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Chuku CC, Silva MF, Lee JS, Reid R, Lazarus K, Carrico AW, Dale SK. A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV. AIDS Care 2024:1-14. [PMID: 38958126 DOI: 10.1080/09540121.2024.2372714] [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: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.
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Affiliation(s)
- Chika Christle Chuku
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Maria F Silva
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachelle Reid
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Kimberly Lazarus
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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SoleimanvandiAzar N, Karimi SE, Ahmadi S, Irandoost SF, Amirkafi A, Azimi A. Exploring the determinants of health service utilization among people living with HIV: a qualitative study in Iran. BMC Health Serv Res 2023; 23:1351. [PMID: 38049768 PMCID: PMC10694986 DOI: 10.1186/s12913-023-10321-0] [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] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Health service utilization among people living with HIV is vital for their survival and quality of life. This study aims to exploring the determinants influencing health service utilization among people living with HIV. METHODS We conducted a qualitative study involving 16 men and women aged 18-64 living with HIV in Tehran. Data were collected between September and December 2021 through semi-structured interviews conducted via telephone and online platforms, utilizing the purposeful sampling method. Data were analyzed by MAXQDA-2018 software using conventional content analysis approaches and the Granheim and Landman method. RESULTS Two main themes, seven categories, and 21 subcategories were obtained from the interviews. The main themes included facilitators of health service utilization (positive personality traits, social factors, and structural-behavioral determinants) and inhibitors of health service utilization (personal conditions, insufficient knowledge and understanding of the disease, negative consequences of disease disclosure, and difficult access to services). CONCLUSION This study underscores the need to invest and expand specialized services for people living with HIV by policy makers, while simultaneously increasing public awareness to reduce the social stigma.
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Affiliation(s)
- Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Ahmadi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Seyed Fahim Irandoost
- Department of Community Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Amirkafi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azimi
- Department of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, Bolden R, Adeojo L, Patrick J, Wallen C, Liu J, Ironson G, Alcaide ML, Safren S, Feaster D. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol 2023; 42:299-313. [PMID: 37141016 PMCID: PMC10167554 DOI: 10.1037/hea0001275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health. METHOD 151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated. RESULTS Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms. CONCLUSION Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Ian A. Wright
- Department of Economics, University of Miami School of Business
| | | | | | | | | | | | | | | | | | | | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), OB/GYN and Public Health, University of Miami Miller School of Medicine
| | | | - Daniel Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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Samuels S, Dale SK. Self-esteem, adverse life events, and mental health diagnoses among Black women living with HIV. ETHNICITY & HEALTH 2023; 28:170-181. [PMID: 35200044 PMCID: PMC10097460 DOI: 10.1080/13557858.2022.2035690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Black women in the U.S. are disproportionately impacted by HIV and adverse life events (ALE). High self-esteem has been noted as a protective factor and low self-esteem has been linked to mental health diagnoses. However, the existing literature is limited in the examination of how self-esteem may buffer relationships between ALE and mental health diagnoses among Black women living with HIV (BWLWH). METHODS One hundred and nineteen BWLWH completed self-report measures on self-esteem (Rosenberg Self-Esteem Scale) and ALE (Life Events Checklist for DSM-5) (e.g. sexual assault, physical assault, accidents, natural disaster) as well as a clinical interview (via Mini-International Neuropsychiatric Inventory) to diagnose current depression, PTSD, and suicidality. RESULTS Multivariable logistic regressions indicated that higher self-esteem was associated with lower likelihood of current depression (OR = .894, p < .01), PTSD (OR = .838, p < .001) and suicidality (OR = .889, p < .05). Interactions between self-esteem and total ALE significantly predicted current depression (OR = .000003, p < .05) and PTSD (OR = 2.7182 × 10-9, p < .001); and higher total ALE related to higher likelihood of current PTSD only among BWLWH reporting lower self-esteem (OR = 1.21, p < .05). CONCLUSION Interventions addressing mental health diagnoses among BWLWH should incorporate strategies to enhance self-esteem.
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Affiliation(s)
- Sherene Samuels
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Miami, FL, USA
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Hopkins CN, Lee CA, Lambert CC, Vance DE, Haase SR, Delgadillo JD, Fazeli PL. Psychological resilience is an independent correlate of health-related quality of life in middle-aged and older adults with HIV in the Deep South. J Health Psychol 2022; 27:2909-2921. [PMID: 35086380 PMCID: PMC9329492 DOI: 10.1177/13591053211072430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Older people living with HIV (PLWH) are at risk for poorer health-related quality of life (HRQoL). Psychological resilience may protect HRQoL in this population. The sample included 174 predominately African American PLWH (age 40-73). Results indicated associations between resilience, socioeconomic status, cognitive performance, instrumental activities of daily living, personality, and depressive symptoms. HIV factors (e.g. viral load, duration of HIV) were not associated with resilience. Adjusting for confounders, resilience was associated with mental HRQoL. Understanding factors associated with resilience among older PLWH and the translation of resilience to HRQoL may inform interventions to improve well-being among individuals aging with HIV.
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HIV-related challenges and women's self-response: A qualitative study with women living with HIV in Indonesia. PLoS One 2022; 17:e0275390. [PMID: 36215264 PMCID: PMC9550025 DOI: 10.1371/journal.pone.0275390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
HIV infection is a major public health concern, with a range of negative impacts on People Living with HIV (PLHIV). A qualitative study in Yogyakarta, Indonesia, using in-depth interviews with 26 Women Living with HIV (WLHIV) was conducted to understand HIV risk factors and impact and their access to HIV care services. This paper describes the self-response of WLHIV towards negative HIV-related experiences facing them and adds to the existing literature which tends to focus on HIV impact only, as opposed to strategies that many WLHIV have used to empower and educate themselves and their family/community. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. Our study highlighted that WLHIV experienced psychological challenges, stigma and discrimination. However, they demonstrated remarkable self-response and capacity in pursuing effective strategies and support to protect themselves, and educating themselves and others around them to rebuild trust and regain respect and acceptance. Our findings indicate that the needs of WLHIV should be addressed through policy and practice to help them cope with HIV-related psychological and social challenges effectively. Family and community members seem to play an important role in those negative challenges against WLHIV, thus there is also a need for HIV education programs for family and community members to enhance their HIV-health literacy and acceptance of PLHIV.
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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.
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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
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Dale SK, Sanders J, Safren SA, Ironson G, O’Cleirigh C. Correlates of resilience after childhood sexual abuse among men who have sex with men. J Trauma Dissociation 2020; 21:365-375. [PMID: 31986997 PMCID: PMC7199796 DOI: 10.1080/15299732.2020.1719263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Men who have sex with men (MSM) are at high risk for physical and mental health conditions and are often discussed in the health literature as "at risk" versus "at promise". However, there is an ongoing need to examine factors that place MSM "at promise" for optimal well-being. This manuscript examines correlates of resilience, the ability to "bounce back" and function adaptively after adversities, among MSM. One hundred and five MSM with a history of childhood sexual abuse, who were enrolled in a randomized control trial were recruited for a supplemental study assessing resilience and other psychosocial factors. Participants completed measures assessing resilient trait and coping (i.e. "I am able to adapt" and "I tend to bounce back"), symptoms of trauma, trauma-related thoughts, and distress tolerance (ability to regulate unpleasant feelings). Findings from multivariable linear regressions controlling for covariates (age, education, race/ethnicity, and income) indicated that higher resilience was associated with (a) lower trauma scores on reexperiencing severity (b = -1.41, SE = .53, p = .01) and avoidance severity (b = -1.61, SE= .67, p = .02), (b) lower post-traumatic cognitions (b = -11.39, SE = 5.08, p = .03) especially negative cognitions about the self (b = -.44, SE = .16, p = .007), and (c) higher distress tolerance (b = .26, SE = .10, p = .01). Our preliminary findings suggest that resilient coping/traits are important to research after childhood sexual abuse among MSM, potentially assess in clinical settings, and address in interventions.
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Deering KN, Braschel M, Logie C, Ranville F, Krüsi A, Duff P, Shannon K. Exploring pathways from violence and HIV disclosure without consent to depression, social support, and HIV medication self-efficacy among women living with HIV in Metro Vancouver, Canada. Health Psychol Open 2020; 7:2055102919897384. [PMID: 32010448 PMCID: PMC6971967 DOI: 10.1177/2055102919897384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We used path analysis to investigate complex pathways from HIV status disclosure without consent, physical/verbal violence and depression, social support, and HIV medication self-efficacy through mediators of HIV stigma among women living with HIV in Canada. In the final model, internalized stigma fully mediated the relationship between physical/verbal violence and reduced medication self-efficacy. Enacted stigma fully mediated the relationship between HIV status disclosure without consent and depression. Internalized stigma (β = 0.252; p < 0.001) had a significant negative direct effect on medication self-efficacy. Enacted stigma had a significant direct effect on depression (β = 0.162; p = 0.037). Findings will help improve services and interventions to promote quality of life and well-being of women living with HIV.
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Affiliation(s)
- Kathleen N Deering
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | | | | | - Flo Ranville
- Centre for Gender & Sexual Health Equity, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
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