1
|
Ribeiro PG, Vitori PVR, Dos Santos MCS, Mazzini YC, Dos Santos-Junior GA, Rocha KSS, Torres TS, Araújo DC. Brazilian Version of the Health Care Provider HIV/AIDS Stigma Scale: Cross-Cultural Adaptation and Psychometric Evaluation Among Healthcare Students. AIDS Behav 2024; 28:2216-2225. [PMID: 38676781 DOI: 10.1007/s10461-024-04350-x] [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: 04/12/2024] [Indexed: 04/29/2024]
Abstract
We aimed to validate the Health Care Provider HIV/AIDS Stigma Scale (HPASS) among healthcare students in Brazil. The validation process occurred in three phases from August 2022 to July 2023: translation and cross-cultural adaptation; content validity assessment involving four experts; and evaluation of psychometric properties among 553 healthcare students from the Federal University of Espírito Santo. We used exploratory factor analysis and convergent validity for structural validation. The average scale content validity index was 0.90, while the evaluation of validity evidence based on the internal structure indicated a robust explanatory model. Parallel analysis indicated that the scale is composed by two dimensions: "Discrimination/Prejudice" and "Stereotype"; the composite reliability values for these dimensions were 0.96 and 0.85, respectively. The Brazilian version of HPASS has shown to be a simple, reliable, and psychometrically valid measure to quantify HIV stigma among healthcare students who speak Brazilian Portuguese.Resumen El objetivo de este estudio fue validar la "Health Care Provider HIV/AIDS Stigma Scale" (HPASS) entre estudiantes de salud en Brasil. El proceso de validación se llevó a cabo en tres etapas: traducción y adaptación transcultural; evaluación de la validez de contenido; y evaluación de las propiedades psicométricas con estudiantes de salud de la Universidad Federal de Espírito Santo. El índice de validez de contenido promedio de la escala fue de 0.90, mientras que la evaluación de la evidencia de validez basada en la estructura interna indicó un modelo explicativo sólido. El análisis paralelo indicó que la escala está compuesta por dos dimensiones: "Discriminación/Prejuicio" y "Estereotipo". La versión brasileña de HPASS ha demostrado ser una medida simple, confiable y psicométricamente válida para cuantificar el estigma del VIH entre estudiantes de salud que hablan portugués brasileño.
Collapse
Affiliation(s)
- Paula Gonçalves Ribeiro
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Paulo Vitor Ramos Vitori
- Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | | | - Yohan Cancilheri Mazzini
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Genival Araujo Dos Santos-Junior
- Graduate Program in Pharmaceutical Sciences, Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Espírito Santo, ES, Alegre, Brazil
| | - Kérilin Stancine Santos Rocha
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil
| | - Thiago Silva Torres
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Dyego Carlos Araújo
- Graduate Program in Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil.
| |
Collapse
|
2
|
Jaimes YAP, Lozada-Martínez ID, Tosàs MR, Tiraboschi J. Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review. LE INFEZIONI IN MEDICINA 2024; 32:168-182. [PMID: 38827831 PMCID: PMC11142417 DOI: 10.53854/liim-3202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
The aim of the present study was to explore the stigma and fear of getting sick in health professionals who treat people living with HIV. An exploratory systematic review was conducted. The search was limited to the presence of stigma and fear of getting sick on the part of healthcare workers who treat people living with HIV, documented by the health workers or patients themselves. No language restriction was made and systematic reviews, comments or communications were excluded. The sources of information were Scopus, PubMed/MEDLINE, Science Direct, and the CENTRAL Registry, from the last 5 years. The quality of the evidence was assessed with an adapted tool and the synthesis of the results was carried out using a narrative synthesis approach. Twenty-three articles were included, which related structural stigma, stigma by health professionals and fear of getting sick. Among the findings, data stood out such as that more than 50% of patients reported having experienced discrimination due to HIV and even accumulated stigma for other additional causes. Stigma enacted in healthcare settings was related to suboptimal adherence to treatment (OR 1.38; 95% CI: 1.03-1.84; p=0.028). Stigma is a structural barrier in the care of people living with HIV and generates a psychological, physical, and social health impact for these people. Some limitations of the present study are that, despite searching the major databases, important manuscripts may have been left out. Additionally, there are regions that are not represented in this review because no manuscripts from those areas were found.
Collapse
Affiliation(s)
| | | | - Mar Rosàs Tosàs
- Blanquerna-Faculty of Health Sciences- Ramon Llull University, Barcelona, Spain
| | - Juan Tiraboschi
- Infectious Diseases Service-Bellvitge-IDIBELL-University Hospital-University of Barcelona. Hospitalet de Llobregat, Spain
| |
Collapse
|
3
|
Prikhodkina M, Melnikov S. Factors that influence medication adherence in women with fibromyalgia: A path analysis. J Clin Nurs 2024. [PMID: 38284436 DOI: 10.1111/jocn.17044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
AIMS To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient-provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections. BACKGROUND Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient-provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear. DESIGN A cross-sectional, correlational study. METHODS The STROBE guidelines for cross-sectional studies were followed. Participants included Hebrew-speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia- Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire-9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient-provider communication, and used the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations between the variables were explored using Pearson's correlations and path analyses. RESULTS The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)-low, 33.3% (N = 47)-medium and 13.5% (N = 19)-high. Depression positively correlated with stigma. Stigma negatively correlated with patient-provider communication. Patient-provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient-provider communication was found. CONCLUSIONS Perceived stigma and patient-provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE Addressing stigma related to fibromyalgia and effective patient-provider communication can positively influence treatment adherence. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Maria Prikhodkina
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Schweitzer AM, Dišković A, Krongauz V, Newman J, Tomažič J, Yancheva N. Addressing HIV stigma in healthcare, community, and legislative settings in Central and Eastern Europe. AIDS Res Ther 2023; 20:87. [PMID: 38082352 PMCID: PMC10714556 DOI: 10.1186/s12981-023-00585-1] [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: 08/08/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Surging HIV prevalence across countries of Central and Eastern Europe (CEE) is largely a result of poor HIV care engagement and a lack of comprehensive support for key populations. This is fostered by widespread stigma across healthcare, community, and legislative settings. DISCUSSION Throughout CEE, HIV stigma and intersectional stigma are serious obstacles to providing adequate medical care to people living with HIV. Anticipated and enacted (experienced) stigma from healthcare professionals, and fears of breaches in confidentiality, deter individuals from having an HIV test and engaging in HIV care. Furthermore, negative connotations surrounding HIV infection can lead to discrimination from family, friends, colleagues, and the public, leading to internalized stigma and depression. Key populations that have higher HIV prevalence, such as men who have sex with men, people who inject drugs, transgender individuals, and sex workers, experience additional stigma and discrimination based on their behaviour and identities. This contributes to the concentrated HIV epidemics seen in these populations in many CEE countries. The stigma is exacerbated by punitive legislation that criminalizes HIV transmission and penalizes sexual orientation, drug use, gender identities, and sex work. Despite high levels of HIV stigma and intersectional stigma, there are many evidence-based interventions that have reduced stigma in other parts of the world. Here, we discuss the interventions that are currently being enacted in various countries of CEE, and we suggest additional effective, evidence-based interventions that will tackle stigma and lead to increased HIV care engagement and higher rates of viral suppression. We cover the promotion of the undetectable = untransmittable (U = U) message, stigma-reduction education and training for healthcare professionals, patient-centric approaches for testing and treatment, and advocacy for non-discriminatory legislation, policies, and practices. We also consider targeted stigma-reduction interventions that acknowledge the wider challenges faced by marginalized populations. CONCLUSIONS HIV stigma and intersectional stigma in CEE drive poor engagement with HIV testing services and care. Widespread adoption of evidence-based interventions to tackle stigma highlighted in this review will improve the quality of life of people living with HIV, improve HIV care engagement, and ultimately slow the surging HIV prevalence and concentrated epidemics occurring throughout CEE.
Collapse
Affiliation(s)
| | - Arian Dišković
- Croatian Association for HIV and Viral Hepatitis (HUHIV), Zagreb, Croatia
| | - Veronica Krongauz
- European Distributor Markets, Medical Department, Gilead Sciences, Uxbridge, UK
| | - Julie Newman
- HIV Strategic Implementation & Franchise, Global Medical Affairs, Gilead Sciences, Melbourne, Australia
| | - Janez Tomažič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria
- Department for Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| |
Collapse
|
5
|
Ohtsuka MS, Shannon K, Krüsi A, Lee M, King D, Braschel M, Deering K. Prevalence and Correlates of HIV Disclosure Without Consent Among Women Living With HIV in Metro Vancouver, Canada. AIDS Patient Care STDS 2023; 37:351-360. [PMID: 37432310 PMCID: PMC10354302 DOI: 10.1089/apc.2023.0018] [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: 07/12/2023] Open
Abstract
This study identified the prevalence and perpetrators of HIV disclosure without consent, and social-structural correlates, among women living with HIV (WLWH). Data were drawn from 7 years (September 14 to August 21) of a longitudinal community-based open cohort of cis and trans WLWH living and/or accessing care in Metro Vancouver, Canada. The study sample included 1871 observations among 299 participants. Overall, 160 (53.3%) women reported lifetime HIV disclosure without consent at baseline, and 115 (38.5%) reported HIV disclosure without consent in the previous 6 months during 7 years of follow-up. In a subanalysis (n = 98), the most common perpetrators of HIV disclosure without consent were friends, people in the community, family, health professionals, and neighbors. In multivariable logistic regression analysis with generalized estimating equations, recent (last 6 months) housing insecurity [adjusted odds ratio (AOR): 1.43, 95% confidence interval: (1.10-1.86)], minoritized sexual identities (LGBQ2S) [AOR: 1.84 (1.22-2.78)], recently being treated, monitored, or diagnosed with depression, anxiety, or post-traumatic stress disorder [AOR: 1.37 (0.98-1.92)], and experiencing physical symptoms related to HIV [AOR: 1.75 (1.25-2.44)] was positively associated with recent disclosure without consent. In a context where HIV nondisclosure before sex is criminalized unless viral load is low and a condom is used, it is concerning that a large proportion of women have experienced HIV disclosure without consent. Laws should focus on protecting rights of WLWH, promoting equity, guaranteeing sexual and reproductive rights, and ensuring access to essential services and privacy. Findings highlight the need for trauma-informed approaches among health and housing services that are responsive to intersections of violence and stigma, and include a focus on confidentiality, autonomy, and safe disclosure practices.
Collapse
Affiliation(s)
- Mika S. Ohtsuka
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Melanie Lee
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Desire King
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | | | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
6
|
Trepka MJ, Ward MK, Fennie K, Sheehan DM, Fernandez SB, Li T, Jean-Gilles M, Dévieux JG, Ibañez GE, Gwanzura T, Nawfal E, Gray A, Beach MC, Ladner R. Patient-Provider Relationships and Antiretroviral Therapy Adherence and Durable Viral Suppression Among Women with HIV, Miami-Dade County, Florida, 2021-2022. AIDS Patient Care STDS 2023; 37:361-372. [PMID: 37432309 PMCID: PMC10354312 DOI: 10.1089/apc.2023.0029] [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: 07/12/2023] Open
Abstract
Women with HIV in the United States are more negatively affected by adverse social determinants such as low education and poverty than men, and thus, especially need a supportive health care system. This cross-sectional study assessed the role of the patient-provider relationship on antiretroviral therapy (ART) adherence and durable viral suppression among women with HIV (WHIV) in Miami-Dade County, Florida. Patient-provider relationship was measured, in part, using the Health Care Relationship Trust Scale and Consumer Assessment of Health Care Providers and Systems. The survey was administered by telephone to women in the Ryan White Program June 2021-March 2022. Adherence was defined as 90% adherent on the average of three self-reported items. Lack of durable viral suppression was defined by at least one viral load ≥200 copies/mL among all tests conducted in a year. Logistic regression models were generated using backward stepwise modeling. Of 560 cis-gender women, 401 (71.6%) were adherent, and 450 (80.4%) had durable viral suppression. In the regression model, adherence was associated with higher patient-provider trust and provider communication as well as excellent perceived health, lack of significant depressive symptoms, no alcohol use within the last 30 days, and lack of transportation problems. In the regression model using provider as a random effect, durable viral suppression was associated with older age, Hispanic ethnicity, and lack of illegal drug use. While the results show that a strong patient-provider relationship facilitates ART adherence in WHIV, there was no association with durable viral suppression.
Collapse
Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Melissa K. Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | | | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Sofia Beatriz Fernandez
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Jessy G. Dévieux
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Ekpereka Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert Ladner
- Behavioral Science Research Corp., Coral Gables, Florida, USA
| |
Collapse
|
7
|
Ham L, Montoya JL, Serrano V, Yeager S, Paltin D, Pasipanodya EC, Marquine MJ, Hoenigl M, Ramers CB, Kua J, Moore DJ. High Psychosocial Burden Relates to Poorer Antiretroviral Treatment Adherence Among Black/African American People with HIV. AIDS Patient Care STDS 2023; 37:103-113. [PMID: 36689195 PMCID: PMC9963477 DOI: 10.1089/apc.2022.0180] [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: 01/24/2023] Open
Abstract
Black/African American communities continue to be disproportionately impacted by HIV with Black people with HIV (PWH) exhibiting poorer outcomes along the HIV treatment cascade. Psychosocial burden may, in part, explain these health disparities among PWH. We implemented a culturally adapted intervention [individualized Texting for Adherence Building (iTAB)] to improve ART adherence among 89 Black PWH in San Diego, CA. We aimed to (1) characterize psychosocial risk factors (depression, negative life events, discrimination, medical mistrust) hypothesized to be barriers to HIV outcomes among Black PWH and (2) determine if these factors influence intervention engagement, HIV outcomes, and self-reported physical and mental health. We identified three levels of psychosocial burden (low, moderate, high) through hierarchical cluster analysis. Participants in the high burden cluster (n = 25) experienced the highest levels of depression, negative life events, and discrimination, in addition to the poorest intervention outcomes, HIV outcomes, and physical and mental health compared to low and moderate burden clusters. Participants in the low (n = 29) burden cluster had less medical mistrust than the moderate (n = 34) and high burden clusters, but low and moderate clusters did not differ on any outcomes. Overall, self-reported ART adherence was 83%, which is above estimates of ART adherence in the Western region of the United States. The iTAB intervention shows promise in improving HIV-related outcomes among Black PWH with low to moderate psychosocial burden; however, additional supports may need to be identified for those with high psychosocial burden.
Collapse
Affiliation(s)
- Lillian Ham
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Jessica L. Montoya
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
| | - Vanessa Serrano
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Samantha Yeager
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Dafna Paltin
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | | | - Maria J. Marquine
- Geriatrics Division, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Medical University of Graz, Graz, Austria
| | - Christian B. Ramers
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - John Kua
- Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA
- Department of Psychiatry and University of California San Diego, La Jolla, California, USA
| |
Collapse
|
8
|
Turan B, Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Brown-Friday J, Gange S, Kassaye S, Pence BW, Turan JM. Resilience and Optimism as Moderators of the Negative Effects of Stigma on Women Living with HIV. AIDS Patient Care STDS 2022; 36:474-482. [PMID: 36484762 PMCID: PMC9805859 DOI: 10.1089/apc.2022.0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Resilience and optimism may not only have main effects on health outcomes, but may also moderate and buffer negative effects of stressors. We examined whether dispositional resilience and optimism moderate the associations between HIV-related stigma in health care settings and health-related outcomes (trust in HIV health care providers and depression symptoms) among women living with HIV (WLHIV). One thousand four hundred five WLHIV in nine US cities completed validated questionnaires for cross-sectional analyses. Higher self-reported experienced and anticipated stigma and lower resilience and optimism were associated with higher depression symptoms and with lower trust in HIV providers. Importantly, resilience moderated the effects of experienced stigma (but not of anticipated stigma): When resilience was high, the association of experienced stigma with higher depression symptoms and lower trust in HIV providers was weaker compared with when resilience was low. Further, significant moderation effects suggested that when optimism was high, experienced and anticipated stigma was both less strongly associated with depression symptoms and with lower trust in one's HIV care providers compared with when optimism was low. Thus, the effects of experienced stigma on depression symptoms and provider trust were moderated by both resilience and optimism, but the effects of anticipated stigma were moderated only by optimism. Our findings suggest that in addition to their main effects, resilience and optimism may function as buffers against the harmful effects of stigma in health care settings. Therefore, optimism and resilience may be valuable intervention targets to reduce depression symptoms or improve trust in providers among populations that experience or anticipate stigma, such as WLHIV.
Collapse
Affiliation(s)
- Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Henna Budhwani
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, TED University, Ankara, Turkey
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Deborah J. Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center (UMMC), Jackson, Mississippi, USA
| | | | - Gina M. Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adaora A. Adimora
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N. Taylor
- College of Medicine, Division of Infectious Disease, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Janet Brown-Friday
- Albert Einstein College of Medicine-Montefiore Medical Center, New York, New York, USA
| | - Stephen Gange
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Seble Kassaye
- Department of Medicine/Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Brian W. Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janet M. Turan
- Health Care Organization & Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
- School of Medicine, Department of Pubic Health, Koc University, Istanbul, Turkey
| |
Collapse
|
9
|
Boga DJ, Dale SK. Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health. AIDS Patient Care STDS 2022; 36:364-374. [PMID: 36040393 PMCID: PMC9514596 DOI: 10.1089/apc.2022.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing. Clinical Trial Registration number NCT02764853.
Collapse
Affiliation(s)
- Devina J. Boga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sannisha K. Dale
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida, USA
| |
Collapse
|
10
|
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: 4] [Impact Index Per Article: 2.0] [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
|
11
|
Leung T, Kiszla BM, Outlaw AY, Oster RA, Mugavero MJ, Johnson MO, Hightow-Weidman LB, Naar S, Turan JM. Adapting a Motivational Interviewing Intervention to Improve HIV Prevention Among Young, Black, Sexual Minority Men in Alabama: Protocol for the Development of the Kings Digital Health Intervention. JMIR Res Protoc 2022; 11:e36655. [PMID: 35830245 PMCID: PMC9330190 DOI: 10.2196/36655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/15/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND African American or Black young men who have sex with men (BYMSM) are at a disproportionate risk for contracting HIV and have high rates of undiagnosed, and therefore untreated, HIV infection. In the southern United States, BYMSM face region-specific hurdles to HIV prevention, such as limited access to care and high levels of racism and intersectional stigma, necessitating HIV testing and pre-exposure prophylaxis interventions that address sociocultural and structural barriers while motivating BYMSM to engage in prevention. Brothers Saving Brothers (BSB) is a motivational interviewing behavioral intervention that successfully and simultaneously increased community-based HIV testing and prevention counseling and education among BYMSM in the midwestern United States. OBJECTIVE The aim of this protocol is to detail the process for the adaption of the BSB intervention for midwestern BYMSM to the Kings intervention for southern BYMSM. During the adaptation process, the intervention will be modernized to include rapid HIV testing, as opposed to HIV testing that requires BYMSM to return for test results, pre-exposure prophylaxis, and the provision of structural supports, and for relevance in the southern United States. METHODS Aim 1 is to gather qualitative data through focus groups and in-depth interviews with BYMSM aged 18 to 29 years in Alabama and in-depth interviews with prevention and outreach workers who routinely work with BYMSM in Alabama. NVivo qualitative software (QSR International) will be used for the coding and analysis of the transcripts via a thematic analysis approach. For aim 2, intervention mapping will guide the adaptation process, intervention content, components, and design. Both aims 1 and 2 will leverage the Exploration, Preparation, Implementation, Sustainment implementation science framework, with emphasis on the exploration and preparation phases of this model. By applying these frameworks, the original midwestern BSB intervention will be scientifically adapted to the southern BYMSM Kings intervention. RESULTS This study is ongoing as of 2022 and is expected to conclude in 2024, with aims 1 and 2 being completed in 2023. Qualitative data will offer insight into the current real-world experiences and preferences of BYMSM in Alabama. Feedback will be collected through the adaptation process to inform intervention refinement. Institutional review board approvals have been received. CONCLUSIONS The findings will inform next steps, that is, testing the Kings intervention for feasibility, acceptability, and preliminary effectiveness in a pilot hybrid type 1 effective-implementation randomized controlled trial. The study results will provide insights about important considerations for HIV prevention among BYMSM in the southern United States. TRIAL REGISTRATION ClinicalTrials.gov NCT03680729; https://clinicaltrials.gov/ct2/show/NCT03680729. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36655.
Collapse
Affiliation(s)
| | - B Matthew Kiszla
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Robert A Oster
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael J Mugavero
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mallory O Johnson
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | | | - Sylvie Naar
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
12
|
Massaroni V, Delle Donne V, Borghetti A, Ciccullo A, Lombardi F, Giuliano G, Farinacci D, Visconti E, Tamburrini E, Di Giambenedetto S. Use of Long-Acting Therapies for HIV Care in Italy: Are People Living with HIV Prepared for Change? A Cross-Sectional Study. AIDS Patient Care STDS 2022; 36:178-185. [PMID: 35507326 DOI: 10.1089/apc.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two hundred two people living with HIV (PLWH) selected from outpatients at the Infectious Disease Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS, in Rome (Italy) were consecutively enrolled from May to July 2021. We used an anonymous telephone questionnaire to investigate opinions of PLWH about combined antiretroviral (ARV) therapy and long-acting (LA) formulations of ARVs. All invited participants completed the questionnaire (100%). We found that most PLWH evaluated taking HIV pills for the rest of their life as a continuous, but undemanding commitment (61.4%; n = 124), although they were willing to stop the daily intake of HIV drugs (78.2%, n = 158). Moreover, most PLWH were unaware of the existence of LA therapies at the time of the investigation (60.4%, n = 122). Almost half the PLWH evaluated the need for injections in the hospital as an obstacle (51.4%, n = 104). Regarding the preference between monthly injections and taking pills everyday, most PLWH (68.8%, n = 139) stated that the injection was more advantageous than pills even if they had some pain/swelling at the injection site. The concern about LA therapy indicated most by PLWH was the possible lower efficacy of the drug (83.7%, n = 169). Regarding the possible benefits of LA therapy, those reported most by PLWH were feeling freer because they did not have to remember to take pills everyday (68,8%, n = 139). In conclusion, to date, PLWH in our cohort seem willing to accept LA therapy, but still show some concern about the efficacy of the new therapy and the obligation to come to the hospital to receive it. Thus, clinicians must take into account the needs of their patients and help them overcome their concerns to facilitate the transition to this new therapeutic modality. Clinical Trial Registration Number ID: 2424.
Collapse
Affiliation(s)
- Valentina Massaroni
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Delle Donne
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale San Salvatore, L'Aquila, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Giuliano
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Farinacci
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Tamburrini
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
13
|
Rayanakorn A, Ong-artborirak P, Ademi Z, Chariyalertsak S. Predictors of Stigma and Health-Related Quality of Life Among People Living with HIV in Northern Thailand. AIDS Patient Care STDS 2022; 36:186-193. [PMID: 35507323 PMCID: PMC9125577 DOI: 10.1089/apc.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-related stigma and discrimination have been a significant barrier to accessing health care, hence contributing to poor health outcomes. This study aimed to investigate factors associated with HIV-related stigma and discrimination and health-related quality of life (HRQoL) among people living with HIV in rural Thailand setting. A cross-sectional convenience sample of 161 HIV-positive Thai patients was recruited from a single rural district hospital using a self-administered questionnaire entailing sociodemographic information, the 12-item stigma scale, the Medical Outcomes Study HIV Health Survey (MOS-HIV), and the EuroQoL 5-Dimension 5-Level (EQ-5D-5L). Linear regression and the multi-variable analyses were used to investigate factors associated with stigma and HRQoL, whereas the correlations between stigma and quality of life variables were tested by Pearson correlations. Being married and duration of antiretroviral therapy were negatively correlated with HIV stigma, while increased age was inversely associated with HRQoL. Being employed and having sufficient money for living contributed positively to predict HRQoL. HIV stigma was negatively associated with mental health summary (MHS) and visual analog scale (VAS) score, whereas duration diagnosed with HIV and the use of two nucleoside reverse transcriptase inhibitors in combination with protease inhibitor regimen were negative factors associated with VAS and health utility, respectively. The findings confirm complex and inseparable associations of factors relating to HIV-related stigma and HRQoL. The development of effective interventions tailored at individual level is warranted to address this gap.
Collapse
Affiliation(s)
- Ajaree Rayanakorn
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai, Thailand
| | - Parichat Ong-artborirak
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
- Epidemiology Research Group of Infectious Disease (ERGID), Chiang Mai University, Chiang Mai, Thailand
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | |
Collapse
|
14
|
Rose C, Díaz M, Díaz T. Addressing Medicine’s Dark Matter (Preprint). Interact J Med Res 2022; 11:e37584. [PMID: 35976194 PMCID: PMC9434397 DOI: 10.2196/37584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian Rose
- Department of Emergency Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Mark Díaz
- Ethical AI, Google, New York, NY, United States
| | - Tomás Díaz
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, United States
| |
Collapse
|