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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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Charatcharoenwitthaya P, Liangpunsakul S, Piratvisuth T. Alcohol-Associated Liver Disease: East Versus West. Clin Liver Dis (Hoboken) 2020; 16:231-235. [PMID: 33489093 PMCID: PMC7805304 DOI: 10.1002/cld.920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/12/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Suthat Liangpunsakul
- Division of Gastroenterology and HepatologyDepartment of MedicineIndiana University School of MedicineIndianapolisIN
- Roudebush Veterans Administration Medical CenterIndianapolisIN
| | - Teerha Piratvisuth
- Division of Gastroenterology and HepatologyDepartment of MedicineFaculty of MedicinePrince of Songkla UniversitySongkhlaThailand
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Perry KE, Dubé K, Concha-Garcia S, Patel H, Kaytes A, Taylor J, Javadi SS, Mathur K, Lo M, Brown B, Sauceda JA, Wohl DA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. "My Death Will Not [Be] in Vain": Testimonials from Last Gift Rapid Research Autopsy Study Participants Living with HIV at the End of Life. AIDS Res Hum Retroviruses 2020; 36:1071-1082. [PMID: 32449625 PMCID: PMC7703253 DOI: 10.1089/aid.2020.0020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
End-of-life (EOL) HIV cure-related research provides a novel approach to studying HIV reservoirs. The Last Gift is a rapid autopsy research study at the University of California San Diego that enrolls terminally ill people living with HIV (PLWHIV) with a desire to contribute to HIV cure-related research. We conducted in-depth baseline and follow-up interviews with Last Gift study participants. We analyzed interview data applying conventional content analysis. Since summer 2017, 13 participants have been enrolled (n = 11 males and 2 females; aged 45-89 years) and 8 participants interviewed. Terminal illnesses included cancers, heart diseases, and neurodegenerative illnesses. Our analysis revealed five key themes: (1) The Last Gift study has tremendous meaning for participants at the end of their life. (2) HIV-specific altruism was a primary motivator to join the Last Gift study, nested within the context of community, scientific advancement, and moral obligation. (3) Participants did not expect physical benefits yet they perceived emotional/psychological, financial, and societal/scientific benefits. (4) There were minimal participant-perceived risks and concerns. (5) Last Gift participants expressed immense gratitude toward study staff. The Last Gift study provides a framework for ethical HIV cure-related research at EOL and highlighted participants' perspectives, motivations, and experiences. Knowing how PLWHIV understand and experience such studies will remain critical to designing ethical, fully informed HIV cure research protocols that are acceptable to PLWHIV.
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Affiliation(s)
- Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susanna Concha-Garcia
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andy Kaytes
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
| | - Jeff Taylor
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Sogol Stephanie Javadi
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Kushagra Mathur
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Megan Lo
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - David A. Wohl
- Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Little
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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Navigating Life with HIV as an Older Adult in South African Communities: A Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165797. [PMID: 32796518 PMCID: PMC7460377 DOI: 10.3390/ijerph17165797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Abstract
The study explored how older adults experience an HIV diagnosis, deal with issues of stigma and disclosure, and navigate the healthcare system. Descriptive phenomenology was used to collect data from 20 older adults receiving antiretroviral treatment in health facilities in Gauteng Province, South Africa. Data analysis was inductive and followed the thematic approach. After diagnosis with HIV, the older adults experienced shock and disbelief, internalized their new reality of being HIV-positive, and found it difficult to disclose their HIV status. Stigma was embedded in their patterns of disclosure, and they chose not to disclose in order to manage stigma, protect their status, and maintain their privacy. Moreover, nondisclosure allowed them to achieve some normality in their lives without the fear of rejection. The older adults adopted various survival skills that aided them to accept their HIV status. Self-acceptance was important for the older adults who did not want to feel cheated out of life by the HIV diagnosis. The positive supportive attitudes of the healthcare professionals provided the much-needed support network for the older adults immediately after they had received their HIV test results. This was instrumental in their acceptance of their HIV status, their adherence to clinic visits, and their ability to live a healthy, positive life.
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Eduardo E, Lamb MR, Kandula S, Howard A, Mugisha V, Kimanga D, Kilama B, El-Sadr W, Elul B. Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries. PLoS One 2014; 9:e103864. [PMID: 25075743 PMCID: PMC4116238 DOI: 10.1371/journal.pone.0103864] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/03/2014] [Indexed: 12/04/2022] Open
Abstract
Background Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa. Methodology Using routinely-collected longitudinal patient-level data among 391,111 adults ≥15 years enrolling in HIV care from January 2005–December 2010 and 184,689 initiating ART, we compared characteristics and outcomes between older (≥50 years) and younger adults at 199 clinics in Kenya, Mozambique, Rwanda, and Tanzania. We calculated proportions over time of newly enrolled and active adults receiving HIV care and initiating ART who were ≥50 years; cumulative incidence of loss to follow-up (LTF) and recorded death one year after enrollment and ART initiation, and CD4+ response following ART initiation. Findings From 2005–2010, the percentage of adults ≥50 years newly enrolled in HIV care remained stable at 10%, while the percentage of adults ≥50 years newly initiating ART (10% [2005]-12% [2010]), active in follow-up (10% [2005]-14% (2010]), and active on ART (10% [2005]-16% [2010]) significantly increased. One year after enrollment, older patients had significantly lower incidence of LTF (33.1% vs. 32.6%[40–49 years], 40.5%[25–39 years], and 56.3%[15–24 years]; p-value<0.0001), but significantly higher incidence of recorded death (6.0% vs. 5.0% [40–49 years], 4.1% [25–39 years], and 2.8% [15–24 years]; p-valve<0.0001). LTF was lower after vs. before ART initiation for all ages, with older adults experiencing less LTF than younger adults. Among 85,763 ART patients with baseline and follow-up CD4+ counts, adjusted average 12-month CD4+ response for older adults was 20.6 cells/mm3 lower than for adults 25–39 years of age (95% CI: 17.1–24.1). Conclusions The proportion of patients who are ≥50 years has increased over time and been driven by aging of the existing patient population. Older patients experienced less LTF, higher recorded mortality and less robust CD4+ response after ART initiation. Increased programmatic attention on older adults receiving HIV care in sub-Saharan Africa is warranted.
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Affiliation(s)
- Eduard Eduardo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Matthew R Lamb
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sasi Kandula
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Andrea Howard
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Veronicah Mugisha
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Davies Kimanga
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Bonita Kilama
- National AIDS Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Wafaa El-Sadr
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Siemon JS, Blenkhorn L, Wilkins S, O’Brien KK, Solomon PE. A grounded theory of social participation among older women living with HIV / Une théorie ancrée pour analyser la participation sociale chez les femmes âgées atteintes du VIH. The Canadian Journal of Occupational Therapy 2013; 80:241-50. [DOI: 10.1177/0008417413501153] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. As adults age with human immunodeficiency virus (HIV), the role for rehabilitation continues to emerge. Understanding how social participation is affected among women aging with HIV can inform occupational therapy assessment and treatment. Purpose. Our purpose was to develop a theoretical model that describes the experiences of social participation from the perspective of older women living with HIV. Method. A grounded theory methodological approach was utilized. We conducted interviews with 20 women living with HIV, age 50 or older, to explore various aspects of social participation, including self-care, relationships with others, and access to health and social services. Emergent themes informed the theoretical model. Findings. The theoretical model comprises four concepts related to social participation: social engagement, social isolation, contrasting perceptions about factors variably influencing participation, and contextual influences that may enhance or hinder social participation. Implications. Women aging with HIV experience social participation as a dynamic process involving social engagement and isolation. Contextual influences may promote and impede social participation.
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Orchi N, Balzano R, Scognamiglio P, Navarra A, De Carli G, Elia P, Grisetti S, Sampaolesi A, Giuliani M, De Filippis A, Puro V, Ippolito G, Girardi E. Ageing with HIV: newly diagnosed older adults in Italy. AIDS Care 2008; 20:419-25. [PMID: 18449818 DOI: 10.1080/09540120701867073] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of HIV/AIDS among people in midlife and late adulthood has been increasing in Western countries over the last decade. We analyzed data from a prospective, observational multi-centre study on individuals newly diagnosed with HIV between January 2004 and March 2007 in 10 public counselling and testing sites in Latium, Italy. At diagnosis, routine demographic, epidemiological, clinical and laboratory data are recorded, and patients are asked to complete a questionnaire investigating socio-demographic and psycho-behavioural aspects. To analyze the association of individual characteristics with age, we compared older adults (> or = 50 years) with their younger counterpart (18-49 years). To adjust for potential confounding effect of the epidemiological, clinical and behavioural characteristics, to identify factors associated with older age at HIV diagnosis, multivariate logistic regression analysis was performed. Overall, 1073 individuals were identified, 125 of whom (11.6%) were aged 50 years or above. The questionnaire was completed by 41% (440/1073). Compared with their younger counterparts, a higher proportion of older patients were males, born in Italy, reported heterosexual or unknown HIV risk exposure, were never tested for HIV before and were in a more advanced stage of HIV infection at diagnosis. In addition, older adults had a lower educational level and were more frequently living with their partners or children. With respect to psycho-behavioural characteristics, older patients were more likely to have paid money for sex and have never used recreational drugs. Interestingly, no differences were found regarding condom use, which was poor in both age groups. These findings may have important implications for the management of older adults with HIV, who should be targeted by appropriate public health actions, such as opportunistic screening and easier access to healthcare. Moreover, strategies including information on HIV and prevention of risk behaviours are needed.
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Affiliation(s)
- N Orchi
- Istituto Nazionale per le Malattie Infettive, L. Spallanzani IRCCS, Rome, Italy
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Cooperman NA, Arnsten JH, Klein RS. Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2007; 19:321-33. [PMID: 17685845 PMCID: PMC2505189 DOI: 10.1521/aeap.2007.19.4.321] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.
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Affiliation(s)
- Nina A Cooperman
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
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Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, Garske J. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med 2006; 32:27-38. [PMID: 16827627 DOI: 10.1207/s15324796abm3201_4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older. PURPOSE This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS. METHOD This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness. RESULTS Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, life-stressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression. CONCLUSIONS Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed.
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Plach SK, Stevens PE, Keigher S. Self-care of women growing older with HIV and/or AIDS. West J Nurs Res 2005; 27:534-53; comment 554-8. [PMID: 16020565 DOI: 10.1177/0193945905275973] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this report is to describe the ways older women living with HIV perceive of and practice self-care. Data are taken from a culturally diverse subsample of 9 women age 50 years or older who participated in a larger longitudinal qualitative study of women who were HIV infected. During a period of 2 years, 10 semistructured narrative interviews were conducted with each of the 9 participants to gain an in-depth understanding of their experiences with symptom management, adherence to medical regimens, reduction of HIV risk, access to health care and social services, and personal efforts to maintain their health. Transcribed data were managed using Nvivo software and analyzed using multistaged narrative analysis. Findings suggest that mature women living with HIV integrate actions to maintain bodily comfort and improve physical well-being with actions that champion and conserve the existential self. Excerpts from their interviews illustrate this dialectical understanding of self-care.
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Affiliation(s)
- Sandra K Plach
- University of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA.
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2003; 18:1149-56. [PMID: 14870737 DOI: 10.1002/gps.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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