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Forney DJ, Sheehan DM, Dale SK, Li T, De La Rosa M, Spencer EC, Sanchez M. The Impact of HIV-Related Stigma on Racial/Ethnic Disparities in Retention in HIV Care Among Adults Living with HIV in Florida. J Racial Ethn Health Disparities 2024; 11:2498-2508. [PMID: 37495905 PMCID: PMC10811278 DOI: 10.1007/s40615-023-01715-1] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Our study examines the effects of distinct HIV stigma subtypes on retention in care and racial-ethnic differences among persons with HIV (PWH). METHODS Using Florida Medical Monitoring Project 2015-2017 data, we analyzed patients' clinical and behavioral characteristics. We analyzed 89,889 PWH in Florida (50.0% non-Hispanic Blacks, 20.8% Hispanics, 29.2% non-Hispanic whites). HIV stigma subtypes, negative self-image, anticipated stigma, personalized stigma, and retention in care were examined with logistic regressions. RESULTS People with high negative self-image and anticipated stigma were less likely to be retained (CI: 0.84-0.92; 0.47-0.53). The association between HIV-related stigma subtypes and retention in care differed between Black, White, and Hispanic participants. Negative self-image was associated with higher retention rates among Hispanics (CI: 5.64-9.26) and Whites (CI: 1.04-1.27), while low retention rates among Blacks (0.617-0.686). The likelihood of staying in care was lower across all racial-ethnic groups when the anticipated stigma was high or moderate. In contrast, personalized stigma increased retention across all racial-ethnic groups. CONCLUSION Results showed that distinct types of HIV stigma differentially impact retention, and these associations differ by race and ethnicity. Future interventions should address the effect HIV stigma subtypes have on racially minoritized PWH retention.
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Affiliation(s)
- Derrick J Forney
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA.
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA.
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA.
| | - Diana M Sheehan
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Miami, USA
| | - Sannisha K Dale
- Center for HIV Research and Mental Health (CHARM), University of Miami, Coral Gables, USA
- Department of Psychology, University of Miami, Coral Gables, Miami, USA
| | - Tan Li
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
| | | | - Mariana Sanchez
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, USA
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Seiler N, Horton K, Organick-Lee P, Heyison C, Osei A, Dwyer G, Karacuschansky A, Washington M, Spott A, Pearson WS. Use of Community Health Workers to Help End the Epidemic of Sexually Transmitted Infections. Public Health Rep 2024; 139:271-276. [PMID: 37846078 PMCID: PMC11037233 DOI: 10.1177/00333549231199481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Affiliation(s)
- Naomi Seiler
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katie Horton
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Paige Organick-Lee
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Claire Heyison
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Alexis Osei
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Gregory Dwyer
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aaron Karacuschansky
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mekhi Washington
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amanda Spott
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - William S. Pearson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marco DN, Omaña-Iglesias O, Caballero G, Marco F. Delayed diagnosis of HIV in migrant patient suffering from opportunistic imported infection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:225-226. [PMID: 38388316 DOI: 10.1016/j.eimce.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Daniel N Marco
- Servicio Enfermedades Infecciosas, Hospital Clínic Barcelona, Barcelona, Spain.
| | | | - Gabriela Caballero
- Servicio de Anatomía Patológica, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesc Marco
- Servicio de Microbiología Clínica, Hospital Clínic Barcelona, Barcelona, Spain
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Pinto RM, Rahman R, Zanchetta MS, Galhego-Garcia W. Brazil's Community Health Workers Practicing Narrative Medicine: Patients' Perspectives. J Gen Intern Med 2021; 36:3743-3751. [PMID: 33826059 PMCID: PMC8642505 DOI: 10.1007/s11606-021-06730-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Narrative medicine (NM) encourages health care providers to draw on their personal experiences to establish therapeutic alliances with patients of prevention and care services. NM medicine practiced by nurses and physicians has been well documented, yet there is little understanding of how community health workers (CHWs) apply NM concepts in their day-to-day practices from patient perspectives. OBJECTIVE To document how CHWs apply specific NM concepts in Brazil's Family Health Strategy (FHS), the key component of Brazil's Unified Health System. DESIGN We used a semi-structured interview, grounded in Charon's (2001) framework, including four types of NM relationships: provider-patient, provider-colleague, provider-society, and provider-self. A hybrid approach of thematic analysis was used to analyze data from 27 patients. KEY RESULTS Sample: 18 females; 13 White, 12 "Pardo" (mixed races), 12 Black. We found: (1) provider-patient relationship-CHWs offered health education through compassion, empathy, trustworthiness, patience, attentiveness, jargon-free communication, and altruism; (2) provider-colleague relationship-CHWs lacked credibility as perceived by physicians, impacting their effectiveness negatively; (3) provider-society relationship-CHWs mobilized patients civically and politically to advocate for and address emerging health care and prevention needs; (4) provider-self relationship-patients identified possible low self-esteem among CHWs and a need to engage in self-care practices to abate exhaustion from intense labor and lack of resources. CONCLUSION This study adds to patient perspectives on how CHWs apply NM concepts to build and sustain four types of relationships. Findings suggest the need to improve provider-colleague relationships by ongoing training to foster cooperation among FHS team members. More generous organizational supports (wellness initiatives and supervision) may facilitate the provider-self relationship. Public education on CHWs' roles is needed to enhance the professional and societal credibility of their roles and responsibilities. Future research should investigate how CHWs' personality traits may influence their ability to apply NM.
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Affiliation(s)
| | - Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - W Galhego-Garcia
- Department of Basic Sciences, Faculty of Dentistry of Araçatuba, Estadual Paulista University, São Paulo, Brazil
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5
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Rivera AV, Carrillo SA, Braunstein SL. Prevalence of U = U Awareness and Its Association with Anticipated HIV Stigma Among Low-Income Heterosexually Active Black and Latino Adults in New York City, 2019. AIDS Patient Care STDS 2021; 35:370-376. [PMID: 34463141 DOI: 10.1089/apc.2021.0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The fact that people with HIV (PWH) who have an undetectable viral load cannot sexually transmit HIV has been disseminated under the messaging "Undetectable = Untransmittable" (U = U). U = U messaging intends to destigmatize HIV by demonstrating that PWH can have healthy sexual lives. Among a sample of low-income heterosexually active Black and Latino adults, we aimed to (1) measure the prevalence of U = U awareness and (2) determine its association with anticipated HIV stigma. Low-income heterosexually active adults were recruited through respondent-driven sampling in New York City. Among Black and Latino participants who self-reported not having HIV, multiple linear regression was used to determine the association between U = U awareness with the following types of anticipated HIV stigma, as determined by principal component analyses: (1) general; (2) dating related; and (3) sex related. Of 485 participants, 35% were aware of U = U. Those who were aware reported less dating-related [adjusted B: -0.20; 95% confidence interval (CI): -0.37 to -0.03] and sex-related (adjusted B: -0.15; 95% CI: -0.29 to -0.002) anticipated HIV stigma. Although the prevalence of U = U awareness was much lower than reported in other populations (e.g., gender and sexual minorities and PWH), prevalence was moderate in our sample, given that awareness efforts have generally not focused on heterosexually active adults. Our findings provide preliminary evidence that U = U awareness may have an impact on anticipated HIV stigma related to dating and sex. Additional methods to disseminate U = U messaging and dismantle HIV stigma in this population should be explored.
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Affiliation(s)
- Alexis V. Rivera
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sidney A. Carrillo
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sarah L. Braunstein
- HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York, USA
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Johnson AK, Buenrostro R, Soberanis G, McCarn B, Magner B, Maiorana A. Salud y Orgullo Mexicano: Development of a Culturally Specific Transnational Linkage and Retention in Care Intervention for Mexican Men Who Have Sex with Men Living with HIV in Chicago. J Immigr Minor Health 2021:10.1007/s10903-021-01185-9. [PMID: 33860874 DOI: 10.1007/s10903-021-01185-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Abstract
This manuscript documents the development of an innovative individual-level peer navigation intervention "Salud y Orgullo Mexicano" (SOM) designed to increase linkage and retention to HIV care for Mexican men who have sex with men (MSM) in Chicago, Illinois. The intervention was developed via a modified intervention mapping process. Elements of two existing interventions were combined and refined with input from the Mexican MSM community, including informant interviews, an expert advisory board, and a design team. A manualized transnational intervention was developed via intervention mapping. A peer health navigation intervention "SOM" was created using intervention mapping and input from the focus community. Next steps include implementing and evaluating the intervention to determine acceptability and efficacy.
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Affiliation(s)
- Amy K Johnson
- Department of Pediatrics, Division of Adolescent Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611-2991, USA.
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- AIDS Foundation of Chicago, Chicago, IL, USA.
| | | | | | | | | | - Andres Maiorana
- Center for AIDS Prevention Studies, University of California San Francisco Prevention Research Center, San Francisco, USA
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Nkulu-Kalengayi FK, Jonzon R, Deogan C, Hurtig AK. Evidence and gaps in the literature on HIV/STI prevention interventions targeting migrants in receiving countries: a scoping review. Glob Health Action 2021; 14:1962039. [PMID: 34404337 PMCID: PMC8381899 DOI: 10.1080/16549716.2021.1962039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Evidence suggests that migration increases vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). However, there is limited knowledge about what has been done or needs to be done to address migrants' vulnerability in receiving countries. OBJECTIVES A scoping review was carried out to map the existing literature in this field, describe its characteristics, identify gaps in knowledge and determine whether a Sexual and Reproductive Health and Rights (SRHR)-perspective was applied. METHODS We used the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines for scoping reviews and subsequent enhancements proposed by other authors. We searched three databases and grey literature to identify relevant publications. RESULTS A total of 1,147 records were found across the three electronic databases and compiled. Of these, only 29 papers that met the inclusion criteria were included. The review shows that research in this field is dominated by studies from the USA that mostly include behavioural interventions for HIV and HBV prevention among migrants from Latin America and Asian countries, respectively. None of the interventions integrated an SRHR perspective. The intervention effects varied across studies and measured outcomes. The observed effects on knowledge, attitudes, perceptions, behavioural intentions and skills were largely positive, but reported effects on testing and sexual risk behaviours were inconsistent. CONCLUSIONS There is a need for good quality research, particularly in parts of the world other than the USA that will address all STIs and specifically target the most vulnerable subgroups of migrants. Further research requires greater scope and depth, including the need to apply an SRHR perspective and incorporate biomedical and structural interventions to address the interacting causes of migrants' vulnerability to HIV/STIs.
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Affiliation(s)
| | - Robert Jonzon
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Sexual Health and HIV Prevention, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Ryerson Espino S, Aguado P, Puente M, Vergara-Rodriguez P. Proyecto Promover: Attempts to Roll Out an HIV Prevention and Testing Initiative Within a Mexican Immigrant Community. J Immigr Minor Health 2020:10.1007/s10903-020-01075-6. [PMID: 32895761 DOI: 10.1007/s10903-020-01075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Latinx immigrants and men, in particular, living in the US are disproportionally impacted by HIV. Despite these concerns, there is limited research on the development, implementation, and evaluation of community-based HIV education and HIV testing interventions. The current study describes such efforts within a historic Mexican immigrant enclave in Chicago. A mixed-methods case study was used to describe intervention development, as well as preliminary evaluation data. Community intervention components were refined through early focus groups, asset mapping, community networking and consultation with cultural advisors. We exceeded our activity goals. We were successful in reaching a segment of the population that is often overlooked and remains unaware of HIV and its risks. Incorporating social network approaches could facilitate reaching at-risk community groups. Demonstration projects require more time and resources (fiscal and technical) to develop, refine, evaluate and sustain community-level intervention components.
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Affiliation(s)
- Susan Ryerson Espino
- Evaluation Consultant, Chicago, IL, USA.
- The Ruth M. Rothstein CORE Center, Hektoen Institute of Medicine, Chicago, IL, USA.
| | - Patricia Aguado
- The Ruth M. Rothstein CORE Center, Hektoen Institute of Medicine, Chicago, IL, USA
- Department of Social Work, Northeastern Illinois University, Chicago, IL, USA
| | - Monica Puente
- The Ruth M. Rothstein CORE Center, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Pamela Vergara-Rodriguez
- The Ruth M. Rothstein CORE Center, Hektoen Institute of Medicine, Chicago, IL, USA
- Cook County Bureau of Health Services, The Ruth M. Rothstein CORE Center, Chicago, IL, USA
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Depressive Symptoms and Sexually Transmitted Disease: Evidence from a Low-Income Neighborhood of New York City. Community Ment Health J 2019; 55:1147-1151. [PMID: 31073663 DOI: 10.1007/s10597-019-00405-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/06/2019] [Indexed: 02/05/2023]
Abstract
We examined the association between sexually transmitted disease (STD) and depressive symptoms. Our analysis utilized the 2015 cross-sectional Washington Heights Community Survey. Multivariable binary logistic regression analysis was used to examine the primary association between having a history of STD and patient health questionnaire-9 (PHQ-9) score while adjusting for potential confounders. Then in separate models, we adjusted for the interaction of social factors with PHQ-9 score to test for modification effect on the primary association. In this low-income neighborhood, STD history was not significantly associated with PHQ-9 score in the overall logistic regression model for the primary association. However, in interaction models, STD and depressive symptoms were associated in sub-groups defined by social factors, namely being Hispanic [odds ratio (OR) 1.08; 95% confidence interval (CI) 1.02-1.15], foreign-born (OR 1.08; 95% CI 1.02-1.15), and having low to moderate social support (OR 1.09; 95% CI 1.02-1.15). Our results demonstrate a need for targeted interventions to be applied to vulnerable subgroups identified.
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10
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Insurance Status and Access to Sexual Health Services Among At-Risk Men: A Qualitative Study. J Assoc Nurses AIDS Care 2019; 30:e122-e131. [DOI: 10.1097/jnc.0000000000000063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dolwick Grieb SM, Shah H, Flores-Miller A, Zelaya C, Page KR. HIV-Related Stigma Among Spanish-speaking Latinos in an Emerging Immigrant Receiving City. J Immigr Minor Health 2018; 19:868-875. [PMID: 27678505 DOI: 10.1007/s10903-016-0497-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV-related stigma has been associated with a reluctance to test for HIV among Latinos. This study assessed community HIV-related stigma within an emerging Latino immigrant receiving city. We conducted a brief survey among a convenience sample of 312 Spanish-speaking Latinos in Baltimore, Maryland. HIV-related stigma was assessed through six items. Associations between stigma items, socio-demographic characteristics, and HIV testing history were considered. Gender, education, and religiosity were significantly associated with stigmatizing HIV-related beliefs. For example, men were 3.4 times more likely to hold more than three stigmatizing beliefs than women, and were also twice as likely as women to report feeling hesitant to test for HIV for fear of people's reaction if the test is positive. These findings can help inform future stigma interventions in this community. In particular, we were able to distinguish between drivers of stigma such as fear and moralistic attitudes, highlighting specific actionable items.
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Affiliation(s)
- Suzanne M Dolwick Grieb
- Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F. Lord Center Tower Suite 4200, Baltimore, MD, 21224, USA.
| | - Harita Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen R Page
- Bureau of HIV/STD Services, Baltimore City Health Department, Baltimore, MD, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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van Haaren MA, Reyme M, Lawrence M, Menke J, Kaptein AA. Illness perceptions of leprosy-cured individuals in Surinam with residual disfigurements - "I am cured, but still I am ill". Chronic Illn 2017; 13:117-127. [PMID: 27385505 DOI: 10.1177/1742395316657398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Leprosy has rarely been the subject of health psychology research despite its substantial impact. Our aim was to explore illness perceptions in patients and their health care providers in Surinam. The Common Sense Model (CSM) was the guiding theoretical model. Design Patients with biomedically cured leprosy and their health care providers completed the B-IPQ and took part in semi-structured interviews. The literature on illness perceptions in patients with leprosy was reviewed. Main outcome measures Patients' B-IPQ scores were compared with samples of patients with other (chronic) illnesses, and with health care providers completing the questionnaire as if they were visibly disfigured patients. Quotations from the semi-structured interviews were used to contextualise the illness perceptions. Results Patients' B-IPQ scores reflected the chronic nature of leprosy and were comparable with those with other chronic illnesses. Health care providers perceived leprosy to have a greater negative impact than did the patients. Perceived understanding of causes differed considerably between patients and health care providers. Conclusion Leprosy continues to be experienced as an illness with major psychological and social consequences such as stigmatisation, even after biomedical cure. Interventions that target patients, health care providers, and society at large may help reduce perceived shame and stigma. The CSM is a helpful theoretical model in studying this population.
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Affiliation(s)
- Mark Ac van Haaren
- 1 Department of Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Jack Menke
- 2 Anton de Kom University, Paramaribo, Surinam
| | - Ad A Kaptein
- 1 Department of Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands
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