1
|
Drumright LN, Johnson MO, Mayer KH, Christopoulos K, Cachay E, Crawford TN, Whitney BM, Dai M, Ruderman SA, Mixson LS, Keruly JC, Chander G, Saag MS, Kitahata MM, Moore RD, Willig AL, Eron JJ, Napravnik S, Nance RM, Hahn A, Ma J, Bamford L, Fredericksen RJ, Delaney JAC, Crane HM. Differences in internalized HIV stigma across subpopulations of people with HIV in care across the United States. AIDS 2024; 38:1206-1215. [PMID: 38349228 PMCID: PMC11144440 DOI: 10.1097/qad.0000000000003864] [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: 05/16/2024]
Abstract
BACKGROUND Few studies have examined which subgroups of people with HIV (PWH) carry the greatest burden of internalized HIV stigma (IHS), which may be important to care provision and interventions. METHODS PWH in the CFAR Network of Integrated Clinical Systems (CNICS) longitudinal, US-based, multisite, clinical care cohort completed tablet-based assessments during clinic visits including a four-item, Likert scale (low 1-5 high), IHS instrument. Associations between sociodemographic characteristics and IHS scores were assessed in adjusted linear regression models. RESULTS Twelve thousand six hundred and fifty-six PWH completed the IHS assessment at least once from February 2016 to November 2022, providing 28 559 IHS assessments. At baseline IHS assessment, the mean age was 49 years, 41% reported White, 38% Black/African American, and 16% Latine race/ethnicity, and 80% were cisgender men. The mean IHS score was 2.04, with all subgroups represented among those endorsing IHS. In regression analyses, younger PWH and those in care fewer years had higher IHS scores. In addition, cisgender women vs. cisgender men, PWH residing in the West vs. the Southeast, and those with sexual identities other than gay/lesbian had higher IHS scores. Compared with White-identifying PWH, those who identified with Black/African American or Latine race/ethnicity had lower IHS scores. Age stratification revealed patterns related to age category, including specific age-related differences by gender, geographic region and race/ethnicity. DISCUSSION IHS is prevalent among PWH, with differential burden by subgroups of PWH. These findings highlight the benefits of routine screening for IHS and suggest the need for targeting/tailoring interventions to reduce IHS among PWH.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Mindy Dai
- University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, WA
| | | | | | | | | |
Collapse
|
2
|
Davtyan M, Kacanek D, Lee J, Berman C, Chadwick EG, Smith R, Salomon L, Frederick T. Factors associated with internalized HIV-related stigma among biological mothers living with HIV enrolled in a US cohort study. AIDS Care 2024; 36:220-226. [PMID: 37757482 PMCID: PMC10842531 DOI: 10.1080/09540121.2023.2263680] [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: 12/13/2022] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Understanding factors associated with internalized HIV-related stigma among mothers living with HIV may improve health outcomes. We examined factors (age, race/ethnicity, education, income, employment, marital status, health limitations, and years since HIV diagnosis) associated with internalized HIV-related stigma among biological mothers of children enrolled in the Surveillance Monitoring for ART Toxicities study of the US-based Pediatric HIV/AIDS Cohort Study. Stigma was measured with the Internalized HIV Stigma Scale (IHSS), completed biennially at their child's 11-17-year visits. Linear regression models were fit with generalized estimating equations to evaluate the association between the factors of interest and internalized HIV-related stigma using all completed IHSS surveys. Among 438 eligible mothers, the mean IHSS score was 43.7 (SD = 19.5). Higher IHSS scores were observed for widowed women compared to married women, with an estimated mean difference of 8.91 (95% CI: 2.25, 15.57) after adjusting for age, education, income, and health limitations. Years since HIV diagnosis was associated with internalized HIV-related stigma. For every year of increase since HIV diagnosis, IHSS scores decreased by 0.54 per year, after adjusting for age (95% CI: -0.92, -0.17). Interventions to reduce internalized HIV-related stigma should target mothers who are widowed and those with a more recent HIV diagnosis.
Collapse
Affiliation(s)
- Mariam Davtyan
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, California
| | - Deborah Kacanek
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, Massachusetts
| | - Jessica Lee
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, Massachusetts
| | - Claire Berman
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Ellen G. Chadwick
- Northwestern University, Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois
| | - Renee Smith
- University of Illinois, College of Medicine, Department of Pediatrics, Chicago, Illinois
| | - Liz Salomon
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Toinette Frederick
- University of Southern California, Keck School of Medicine, Department of Pediatrics, Los Angeles, California
| | | |
Collapse
|
3
|
Wang J, Wang G, Zhu X, Li L, Kang D, Liu Y, Zhang N. The care status and factors affecting antiretroviral therapy timing for people living with HIV: a retrospective cohort study in Shandong Province, China. AIDS Care 2023; 35:1963-1970. [PMID: 36919489 DOI: 10.1080/09540121.2023.2185197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
This study described the care status of People Living with HIV (PLWH) including antiretroviral therapy (ART) and viral suppression from 2018 to 2020. We recognized that immediate ART was associated with improved viral suppression. Therefore, we also aimed to explore the factors affecting the early initiation of ART. We initiated a retrospective cohort study to evaluate the care status of people living with HIV in Shandong Province. From 2018 to 2020, patients infected by homosexual transmission in particular had a higher ART rate (78.82%, 79.69%, and 87.72%, respectively). Of PLWH who received ART, 79.57%, 77.63%, and 67.71% achieved viral suppression, respectively. However, COVID-19 may affect the rate of ART and viral suppression, which we need to explore in our research. From 2018 to 2020, the proportion of immediate antiretroviral therapy within 30 days of diagnosis increased from 48.12% to 65.42%. Multivariate logistic regression demonstrated that patients with junior college degree or above (OR, 1.39 [95%CI, 1.12-1.73]) and key population or medical institutions (OR, 3.62 [95%CI, 2.18-6.16]; OR, 3.88 [95%CI, 2.33-6.59]) were substantially likely to receive ART immediately, while patients outside the province (OR, 0.60 [95%CI, 0.50-0.73]) were less likely to receive ART immediately.
Collapse
Affiliation(s)
- Jiongjiong Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| |
Collapse
|
4
|
Kerman J, Brewer R, Hotton A, Flores R, Devlin SA, Friedman EE, Schneider JA, McNulty MC. Multi-Level and Intersectional Stigma Experienced by Black Transgender Women in Chicago: a Qualitative Study to Inform Sociostructural Interventions for Reducing Stigma and Improving Health Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01853-6. [PMID: 37957538 PMCID: PMC11089070 DOI: 10.1007/s40615-023-01853-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Stigma contributes to health disparities including increased HIV vulnerability among minority communities. Black transgender women experience multiple forms of stigma (e.g., anticipated, experienced), which can result in poor HIV-related outcomes. We utilized an adapted social ecological model (ASEM) to better understand the levels at which stigma is encountered and its impact on lived experience, particularly related to making healthcare decisions. METHODS Semi-structured interviews and two focus groups (n = 38) were conducted with Black transgender women and Black transfeminine individuals in Chicago from 2016 to 2017. Participants were asked about discrimination in the community, healthcare experiences, and their thoughts and decision-making process with their healthcare provider regarding HIV pre-exposure prophylaxis. We conducted thematic analysis and organized our findings based on the levels of the ASEM: individual, interpersonal, organizational, community, and structural. RESULTS Participants experienced and anticipated stigma at each ASEM level. Stigma was not experienced in isolation: stigma experienced at one level caused anticipated stigma at other levels and internalized stigma leading to negative self-image. In each case, stigma adversely impacted health outcomes (e.g., medication nonadherence, disengagement from care). Stigma within healthcare settings, medication-related stigma, and stigma directed at appearance and identity are particularly detrimental to shared decision-making with a healthcare provider. CONCLUSIONS Recognizing and valuing Black transgender women's experience with stigma are essential for developing social and structural interventions that may work collaboratively across multiple levels of lived experience to reduce stigma and healthcare disparities faced by Black transgender women.
Collapse
Affiliation(s)
- Jared Kerman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Rey Flores
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Samantha A Devlin
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Eleanor E Friedman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Chicago Center for HIV Elimination, Chicago, IL, USA.
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| |
Collapse
|
5
|
Thompson EC, Muhammad JN, Adimora AA, Chandran A, Cohen MH, Crockett KB, Goparaju L, Henderson E, Kempf MC, Konkle-Parker D, Kwait J, Mimiaga M, Ofotokun I, Rubin L, Sharma A, Teplin LA, Vance DE, Weiser SD, Weiss DJ, Wilson TE, Turan JM, Turan B. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV. AIDS Patient Care STDS 2022; 36:336-342. [PMID: 36099481 PMCID: PMC9810353 DOI: 10.1089/apc.2022.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
Collapse
Affiliation(s)
- Emma C. Thompson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Josh N. Muhammad
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adoara A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aruna Chandran
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mardge H. Cohen
- Chicago Women's Interagency HIV Study, Chicago, Illinois, USA
| | - Kaylee B. Crockett
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lakshmi Goparaju
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Emmett Henderson
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mirjam-Colette Kempf
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennafer Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Matthew Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah Rubin
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anjala Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda A. Teplin
- School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Deborah J. Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tracey E. Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| |
Collapse
|
6
|
Hohmann L, Berger J, Kastell SU, Holtkamp M. Perceived epilepsy-related stigma is linked to the socioeconomic status of the residence. Front Public Health 2022; 10:952585. [PMID: 36091545 PMCID: PMC9459334 DOI: 10.3389/fpubh.2022.952585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Epilepsy is one of the most common neurological disorders with high costs for the healthcare systems and great suffering for patients. Beyond seizures, psychosocial comorbidities can have detrimental effects on the well-being of people with epilepsy. One source of social stress and reduced quality of life is epilepsy-related stigma that often occurs, e.g., due to public misconceptions or myths. Stigma has individual biological, psychological and social correlates. Moreover, environmental factors like living in remote areas are associated with stigma. However, little is known about the link between the social structure of the residence and stigma in epilepsy. Thus, we investigated the association between the structural socioeconomic status (SES) and perceived stigma in an urban epilepsy population. Methods This prospective, cross-sectional study examined 226 adult in-patients with epilepsy from Berlin. Multiple regression analyses were performed to check the relationship between structural SES and stigma controlling for individual-level demographic, clinical, psychological and social factors. Continuous social indices (SI) of the districts and neighborhoods ("SI district" and "SI neighborhood") of Berlin were used to measure different levels of structural SES. Non-linear relationships are tested by grouping the SI in quartiles. Results Both indicators of structural SES were independently linked to stigma (p = 0.002). For "SI district", we identified a non-linear relationship with patients from the most deprived quartile feeling less stigmatized compared to those in the second (p < 0.001) or least deprived quartile (p = 0.009). Furthermore, more restrictions of daily life (p < 0.001), unfavorable income (p = 0.009) and seizure freedom in the past 6 months (p = 0.05) were related to increased stigma. A lower "SI neighborhood" was associated with higher stigma (p = 0.002). Conclusion Strategies to reduce epilepsy-related stigma need to consider the sociostructural living environment on different regional levels. Unfavorable relations with the immediate living environment may be directly targeted in patient-centered interventions. Non-linear associations with the structural SES of broader regional levels should be considered in public education programs. Further research is needed to examine possible underlying mechanisms and gain insight into the generalizability of our findings to other populations.
Collapse
Affiliation(s)
- Louisa Hohmann
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany,*Correspondence: Louisa Hohmann
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Shirley-Uloma Kastell
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany,Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
7
|
Wright IA, Reid R, Shahid N, Ponce A, Nelson CM, Sanders J, Gardner N, Liu J, Simmons E, Phillips A, Pan Y, Alcaide ML, Rodriguez A, Ironson G, Feaster DJ, Safren SA, Dale SK. Neighborhood Characteristics, Intersectional Discrimination, Mental Health, and HIV Outcomes Among Black Women Living With HIV, Southeastern United States, 2019‒2020. Am J Public Health 2022; 112:S433-S443. [PMID: 35763751 PMCID: PMC9241469 DOI: 10.2105/ajph.2021.306675] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
Objectives. To examine the effects of within-neighborhood and neighboring characteristics on discrimination, stigma, mental health, and HIV outcomes among Black women living with HIV (BWLWH). Methods. A total of 151 BWLWH in a southeastern US city provided baseline data (October 2019‒January 2020) on experienced microaggressions and discrimination (race-, gender-, sexual orientation-, or HIV-related), mental health (e.g., depression, posttraumatic stress disorder), and HIV outcomes (e.g., viral load, antiretroviral therapy adherence). Neighborhood characteristics by census tract were gathered from the American Community Survey and the National Center for Charitable Statistics. Spatial econometrics guided the identification strategy, and we used the maximum likelihood technique to estimate relationships between a number of predictors and outcomes. Results. Within-neighborhood and neighboring characteristics (employment, education, crime, income, number of religious organizations, and low-income housing) were significantly related to intersectional stigma, discrimination, mental health, HIV viral load, and medication adherence. Conclusions. Policy, research, and interventions for BWLWH need to address the role of neighborhood characteristics to improve quality of life and HIV outcomes. (Am J Public Health. 2022;112(S4):S433-S443. https://doi.org/10.2105/AJPH.2021.306675).
Collapse
Affiliation(s)
- Ian A Wright
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Rachelle Reid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Naysha Shahid
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Amanda Ponce
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - C Mindy Nelson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jasmyn Sanders
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Nadine Gardner
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Jingxin Liu
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Ervin Simmons
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Arnetta Phillips
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Yue Pan
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Maria L Alcaide
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Allan Rodriguez
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Gail Ironson
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Daniel J Feaster
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Steven A Safren
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| | - Sannisha K Dale
- Ian A. Wright is with the Department of Economics, University of Miami Herbert Business School, Miami, FL. Rachelle Reid, Naysha Shahid, Amanda Ponce, Jasmyn Sanders, Nadine Gardner Sanders, Ervin Simmons, Gail Ironson, Steven A. Safren, and Sannisha K. Dale are with the Department of Psychology, College of Arts and Sciences, University of Miami. C. Mindy Nelson, Jingxin Liu, Yue Pan, and Daniel J. Feaster are with the Department of Public Health Sciences, University of Miami Miller School of Medicine. Arnetta Phillips is with the Department of Psychiatry, University of Miami Miller School of Medicine. Maria L. Alcaide and Allan Rodriguez are with the Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine
| |
Collapse
|
8
|
Thapinta D, Srithanaviboonchai K, Uthis P, Suktrakul S, Wiwatwongnawa R, Tangmunkongvorakul A, Wannachaiyakul S, Sripan P. Association between Internalized Stigma and Depression among People Living with HIV in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084471. [PMID: 35457339 PMCID: PMC9031422 DOI: 10.3390/ijerph19084471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022]
Abstract
Internalized stigma and depression are among the most common mental health problems in people living with HIV (PLHIV). This study aimed to examine the association between depression and overall internalized stigma, as well as different aspects of internalized stigma in PLHIV. The study included 400 PLHIV receiving care in Bangkok and Chiang Mai, Thailand. Data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation coefficients. The results indicated the PLHIV with mild depression had lower median scores for the social relationship internalized stigma subscale than PLHIV with major depressive disorder (p = 0.009). Total HIV internalized stigma scores were significantly correlated with PHQ-9 scores in the mild depression group (r = 0.327, p = 0.004). Depression and internalized stigma were prevalent and associated, especially in the area of social relationships. Health personnel should be aware of possible depression in PLHIV who have internalized stigma. Intervention to promote understanding and social support for PLHIV is warranted.
Collapse
Affiliation(s)
- Darawan Thapinta
- Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand; (D.T.); (S.W.)
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
| | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand; (P.U.); (S.S.)
| | - Sunisa Suktrakul
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand; (P.U.); (S.S.)
| | | | - Arunrat Tangmunkongvorakul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
| | | | - Patumrat Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
| |
Collapse
|
9
|
Hubbard D, Beer L, Jeffries WL, Tie Y, Fagan J, Crim SM. Sociodemographic Correlates of Self-reported Discrimination in HIV Health Care Settings Among Persons With Diagnosed HIV in the United States, Medical Monitoring Project, 2018-2019. J Acquir Immune Defic Syndr 2021; 88:457-464. [PMID: 34446678 PMCID: PMC8585688 DOI: 10.1097/qai.0000000000002788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-related discrimination in health care settings is associated with negative health outcomes among persons with HIV (PWH). This article describes and compares differences in the prevalence of self-reported experiences with discrimination in health care settings by sociodemographic and clinical care factors among persons with diagnosed HIV in the United States. METHODS We analyzed interview and medical record data collected during June 2018-May 2019 from 3850 PWH who had received HIV care in the past 12 months. We calculated weighted percentages and associated 95% confidence intervals and assessed the association between any experience of discrimination and selected sociodemographic and clinical characteristics using prevalence ratios with predicted marginal means. RESULTS Approximately 25% of PWH who had an HIV care visit in the past 12 months reported experiencing any discrimination. Experiences with discrimination were significantly more prevalent among persons aged 18-29 years (34%); transgender persons (41%); persons of gay (25%), bisexual (31%), or other (40%) sexual orientations; and persons who did not have a regular provider (39%), lived at/below poverty level (28%), were homeless (39%) or incarcerated (37%) in the past 12 months. PWH who experienced discrimination were more likely to have missed at least one HIV care visit, not be taking antiretroviral therapy, and have missed antiretroviral therapy doses. Recent and sustained viral suppression were not significantly associated with experiencing any discrimination. CONCLUSIONS Interventions that address the sociocultural and structural factors associated with discrimination in all health care settings are needed to improve health outcomes among PWH and end the HIV epidemic in the United States.
Collapse
Affiliation(s)
- Donna Hubbard
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| | - Linda Beer
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| | - William L. Jeffries
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| | - Yunfeng Tie
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| | - Jennifer Fagan
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| | - Stacy M. Crim
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, CDC
| |
Collapse
|
10
|
Dawit R, Trepka MJ, Duncan DT, Li T, Pires SF, Brock P, Ladner RA, Sheehan DM. Neighborhood Factors Associated with Racial/Ethnic Disparities in Achieving Sustained HIV Viral Suppression Among Miami-Dade County Ryan White Program Clients. AIDS Patient Care STDS 2021; 35:401-410. [PMID: 34623889 PMCID: PMC8665786 DOI: 10.1089/apc.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Racial/ethnic minorities are disproportionately affected by poor HIV care outcomes. Studies have also examined the effects of neighborhood-level factor on an individual's health outcomes. Thus, the objective of this study was to assess the effects of neighborhood factors on the association between race/ethnicity and sustained viral suppression (all viral load tests <200 copies/mL per year). Data for 6491 people with HIV in the 2017 Miami-Dade County Ryan White Program and neighborhood-level data by ZIP code tabulated areas from the American Community Survey were utilized. Multi-level logistic regression models were used to assess the role of neighborhood factors on the association between race/ethnicity and sustained viral suppression. Results show that non-Hispanic Blacks had lower odds of sustained viral suppression in low socioeconomic disadvantage [adjusted odds ratio (aOR): 0.39; 95% confidence interval (CI): 0.20-0.74], moderate residential instability (aOR: 0.31; 95% CI: 0.15-0.65), and low and high racial/language homogeneity neighborhoods (aOR: 0.38; 95% CI: 0.16-0.88) and (aOR: 0.38; 95% CI: 0.19-0.75), respectively, when compared to non-Hispanic Whites (NHWs). Haitians also exhibited poor outcomes in neighborhoods characterized by moderate residential instability (aOR: 0.42; 95% CI: 0.18-0.97) and high racial/language homogeneity (aOR: 0.49; 95% CI: 0.26-0.93), when compared to NHWs. In conclusion, disparities in rates of sustained viral suppression were observed for racial/ethnic minorities within various neighborhood-level factors. These findings indicate the importance of addressing neighborhood characteristics to achieve optimal care for minorities.
Collapse
Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA
| | - Dustin T. Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Stephen F. Pires
- Department of Criminology and Criminal Justice, Steven J. Green School of International and Public Affairs, Florida International University, Miami, Florida, USA
| | - Petra Brock
- Behavioral Science Research Corporation, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, Florida, USA.,Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, Florida, USA.,Address correspondence to: Diana M. Sheehan, PhD, MPH, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC 5, Room 479, Miami, FL 33199, USA
| |
Collapse
|
11
|
Lardier DT, Opara I, Reid RJ, Garcia-Reid P, Herrera A, Cantu I. Increasing HIV/AIDS knowledge among urban ethnic minority youth: Findings from a community-based prevention intervention program. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2021; 20:76-96. [PMID: 34177389 PMCID: PMC8225251 DOI: 10.1080/15381501.2021.1910097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/05/2021] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
HIV (Human Immunodeficiency Virus)/AIDs (Acquired immunodeficiency syndrome) prevention and research are imperative. Prevention-intervention programming is minimal in low-income communities of color. Additional research is needed that uncovers points of support and prevention to increase HIV knowledge and awareness and limit new HIV infections among adolescents of color. This study presents preliminary findings from a community-based HIV/AIDS, substance abuse, and viral hepatitis (VH) prevention education intervention for ethnic minority youth in a northeastern urban community. We evaluated HIV/AIDS knowledge and factors associated with knowledge. Participants (N = 599) completed a baseline survey followed by an exit survey measuring HIV/AIDS knowledge. Exit survey findings indicated that there was an increase in HIV/AIDs knowledge. Multivariate regression analyses showed that change scores in VH knowledge accuracy, sexual negotiation skills, risk perception, and ethnic identity were positively associated with change in HIV/AIDs knowledge score. The development and implementation of HIV/AIDS knowledge interventions can be crucial in alleviating new infections in the U.S.
Collapse
Affiliation(s)
- David T. Lardier
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Ijeoma Opara
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA
| | - Robert J. Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Andriana Herrera
- Department of Public Health, Montclair State University, Montclair, NJ, USA
| | - Irene Cantu
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
12
|
Reducing HIV Risk Behaviors Among Black Women Living With and Without HIV/AIDS in the U.S.: A Systematic Review. AIDS Behav 2021; 25:732-747. [PMID: 32918639 DOI: 10.1007/s10461-020-03029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
This systematic review provides an examination of the status of HIV/AIDS prevention interventions for Black, heterosexual women in the U.S. from 2012 to 2019. Using PRISMA guidelines, 28 interventions were identified. Over half of the interventions were: conducted in the southern region of the U.S.; evaluated using a randomized controlled trial; focused on adults; used a group-based intervention delivery; were behaviorally focused and theoretically driven. None included biomedical strategies of PrEP, nPEP, and TasP. Few interventions included adolescent or aging Black women; none included their sex/romantic partners. Future studies dedicated to addressing the specific needs of subpopulations of Black, heterosexual women may provide opportunities to expand and/or tailor current and future HIV/AIDS prevention interventions, including offering participants with options to choose which, and the level of involvement, of their sex/romantic partner(s) in their sexual health decision-making. While strides to improve HIV prevention efforts with Black, heterosexual women have occurred, more is needed.
Collapse
|
13
|
Spence AB, Michel K, Wang C, Dutton MA, Lee K, Merenstein D, Adams-Campbell L, Bell K, Kikkisetti A, Doyle A, Cochrane M, Goparaju L, Kassaye S. Viral Suppression Is Associated with HIV Treatment Self-Efficacy in a Cohort of Women in Washington, DC. AIDS Patient Care STDS 2021; 35:75-83. [PMID: 33689457 PMCID: PMC7987352 DOI: 10.1089/apc.2020.0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The goal of HIV treatment is viral suppression as it is linked with improved health outcomes and decreased risk of viral transmission. We assessed the sociodemographic, behavioral, and patient-provider interaction associations with viral suppression with an administered survey to HIV-seropositive women in the metropolitan Washington, DC, site of the Women's Interagency HIV Study (WIHS) between 2017 and 2018. Logistic and mixed models were used to explore related factors between HIV viral suppression groups and HIV treatment self-efficacy, respectively. Higher HIV treatment self-efficacy and disclosure concerns were positively associated with viral suppression, while illicit drug use had a negative association. In mixed models, more health care provider trust was associated with higher HIV treatment self-efficacy, while depressive symptoms were associated with lower HIV treatment self-efficacy. Depression, illicit substance use, and HIV treatment self-efficacy are potentially modifiable factors that can influence viral suppression. Implementation studies are needed to determine whether interventions to manage depression or self-efficacy and improve trust in health care providers will influence treatment outcomes.
Collapse
Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Disease, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Katherine Michel
- Division of Infectious Disease, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Cuiwei Wang
- Division of Infectious Disease, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mary Ann Dutton
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Kathryn Lee
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Lucile Adams-Campbell
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Katheryn Bell
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | - Allison Doyle
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | | | - Lakshmi Goparaju
- Division of Infectious Disease, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seble Kassaye
- Division of Infectious Disease, Georgetown University Medical Center, Washington, District of Columbia, USA
| |
Collapse
|
14
|
Yigit I, Bayramoglu Y, Weiser SD, Johnson MO, Mugavero MJ, Turan JM, Turan B. Changes in Internalized Stigma and HIV Health Outcomes in Individuals New to HIV Care: The Mediating Roles of Depression and Treatment Self-Efficacy. AIDS Patient Care STDS 2020; 34:491-497. [PMID: 33147084 DOI: 10.1089/apc.2020.0114] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.
Collapse
Affiliation(s)
- Ibrahim Yigit
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yunus Bayramoglu
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, 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
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Mugavero
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 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, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
15
|
Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. Cumulative Effects of Stigma Experiences on Retention in HIV Care Among Men and Women in the Rural Southeastern United States. AIDS Patient Care STDS 2020; 34:484-490. [PMID: 33147086 DOI: 10.1089/apc.2020.0144] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The stigmatization of HIV infection impedes every step along the HIV continuum of care, particularly care engagement and retention. The differential effects of various sources of stigma on retention in HIV care have been the subject of limited research. We examined the accumulation of HIV stigma experiences over 1 year in relationship to treatment retention among 251 men and women marginally engaged in HIV care in the southeastern United States. Results showed that cumulative stigma experiences predicted poorer retention in care, with greater stigma experiences related to less consistency in attending scheduled medical appointments. HIV stigma originating from family members and acts of overt discrimination were the most frequently experienced sources of stigma and were most closely associated with disengagement from HIV care. In addition, analyses by gender indicated that retention in care for men was impacted by stigma to a greater extent than among women. These findings reaffirm the importance of HIV stigma as a barrier to HIV care and provide new directions for interventions to mitigate the negative effects of stigma on patients who are not fully engaged in HIV care. Clinical trials registration NCT104180280.
Collapse
Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
16
|
Modi RA, McGwin GL, Willig JH, Westfall AO, Griffin RL, Amico R, Martin KD, Raper JL, Keruly JC, Golin CE, Zinski A, Napravnik S, Crane HM, Mugavero MJ. Factors Associated with HIV Disclosure Status Among iENGAGE Cohort of New to HIV Care Patients. AIDS Patient Care STDS 2020; 34:213-227. [PMID: 32396474 DOI: 10.1089/apc.2019.0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV disclosure is an important behavior with implications for HIV treatment and prevention but understudied among new to HIV care patients who face unique challenges adjusting to a new diagnosis. This study evaluated the factors associated with HIV disclosure status and patterns of HIV disclosure among new to HIV care patients. A cross-sectional study was conducted evaluating the iENGAGE (integrating ENGagement and Adherence Goals upon Entry) cohort. Participants were enrolled in this randomized behavioral trial between December 2013 and June 2016. The primary and secondary outcomes included HIV disclosure status (Yes/No) and patterns of disclosure (Broad, Selective and Nondisclosure), respectively. Logistic and Multinomial Logistic Regression were used to evaluate the association of participant factors with HIV disclosure and patterns of HIV disclosure, respectively. Of 371 participants, the average age was 37 ± 12 years, 79.3% were males, and 62.3% were African Americans. A majority of participants (78.4%) disclosed their HIV status at baseline, 63.1% were broad disclosers and 15.2% were selective disclosers. In multivariable regression, black race, emotional support, and unmet needs predicted any HIV and broad disclosure, whereas males, emotional support, active coping, and acceptance were associated with selective disclosure. Interventions to promote early disclosure should focus on coping strategies and unmet needs, particularly among black and male people living with HIV initiating care.
Collapse
Affiliation(s)
- Riddhi A. Modi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald L. McGwin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James H. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew O. Westfall
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell L. Griffin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Rivet Amico
- Department of Health Behavior and Education, University of Connecticut, Storrs, Connecticut
| | - Kimberly D. Martin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James L. Raper
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeanne C. Keruly
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carol E. Golin
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne Zinski
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heidi M. Crane
- Department of Medicine, University of Washington, Seattle, Washington
| | - Michael J. Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
17
|
Olatosi B, Weissman S, Zhang J, Chen S, Haider MR, Li X. Neighborhood Matters: Impact on Time Living with Detectable Viral Load for New Adult HIV Diagnoses in South Carolina. AIDS Behav 2020; 24:1266-1274. [PMID: 31754967 PMCID: PMC8114415 DOI: 10.1007/s10461-019-02734-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the association between neighborhood disadvantages and percent person-time spent with increased transmission risk (VL > 1500 copies/ml) for people living with HIV (PLWH) in South Carolina (SC). The study population included PLWH diagnosed between 1/1/2014 and 12/31/2017, with two or more VL tests 6 months apart (n = 2076). Proportion of time living with VL > 1500 copies/ml after linkage to care was determined. Neighborhood disadvantage was assessed using the area deprivation index (ADI). A generalized linear model was fit to generate parameter estimates for time spent with detectable VL. Almost half of PLWH (49.5%) lived with VL > 1500 copies/ml for some time (median days = 46). Young adults and PLWH who injected drugs experienced the highest proportion for time living with detectable VL. Targeted programs are needed to improve VL suppression, reduce new transmissions and decrease disparities in HIV outcomes in all neighborhoods.
Collapse
Affiliation(s)
- Bankole Olatosi
- Department of Health Services Policy and Management, 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.
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|