Social support of people with HIV/AIDS: the Social Determinants of Health Model

Promoting Resilience among Middle-Aged and Older Men Who Have Sex with Men Living with HIV/AIDS in Southern Nevada: An Examination of Facilitators and Challenges from a Social Determinants of Health Perspective

Most prior research on resilience to HIV/AIDS among middle-aged and older men who have sex with men (MSM) has utilized quantitative methods that employ surveys and scales to measure constructs researchers have used to approximate the concept of resilience to HIV/AIDS. Only a few studies have purposively made efforts to incorporate the input of relevant stakeholders to guide their research on HIV/AIDS resilience and examine the perspectives and lived experiences of middle-aged and older MSM. To address this research gap, we conducted a community-based participatory research qualitative study to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM from Southern Nevada in order to identify factors that promote such resilience. We conducted 16 semi-structured interviews with middle-aged and older MSM living with HIV/AIDS from January to April 2022. From our thematic analysis of our interviews, we identified factors that served as facilitators or challenges to the promotion of our participants' HIV/AIDS resilience. We discuss in this article both the facilitators and challenges to our participants' resilience-building as the key themes from our interviews. We recognized that the impacts of these factors were mediated by their strong influence on the social determinants of health that were explicitly relevant to our participants. We offer important insights based on our findings, which could be especially useful to future research on resilience to HIV/AIDS.

Predicting the HIV/AIDS Knowledge among the Adolescent and Young Adult Population in Peru: Application of Quasi-Binomial Logistic Regression and Machine Learning Algorithms

Inadequate knowledge is one of the principal obstacles for preventing HIV/AIDS spread. Worldwide, it is reported that adolescents and young people have a higher vulnerability of being infected. Thus, the need to understand youths' knowledge towards HIV/AIDS becomes crucial. This study aimed to identify the determinants and develop a predictive model to estimate HIV/AIDS knowledge among this target population in Peru. Data from the 2019 DHS Survey were used. The software RStudio and RapidMiner were used for quasi-binomial logistic regression and computational model building, respectively. Five classification algorithms were considered for model development and their performance was assessed using accuracy, sensitivity, specificity, FPR, FNR, Cohen's kappa, F1 score and AUC. The results revealed an association between 14 socio-demographic, economic and health factors and HIV/AIDS knowledge. The accuracy levels were estimated between 59.47 and 64.30%, with the random forest model showing the best performance (64.30%). Additionally, the best classifier showed that the gender of the respondent, area of residence, wealth index, region of residence, interviewee's age, highest educational level, ethnic self-perception, having heard about HIV/AIDS in the past, the performance of an HIV/AIDS screening test and mass media access have a major influence on HIV/AIDS knowledge prediction. The results suggest the usefulness of the associations found and the random forest model as a predictor of knowledge of HIV/AIDS and may aid policy makers to guide and reinforce the planning and implementation of healthcare strategies.

The role of online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran: Development of a conceptual model

Online social networks have been used to enhance human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevention, diagnosis, and treatment programs worldwide. This study aimed to develop a conceptual model of using online social networks in improving health literacy and medication adherence among people living with HIV/AIDS in Iran. This mixed-method sequential exploratory study was conducted in three phases. Firstly, a series of semi-structured interviews with a purposive sample of 29 HIV-positive patients were conducted to investigate the perceptions and experiences of HIV-positive patients about using online social networks to support health literacy and medication adherence. Thematic analysis was used to analyse qualitative interviews, extract potential components, and design a conceptual model. Then, a Delphi study with 27 HIV-positive patients was subsequently conducted to examine the consensus of patients on the proposed model. Finally, the trustworthiness and credibility of the proposed model were reviewed and evaluated by expert panel members from epidemiology and public health. Seven themes and 24 sub-themes emerged from the qualitative interviews. Five themes encompassed components of online social networks that supported communication and information-seeking behaviour of people living with HIV/AIDS. The two other themes encompassed social support and health-related outcomes including medication adherence. The credibility of the proposed conceptual model was confirmed methodologically using the expert panel and Delphi technique. Our findings highlighted that using online social networks has empowered Iranian people living with HIV/AIDS, making them more connected, safe, and able to access HIV/AIDS-related information and services. The role of online social networks in improving health literacy and medication adherence was also demonstrated in a conceptual model to understand the supportive components of online social networks in the HIV care continuum as well as customized interventions to improve the success of antiretroviral therapies.

Structure of social networks of people living with HIV and AIDS

OBJECTIVE

To analyze the structure of the social network of people living with HIV and AIDS.

METHOD

Exploratory and descriptive research with a qualitative approach, developed through interviews with twenty-two people living with HIV and AIDS, from November to December 2019. For analysis, the theoretical-methodological framework of social network was used.

RESULTS

The primary networks were of medium size and low density, formed by family members, relatives, friends, neighbors, and colleagues. The secondary networks were characterized by public, private, third sector institutions, workplaces, and by the informal network, which provided support according to the need for care.

CONCLUSION

The family was considered the center of the primary social network structure; however, weaknesses in these social relationships were evidenced. The family relational context of the person with HIV and AIDS was influenced by the secrecy of the diagnosis due to the fear of prejudice and discrimination for being HIV-positive. There was a predilection for the services of the secondary social network that took on the role of specific care for the disease.

Social Determinants of Disease: HIV and COVID-19 Experiences

PURPOSE OF REVIEW

The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis.

RECENT FINDINGS

With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.

Aspectos relacionados ao letramento em saúde, autocuidado e adesão ao tratamento de pessoas vivendo com HIV

RESUMO Objetivo: verificar a relação entre letramento em saúde, adesão à terapia antirretroviral e autocuidado de pessoas vivendo com HIV. Método: trata-se de estudo transversal, desenvolvido entre janeiro e julho de 2019, por meio de escalas validadas sobre letramento em saúde (SAHLPA), adesão (CEAT-HIV) e autocuidado (EACAC). Resultados: participaram do estudo 303 pessoas cadastradas em três serviços de atendimento ambulatorial-HIV, apresentando grau satisfatório de letramento (52,5%), ótimo nível de autocuidado (62,9%) e adesão estrita à terapia antirretroviral (57,1%). Os não letrados apresentaram adesão medicamentosa insuficiente, quando comparados com os letrados (RP = 1,17). A adesão estrita foi significativa para o autocuidado (p-valor < 0,001). Uma maior relação de risco para o não letramento esteve associada ao sexo feminino, pessoas com ensino fundamental, que recebem benefícios, com renda de até um salário mínimo, não ter hábito de buscar informações em saúde e maior tempo de uso da TARV. Conclusão identificou-se relação entre o letramento e a adesão insuficiente. O risco para adesão medicamentosa insuficiente aumenta à medida que o autocuidado diminui. Medidas sociais redutoras de iniquidades podem contribuir para melhoria da assistência a pessoas que vivem com HIV.

Aspects related to health literacy, self-care and compliance with treatment of people living with HIV

OBJECTIVE

to verify the relationship between health literacy, compliance with antiretroviral therapy and self-care of people living with HIV.

METHOD

this is a cross-sectional study, developed between January and July 2019, using validated scales on health literacy (SAHLPA), compliance (CEAT-HIV) and self-care (EACAC).

RESULTS

a total of 303 people enrolled in three HIV outpatient care services participated in the study, with a satisfactory level of literacy (52.5%), excellent level of self-care (62.9%) and strict compliance with antiretroviral therapy (57.1%). The illiterate had insufficient medication compliance, when compared with the literate (PR = 1.17). Strict compliance was significant for self-care (p-value < 0.001). A higher risk ratio for illiteracy was associated with females, people with elementary education, who receive benefits, with an income of up to one minimum wage, not having the habit of seeking health information and longer use of ART.

CONCLUSION

a relationship was identified between literacy and insufficient compliance. The risk for insufficient medication compliance increases as self-care declines. Social measures that reduce inequities can contribute to improving care for people living with HIV.

Retention in HIV care and associated factors among youths aged 15-24 years in rural southwestern Uganda

BACKGROUND

Retention in HIV care contributes to antiretroviral therapy adherence, which is a key factor for improved treatment outcomes and prevention of drug resistance. However, HIV treatment among the youths is characterized by loss to follow up, poor adherence to ART, risk of treatment failure and high mortality rates compared to young children and adults. There is limited information about factors associated with retention of youths in HIV care in rural settings in Uganda. We aimed to determine retention in HIV care and associated factors among youths aged 15-24 years in rural southwestern Uganda.

METHODS

A cross-sectional study was conducted among youths aged 15-24 years who were receiving care at the HIV clinic at Kabuyanda HC IV who had been in care for at least 1 year before the study. We used an interviewer-administered questionnaire to collect socio-demographic information. Participant chart abstraction was used to collect information on HIV clinic attendance. We collected information on HIV related stigma using the 40-item Berger Stigma Scale. Chi-square test and multivariable logistic regression analysis were used to determine the factors associated with retention in HIV care with a significance level of < 0.05. Retention in HIV care was, defined as having sought care at least once per quarter in the 12 months prior to the study.

RESULTS

We enrolled 102 participants with a mean age of 20.95 (SD ± 3.07) years. Two thirds (65.7%) of the youths had been retained in HIV care in the previous 12 months. In adjusted analyses, being male, married and had perinatally acquired HIV were independently associated with retention in HIV care. The association between HIV related stigma and retention in HIV care was not statistically significant.

CONCLUSION

Retaining adolescents and young adults in HIV care in rural southwestern Uganda is still much lower than the WHO target of 90%. Being male, having perinatally acquired HIV and married or in a relationship are associated with retention in HIV care. Interventions targeting adolescents and young adults living with HIV are necessary to improve retention in HIV care to the WHO target of 90%.

Social representations of the quality of life of the young people living with HIV

OBJECTIVES

to analyze the social representations of the quality of life of the young people living with HIV.

METHODS

qualitative survey, based on the Social Representations Theory, with 24 young people living with HIV, monitored in specialized services in Rio de Janeiro, through semi-structured interviews, and the analysis supported by the software IRAMUTEQ.

RESULTS

multidimensionality of the quality of life was observed unfolding the implications of living with HIV/aids concerning the familiar and social support network, time of diagnosis, healthcare services, antiretroviral therapy, and prejudice expressions.

FINAL CONSIDERATIONS

a conceptual synthesis of quality of life is observed when it is associated with healthy lifestyle habits, interpersonal relationships, and health services and professional practices.

Analysis of the needs for help of men who have sex with men and live with HIV

OBJECTIVE

To understand the needs for help of men who have sex with men and live with HIV in the light of a Prescriptive Theory.

METHOD

Descriptive and qualitative study, conducted with men who have sex with men and live with HIV who were treated in a Specialized Outpatient Service in a capital in Northeastearn Brazil, between the months of November 2017 and May 2018. The study used the analysis of the discourse of the collective subject.

RESULTS

49 men with HIV who self-identified as men who have sex with men participated in the study. Help was described as support, welcoming, psychosocial and family support. The desire to receive assistance was related to accepting and forgetting the diagnosis. The problems experienced were related to the acceptance of the diagnosis, fear and prejudice. Professionals and family members stood out as sources of support. Nursing care was cited as significant and the main help required was psychological.

CONCLUSION

The needs for help identified were mainly related to psychological support coming from health professionals and family members. Participants were willing to receive help, especially to cope with the diagnosis.

Association between social support and adherence to anti-retroviral treatment in people living with HIV

OBJECTIVE

To investigate the association between social support, adherence to HIV anti-retroviral therapy, and clinical and sociodemographic factors.

METHOD

A cross-sectional study conducted from July 2016 to August 2018 in a specialized outpatient clinic in southern Brazil. Individual interviews were conducted for the application of the following instruments: Questionnaire for the Evaluation of Adherence to Anti-retroviral Treatment (CEAT-HIV) and Social Support Scale for People Living with HIV/AIDS. The Spearman bivariate correlation test was used for analysis purposes.

RESULTS

Among the 168 participants, the mean social support score was 3.53 points (SD = 0.66), and 64.9% (n = 109) of the respondents had insufficient adherence. There was a significant association (p < 0.05) between emotional social support and the following adherence domains: antecedents of non-adherence behaviors and doctor-patient communication.

CONCLUSIONS

Social support is associated with antecedents of non-adherence behaviors and doctor-patient communication.