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Huertas-Zurriaga A, Alonso-Fernández S, Leyva-Moral JM. Reproductive Decision Making of Spanish Women Living With HIV: A Constructivist Grounded Theory Study. J Assoc Nurses AIDS Care 2024; 35:201-209. [PMID: 38417079 DOI: 10.1097/jnc.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
ABSTRACT The process of reproductive decision making among women living with HIV is intricate and multifaceted, influenced by health considerations, societal factors, and personal values. In this study, we employed Charmaz's Constructivist Grounded Theory to understand how Spanish women living with HIV make decisions regarding reproduction. We conducted 26 face-to-face interviews until data saturation was achieved. Findings suggested that social constructs such as femininity and motherhood play a significant role in the reproductive decision-making process for women living with HIV. The women's beliefs about HIV, doubts, marginalizing situations, and health barriers create challenges to making reproductive decisions. These findings provide valuable implications for designing care plans that meet the unique sexual and reproductive health needs of women with HIV. An integrated and comprehensive multidisciplinary counseling approach is necessary to improve the quality of care.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Ariadna Huertas-Zurriaga, PhD, MSc, RN, is an adjunct professor, Nursing Department-Faculty of Medicine, Universitat Autonoma de Barcelona, Spain and is a registered nurse at Hospital Germans Trias i Pujol, Badalona, Spain
- Sergio Alonso-Fernandez, PhD, MSc, RN, is a registered nurse at the Hospital Germans Trias i Pujol, Badalona, Spain and is a researcher at the GRIN Research Group, IDIBELL, Bellvitge Biomedical Research Institute, L'Hospitalet, Spain
- Juan M. Leyva-Moral, PhD, MSc, BSN, CHNS, BSN, is an Associate Professor and Coordinator of the Nursing Research Group in Vulnerability and Health-GRIVIS, Nursing Department-Faculty of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Sergio Alonso-Fernández
- Ariadna Huertas-Zurriaga, PhD, MSc, RN, is an adjunct professor, Nursing Department-Faculty of Medicine, Universitat Autonoma de Barcelona, Spain and is a registered nurse at Hospital Germans Trias i Pujol, Badalona, Spain
- Sergio Alonso-Fernandez, PhD, MSc, RN, is a registered nurse at the Hospital Germans Trias i Pujol, Badalona, Spain and is a researcher at the GRIN Research Group, IDIBELL, Bellvitge Biomedical Research Institute, L'Hospitalet, Spain
- Juan M. Leyva-Moral, PhD, MSc, BSN, CHNS, BSN, is an Associate Professor and Coordinator of the Nursing Research Group in Vulnerability and Health-GRIVIS, Nursing Department-Faculty of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Juan M Leyva-Moral
- Ariadna Huertas-Zurriaga, PhD, MSc, RN, is an adjunct professor, Nursing Department-Faculty of Medicine, Universitat Autonoma de Barcelona, Spain and is a registered nurse at Hospital Germans Trias i Pujol, Badalona, Spain
- Sergio Alonso-Fernandez, PhD, MSc, RN, is a registered nurse at the Hospital Germans Trias i Pujol, Badalona, Spain and is a researcher at the GRIN Research Group, IDIBELL, Bellvitge Biomedical Research Institute, L'Hospitalet, Spain
- Juan M. Leyva-Moral, PhD, MSc, BSN, CHNS, BSN, is an Associate Professor and Coordinator of the Nursing Research Group in Vulnerability and Health-GRIVIS, Nursing Department-Faculty of Medicine, Universitat Autònoma de Barcelona, Spain
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Avallone F, Engler K, Cox J, Hickson F, Lebouché B. Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review. AIDS Behav 2024; 28:450-472. [PMID: 38296920 DOI: 10.1007/s10461-023-04237-3] [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: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.
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Affiliation(s)
- Francesco Avallone
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ford Hickson
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, QC, Canada.
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Leyva-Moral JM, Castro Ávila J, Villar M, López B, Adell H, Meroño M, Santander K, Ferrer L, Mesías-Gazmuri J, Astudillo Alonso R, Rojas Castro D, Casabona J, Folch C. Impact of the COVID-19 Health Crisis on Trans Women and Cis Men Sex Workers in Spain. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:629-638. [PMID: 36066681 PMCID: PMC9447961 DOI: 10.1007/s10508-022-02405-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/14/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The objective of the study was to describe the impact of the COVID-19 pandemic on sex workers in accessing health and social services. A qualitative study was conducted using semi-structured interviews with 29 participants in Barcelona, Spain. Data were analyzed using thematic analysis. Four themes were identified: (1) impact of COVID-19 on physical/mental health, (2) barriers and facilitators to health/social service access, (3) health decision-making, and (4) suggestions for future pandemic situations. Barriers to accessing health services were structural. Non-governmental organization support was the main facilitating factor. A person-centered, intersectional approach is suggested for future practice, considering co-occurring syndemic factors.
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Affiliation(s)
- Juan M Leyva-Moral
- Nursing Department, Faculty of Medicine, Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
| | | | | | - Beti López
- Fundació Àmbit Prevenció, Barcelona, Spain
| | | | | | - Kevin Santander
- Stop Sida, Barcelona, Spain
- Clinical Instructor at Nursing Department, Universtiat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Ferrer
- Departament de Salut, Generalitat de Catalunya, Centre d'Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- Departament d'Igualtat i Diversitat Ciutadana, Ajuntament de Mataró, Mataró, Spain
| | - Jocelyn Mesías-Gazmuri
- Departament de Salut, Generalitat de Catalunya, Centre d'Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Rocío Astudillo Alonso
- Departament de Salut | Generalitat de Catalunya, ASSIR Esquerra Barcelona, Servei Trànsit Barcelona. Institut Català de La Salut, Barcelona, Spain
| | | | - Jordi Casabona
- Departament de Salut, Generalitat de Catalunya, Centre d'Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cinta Folch
- Departament de Salut, Generalitat de Catalunya, Centre d'Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Leyva-Moral JM, Palmieri PA, Loayza-Enriquez BK, Vander Linden KL, Elias-Bravo UE, Guevara-Vasquez GM, Davila-Olano LY, Aguayo-Gonzalez MP. 'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru. BMJ Glob Health 2021; 6:e006772. [PMID: 34711579 PMCID: PMC8557298 DOI: 10.1136/bmjgh-2021-006772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. METHODS A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. RESULTS The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. CONCLUSION Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
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Affiliation(s)
- Juan Manuel Leyva-Moral
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick Albert Palmieri
- South American Center for Qualitative Research, Universidad Privada Norbert Wiener, Lima, Peru
- College of Graduate Health Studies, A.T. Still University, Kirksville, Missouri, USA
| | - Blanca Katiuzca Loayza-Enriquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Facultad de Medicina Humana, Universidad San Martin de Porres, Chiclayo, Peru
| | - Kara Lynette Vander Linden
- Department of Research, Saybrook University, Pasadena, California, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, California, USA
| | - Ursula Elisa Elias-Bravo
- Escuela de Enfermería, Universidad Cientifica del Sur, Miraflores, Peru
- Estrategia Sanitaria de Prevención y Control de VIH-SIDA, Hospital Regional Lambayeque, Chiclayo, Peru
| | - Genesis Masiel Guevara-Vasquez
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Departamento del Desarrollo de Investigación Básica Clínica, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - Mariela Patricia Aguayo-Gonzalez
- Grup de Recerca Infermera en Vulnerabilitat i Salut (GRIVIS), Departament d'Infermeria, Universitat Autonoma de Barcelona, Barcelona, Spain
- Qualitative Health Research, Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
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