean for Global and Community Health Affairs, Duke University School of Nursing and Associate Research Professor, Duke Global Health Institute, Durham, North Carolina, USA
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8
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Brody LR, Firpo-Perretti Y, Bruck-Segal D, Dale SK, Ruffing EG, Cassiello-Robbins C, Weber KM, Cohen MH. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int J Behav Med 2021; 29:469-479. [PMID: 34713412 PMCID: PMC9046468 DOI: 10.1007/s12529-021-10032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml). METHOD Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses. RESULTS Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence. CONCLUSION Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.
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Affiliation(s)
- Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, USA.
| | | | - Dana Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Elizabeth G Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kathleen M Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA
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9
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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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10
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Bassett SM, Brody LR, Jack DC, Weber KM, Cohen MH, Clark TM, Dale SK, Moskowitz JT. Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV. AIDS Behav 2021; 25:1737-1750. [PMID: 33389322 PMCID: PMC7778488 DOI: 10.1007/s10461-020-03103-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
While programs and interventions intended to increase positive affect among people living with HIV (PLWH) and other chronic diseases have been associated with improved health outcomes, including decreased depression, programs have not been tailored specifically for Black women. We tailored a program designed to increase positive affect and to decrease depressive symptoms in PLWH to a group format for Black WLWH. We also added skills to increase gender empowerment. We then tested the acceptability and feasibility of this program with 8 Black WLWH. The program was acceptable and relatively feasible, as assessed by women’s participation and feedback about program clarity and helpfulness, which women rated above 9 on a 10-point scale. A few women suggested that optimal delivery point for some skills taught would be shortly after HIV diagnosis. A proof-of-concept program intended to bolster positive emotions and gender empowerment and decrease depression can be tailored for Black WLWH and is relatively feasible and acceptable. A randomized controlled trial is needed to assess the preliminary efficacy of this program on positive affect, depression, and other health outcomes for WLWH.
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Affiliation(s)
- S M Bassett
- Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - L R Brody
- Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - D C Jack
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, WA, USA
| | - K M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - M H Cohen
- Department of Medicine, Rush University and Stroger Hospital of Cook County, Chicago, IL, USA
| | - T M Clark
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - S K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - J T Moskowitz
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
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11
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Amutah-Onukagha N, Ibeziako N, Tibbitt C, Louis L, Amarnath A. Wisdom Matters: Honoring the Wisdom and Assessing the Health Literacy of Black Women Living with HIV. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:204-224. [PMID: 36818219 PMCID: PMC9930510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Low literacy levels in Black women with HIV (WWH) have been shown to amplify pre-existing health disparities and sequelae of non-adherence to health-related guidance. Wisdom Matters is a community-based participatory research program with an aim of improving health literacy in populations of Black WWH and assessing the existing knowledge, attitudes, and beliefs surrounding HIV care delivery and psychosocial barriers in these populations. Our research was conducted in Boston, MA, where 17 Black WWH were recruited to complete a 6-week curriculum designed to provide a thorough and cohesive path to empowerment, both individually and collectively, pertaining to living with HIV. Data collection was augmented through pre- and posttest data as well as qualitative data collected via focus groups. Content and narrative analyses of these qualitative data demonstrate individual and group improvement in the areas of nutrition, medication adherence, stress management, and disclosure of HIV status after participation in the Wisdom Matters program. The study demonstrates the feasibility and acceptability of health literacy interventions based within community settings and addresses gaps in literacy that healthcare workers can prioritize in the education of their patients.
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12
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Fletcher FE, Sherwood NR, Rice WS, Yigit I, Ross SN, Wilson TE, Weiser SD, Johnson MO, Kempf MC, Konkle-Parker D, Wingood G, Turan JM, Turan B. Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis. AIDS Patient Care STDS 2020; 34:356-366. [PMID: 32757978 DOI: 10.1089/apc.2019.0309] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.
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Affiliation(s)
- Faith E. Fletcher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas R. Sherwood
- The Jimmy & Rosalynn Carter School for Peace and Conflict Resolution, George Mason University, Fairfax, Virginia, USA
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ibrahim Yigit
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shericia N. Ross
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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13
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Andini S, Yona S, Waluyo A. Self-efficacy, depression, and adherence to antiretroviral therapy (ART) among Indonesian women with HIV. ENFERMERIA CLINICA 2019. [PMID: 31302024 DOI: 10.1016/j.enfcli.2019.04.105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed at investigating the relationship between self-efficacy, depression, and adherence to antiretroviral therapy (ART) in Indonesian women with HIV. METHOD This study employed a cross-sectional research design. The participants were 120 women with HIV aged 18-60 years on self-administered ART regimens. RESULTS This study shows a significant relationship between self-efficacy and adherence to ART (p-value=0.004; OR 2.330). Women are living with HIV with high self-efficacy adherence to following their ART 2.33 times more often than those with low self-efficacy. It is shown that a significant relationship exists between depression and adherence to ART (p-value=0.001; OR 3.647). Depressed HIV women took ART medication 3.64 times less often than who did not have depression. CONCLUSION It is recommended to increase the level adherence rate by improving self-efficacy and reduce depression.
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Affiliation(s)
- Sandra Andini
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia; Dr. H. Abdul Moeleok Hospital, Lampung, Bandar Lampung, Indonesia
| | - Sri Yona
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia.
| | - Agung Waluyo
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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14
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Resilience resources among African American women living with HIV in Southern United States. AIDS 2019; 33 Suppl 1:S35-S44. [PMID: 31397721 DOI: 10.1097/qad.0000000000002179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES African American women living with HIV (WLH) often face various challenges to access to and benefit from healthcare across the HIV treatment cascade. Despite experiencing multiple forms of ongoing adversity, some African American WLH are able to adapt and stand strong. The current study aims to identify resources at various socioecological levels that facilitate resilience and explore how these resources interact with each other. DESIGN Guided by the theories of resilience, we collected qualitative data through in-depth interviews with 14 African American WLH in South Carolina, United States. METHODS Participants were purposely recruited and interviewed in private settings in 2016. With appropriate consent, each interview was recorded and was transcribed verbatim. Data analysis was conducted using NVivo 11.0. RESULTS The participants described six major resilience resources including first, internal strength; second, religion and spirituality; third, hopefulness about life and future; fourth, self-awareness and self-care; fifth, social support from family and community; and sixth, HIV-related health facilities. The themes that occurred in qualitative data also show how resilience resources at the family/community level and institutional level affected individual resources, and how these resources collaborated with each other. CONCLUSION The findings suggest that resilient African American WLH maintain hope in the face of adversity and seek out and obtain social support. Self-care, social support, and health facilities are particularly critical resources for African American WLH. Comprehensive interventions are needed to integrate these resources across multiple socioecological levels to enhance resilience and treatment outcomes in African American WLH.
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15
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Firpo-Perretti YM, Cohen MH, Weber KM, Brody LR. Past, present or future? Word tense and affect in autobiographical narratives of women with HIV in relation to health indicators. J Behav Med 2018; 41:875-889. [PMID: 29938385 PMCID: PMC6209518 DOI: 10.1007/s10865-018-9944-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
Abstract
This study examined how the expression of positive and negative affect words and word tense in autobiographical narratives of 98 HIV+ women, predominantly African American, predicted undetectable HIV viral load (UDVL), CD4+ cells/mm3 counts and antiretroviral therapy medication (ART) adherence assessed concurrently (T1) and at 3 to 9-month follow-up (T2). Logistic regressions revealed that higher past tense words predicted worse odds of UDVL, CD4+ cells/mm3 above 350 at T1, and worse odds of 95% ART adherence at T2. However, using both high past tense words and high positive affect words predicted better odds of CD4+ cells/mm3 > 350 at T2. Higher future tense words predicted better odds of CD4+ cells/mm3 > 350 at T1. Additionally, using both high present tense words and negative affect words predicted better odds of UDVL at T1. These findings provide preliminary evidence that the quality of affect expression significantly interacts with temporal context to relate to the health of women with HIV.
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Affiliation(s)
- Yudelki M Firpo-Perretti
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, Room 227, Boston, MA, 02215, USA.
| | - Mardge H Cohen
- Cook County Health and Hospitals System, Hektoen Institute of Medicine, 2225 W. Harrison, Suite B, Chicago, IL, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System, Hektoen Institute of Medicine, 2225 W. Harrison, Suite B, Chicago, IL, USA
| | - Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, Room 227, Boston, MA, 02215, USA
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16
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Amutah-Onukagha N, Mahadevan M, Opara I, Rodriguez M, Trusdell M, Kelly J. Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective. AIDS Patient Care STDS 2018; 32:119-128. [PMID: 29630851 PMCID: PMC5972771 DOI: 10.1089/apc.2017.0215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.
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Affiliation(s)
- Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, New Jersey
| | - Ijeoma Opara
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey
| | - Monica Rodriguez
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Megan Trusdell
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Jessica Kelly
- Department of Public Health, Montclair State University, Montclair, New Jersey
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17
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Geter A, Sutton MY, Hubbard McCree D. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005-2016. AIDS Care 2018; 30:409-416. [PMID: 29376409 DOI: 10.1080/09540121.2018.1426827] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Black/African American (black) women comprised 59% of women living with HIV at the end of 2014 and 61% of HIV diagnoses among women in 2015. Black women living with HIV infection (BWLH) have poorer health outcomes compared with women of other races/ethnicities; social and structural determinants are often cited as barriers and facilitators of care. The objective of this qualitative review was to identify social and structural barriers and facilitators of HIV treatment and care among BWLH. The systematic review was conducted in six-stages using databases such as PubMed, PsycINFO, and Google Scholar: 1) searched for studies that enrolled BWLH published between January 2005 and December 2016, 2) excluded unpublished reports and commentaries, 3) limited the search to our primary keywords, 4) limited our search to studies that included participants living with HIV infection that were >60% black and 100% female, 5) extracted and summarized the data, and 6) conducted a contextual review to identify common themes. Of 534 studies retrieved, 16 were included in the final review. Studies focused on: ART medication adherence (n = 5), engagement/retention in care (n = 4), HIV care and treatment services (n = 3), viral suppression (n = 1), and addressing multiple HIV care outcomes (n = 3). Main barrier themes included lack of family and/or social support, poor quality HIV services, and HIV-related stigma, particularly from healthcare providers; facilitator themes included resilience, positive relationships between case management and support services, high racial consciousness, and addressing mental health. Interventions that decrease these noted barriers and strengthen facilitators may help improve care outcomes for BWLH. Also, more HIV stigma-reduction training for healthcare providers may be warranted.
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Affiliation(s)
- Angelica Geter
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Madeline Y Sutton
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Donna Hubbard McCree
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
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18
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Geter A, Sutton MY, Armon C, Durham MD, Palella FJ, Tedaldi E, Hart R, Buchacz K. Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015. PLoS One 2018; 13:e0189973. [PMID: 29293632 PMCID: PMC5749722 DOI: 10.1371/journal.pone.0189973] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/05/2017] [Indexed: 12/02/2022] Open
Abstract
In the United States, women accounted for 19% of new HIV diagnoses in 2015 and were less likely to reach virologic suppression when compared to men. We assessed trends and disparities in virologic suppression among HIV-positive women to inform HIV treatment strategies. Data were from a prospective cohort of the HIV Outpatient Study and collected at nine United States HIV clinics. We included women aged ≥18 years, with ≥1 visit, who were prescribed antiretroviral therapy, and had ≥1 viral load test performed between 2010 and 2015. We defined virologic suppression as viral load <50 copies/mL and calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for virologic suppression by race/ethnicity and year of measure. Generalized estimating equations were used for multivariable analyses to assess factors associated with virologic suppression. Among 809 women (median age = 44 years), 482 (60%) were black, 177 (22%) white, 150 (19%) Hispanic/Latina. Virologic suppression was less prevalent among black women (73%) compared with Hispanic/Latina women (83%) and white women (91%). In multivariable analyses, not achieving virologic suppression was more likely among black women (aPR = 2.13; CI = 1.50–3.02) or Hispanic/Latina women (aPR = 1.66; CI = 1.08–2.56) compared with white women, and among women who attended public clinics (aPR = 1.42; CI = 1.07–1.87) compared with those who attended a private clinic. Between 2010 and 2015, virologic suppression among HIV-positive women increased from 68% to 83%, but racial/ethnic disparities persisted. Black and Hispanic/Latina women had significantly lower rates of virologic suppression than white women. Interventions targeting virologic suppression improvement among HIV-positive women of color, especially those who attend public clinics, are warranted.
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Affiliation(s)
- Angelica Geter
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Madeline Y. Sutton
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, United States of America
| | - Marcus D. Durham
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Frank J. Palella
- Infectious Diseases Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ellen Tedaldi
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Rachel Hart
- Cerner Corporation, Kansas City, MO, United States of America
| | - Kate Buchacz
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. ACTA ACUST UNITED AC 2017; 8. [PMID: 29201531 PMCID: PMC5708581 DOI: 10.4172/2155-6113.1000730] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access. Conclusion Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.
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20
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Pierre S, Riviera V, Jean CP, Louis MJJ, Reif LK, Severe P, Rouzier V, Johnson WD, Pape JW, Fitzgerald DW, McNairy ML, Boutin-Foster C. Live with the Disease Like You Used to Before You Knew You Were Infected: A Qualitative Study Among 10-Year Survivors Living with HIV in Haiti. AIDS Patient Care STDS 2017; 31:145-151. [PMID: 28282245 DOI: 10.1089/apc.2016.0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2003, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a nonprofit organization, began administering antiretroviral therapy (ART) to its patients. This practice transformed HIV from a fatal disease to a more manageable chronic condition. However, relatively few studies focus on the experiences of survivors. This study provided a unique opportunity to interview patients who survived at least 10 years after being treated with ART at GHESKIO. The goal of the study was to elicit from patients their perspectives on what enabled them to survive with AIDS. Grounded Theory, a qualitative research method was used to guide data collection, coding, and analysis. Individual interviews were conducted, audio-taped, transcribed and analyzed in Creole, and translated into English. Data saturation was reached at 25 participants. Of which, 64% were women, the mean age was 49, range of 43-55 years, 24% were married, 44% had not completed elementary school, and 72% had no income, the remaining participants had incomes ranging from $1000 to $5000 annually. Qualitative analysis resulted in 681 codes, which were grouped into six categories: being spiritually grounded, having supportive interactions with providers, caring for children, setting personal goals, persevering and living life as usual, and maintaining strict medication adherence practices. The overarching theory was that having a reason to live despite one's circumstances and living life as usual enabled one to survive. Having a strong spiritual foundation coupled with supportive family and providers motivated participants to live and adhere to their ART. As the number of patients who are living longer with HIV in Haiti increases, results from this study will be important in helping tailor interventions that enhance their overall quality of life.
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Affiliation(s)
- Samuel Pierre
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Riviera
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Circee Phara Jean
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Marie Jude Jean Louis
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Lindsey K. Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Patrice Severe
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Warren D. Johnson
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Jean W. Pape
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | | | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York
- Division of General Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carla Boutin-Foster
- Brooklyn Health Disparities Center, SUNY Downstate Medical Center, New York, New York
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