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Traylor DO, Enriquez M, Thompson-Robinson M, Yu M, Bloom T, Bullock L. Barriers and Facilitators That Influence HIV Pre-exposure Prophylaxis (PrEP)-Prescribing Behaviors Among Primary Care Providers in the Southern United States. Cureus 2024; 16:e66868. [PMID: 39280522 PMCID: PMC11399752 DOI: 10.7759/cureus.66868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
The Southern United States (US) bears the highest burden of HIV prevalence in the country, disproportionately affecting African American communities. Despite the proven efficacy of pre-exposure prophylaxis (PrEP) in reducing HIV transmission, its uptake remains suboptimal in this region. This study aimed to identify factors influencing PrEP-prescribing behaviors among primary care providers (PCPs) in the Southern US through the application of the transtheoretical model of behavior change. A cross-sectional survey was conducted among PCPs in 10 Southern states to assess their PrEP-prescribing practices, barriers, and facilitators. The results indicate that non-White PCPs and those practicing in urban and suburban settings are more likely to prescribe PrEP. Key barriers include lack of training, perceived stigma, and systemic issues such as health insurance coverage and time constraints. Significant facilitators are access to prescribing resources, streamlined insurance procedures, and patient motivation. Targeted educational programs and policy changes to address these barriers can enhance PrEP uptake, thereby reducing HIV transmission in high-risk populations. The findings underscore the need for tailored interventions to support PCPs in integrating PrEP into routine care, ultimately contributing to better public health outcomes in the Southern US.
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Affiliation(s)
- Daryl O Traylor
- Public Health, A.T. Still University College of Graduate Health Sciences, Mesa, USA
- Basic Sciences, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Maithe Enriquez
- Infectious Diseases, Sinclair School of Nursing, University of Missouri, Columbia, USA
| | | | - Mansoo Yu
- Social Work and Public Health, University of Missouri, Columbia, USA
| | - Tina Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, USA
| | - Linda Bullock
- Research, Sinclair School of Nursing, University of Missouri, Columbia, USA
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2
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Konkle-Parker D, Cleveland JD, Long D, Nair V, Fischl M, Wingood G, Edmonds A. Population Density and Health Outcomes in Women with HIV in the Southern United States: A Retrospective Longitudinal Analysis. J Womens Health (Larchmt) 2024; 33:1111-1119. [PMID: 38864119 DOI: 10.1089/jwh.2023.0698] [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] [Indexed: 06/13/2024] Open
Abstract
Purpose: Published studies have revealed challenges for people with human immunodeficiency virus (HIV) living in rural areas compared to those in urban areas, such as poor access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes in the largest cohort of women with HIV (WWH) in the United States. Methods: Women's Interagency HIV Study (WIHS) participants from Southern sites (n = 561) in 2013-2018 were categorized and compared by population density quartiles. The most urban quartile was compared with the most rural quartile in several psychosocial and clinical variables, including HIV viral load suppression, HIV medication adherence, HIV care attendance, depression, internalized HIV stigma, and perceived discrimination in healthcare settings. Results: Although women in the lowest density quartile were unexpectedly more highly resourced, women in that quartile had greater odds of not attending an HIV care visit in the last six months (odds ratio [OR] = 0.64, 95% confidence interval [CI] [0.43-0.95]), yet higher odds for having fully suppressed HIV when compared to women in the highest density quartile (OR = 1.64, 95% CI [1.13-2.38]). Highly urban WWH had greater likelihood of unsuppressed HIV, even after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Discussion: Further investigation into the reasons for these disparities by population density is needed, and particular clinical attention should be focused on individuals from high population density areas to help maximize their health outcomes.
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Affiliation(s)
- D Konkle-Parker
- Schools of Medicine, Nursing, Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - J D Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - V Nair
- School of Population Health, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - G Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sommer SB, Barroso JV, Bass SB, Congema MR, Schoemann AM, Caiola CE. Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States. AIDS Care 2024; 36:130-138. [PMID: 37535630 PMCID: PMC10837316 DOI: 10.1080/09540121.2023.2233498] [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: 03/10/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023]
Abstract
Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.
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Affiliation(s)
- Sadie B Sommer
- School of Nursing, Vanderbilt University, Nashville, U.S.A
| | | | - Sarah B Bass
- Department of Social and Behavioural Sciences, Temple University, Philadelphia, U.S.A
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Sommer S, Barroso J. A qualitative metasynthesis of stigma in women living with HIV in the United States. Int J Equity Health 2023; 22:158. [PMID: 37605194 PMCID: PMC10441719 DOI: 10.1186/s12939-023-01969-5] [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: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Our goal was to synthesize qualitative studies on HIV-related stigma as experienced by women living with HIV (WLWH) in the U.S. Qualitative metasynthesis techniques as developed by Sandelowski et al. (Res Nurs Health 30(1):99-111, 2007) were used to integrate and update findings on stigma in WLWH in the U.S. in 43 reports of qualitative studies conducted between 2004 and 2023 with 1118 participants. Developed themes explored a collective narrative of women first surviving the intersectionality of multiple sources of stigma, discovering non-linear pathways to transcend their stigma, and finally experiencing resilience through their transcendence of stigma. While this metasynthesis revealed similarities to an earlier metasynthesis in the ubiquity and persistence of stigma, they differ primarily in women's abilities to find agency in managing and opposing their stigma. This cognitive reframing of their stigma helped women to redefine stigma as ignorance and move towards a more positive assessment of the self. In doing so, they separated themselves from their stigma and the damaging effects of it. Findings from this metasynthesis may serve as a useful tool for the development of stigma reduction interventions specific to the needs and experiences of WLWH in the U.S.
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Affiliation(s)
- Sadie Sommer
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA.
| | - Julie Barroso
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, 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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Edmonds A, Haley DF, Tong W, Kempf MC, Rahangdale L, Adimora AA, Anastos K, Cohen MH, Fischl M, Wilson TE, Wingood G, Konkle-Parker D. Associations between population density and clinical and sociodemographic factors in women living with HIV in the Southern United States. AIDS Care 2021; 33:229-238. [PMID: 32449377 PMCID: PMC7686024 DOI: 10.1080/09540121.2020.1769829] [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] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
To explore the associations of urbanicity with clinical/behavioral outcomes and sociodemographic factors among women living with HIV in the Southern United States, 523 participants of the Women's Interagency HIV Study were classified into population density quartiles. Rural-Urban Commuting Area codes revealed that 7% resided in areas where >30% commute to urban areas, 2% resided in small towns or rural areas, and 91% resided in varying densities of urban areas. Although women in lower density, mostly suburban areas reported higher socioeconomic indicators such as advanced education and greater annual household income, larger proportions of women in the lowest density quartile perceived discrimination in health care settings and agreed with several internalized HIV stigma scale items. Women in the lower quartiles had higher CD4 counts, while those in the lowest quartile were more likely to have a suppressed HIV viral load, report being employed, and not report a history of drug use or current heavy alcohol use. More research is needed to understand the interplay between population density and mechanisms contributing to HIV control as well as increased internalized stigma and perceived discrimination, along with how to target interventions to improve outcomes for individuals with HIV across urban, suburban, and rural areas.
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Affiliation(s)
- Andrew Edmonds
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC
| | - Danielle F Haley
- Northeastern University, Department of Health Sciences, Institute for Health Equity and Social Justice Research, Bouvé College of Health Sciences, Boston, MA
| | | | | | - Lisa Rahangdale
- The University of North Carolina at Chapel Hill, Department of Obstetrics & Gynecology, School of Medicine, Chapel Hill, NC
| | - Adaora A Adimora
- The University of North Carolina at Chapel Hill, School of Medicine, Division of Infectious Diseases, Chapel Hill, NC
| | - Kathryn Anastos
- Albert Einstein College of Medicine/Montefiore Medical Center, Departments of Medicine, Epidemiology, and Population Health, Bronx, NY
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital of Cook County and Rush University, Chicago, IL
| | - Margaret Fischl
- University of Miami School of Medicine, Department of Medicine, Division of Infectious Diseases, Miami, FL
| | - Tracey E Wilson
- SUNY Downstate Health Sciences University, Department of Community Health Sciences
| | - Gina Wingood
- Columbia University, Mailman School of Public Health, New York, NY
| | - Deborah Konkle-Parker
- University of Mississippi Medical Center, Department of Medicine, Division of Infectious Diseases, Jackson, MS
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7
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Abstract
The Southern United States has been disproportionately affected by HIV diagnoses and mortality. To inform efforts to effectively address HIV in the South, this manuscript synthesizes recent data on HIV epidemiology, care financing, and current research literature on factors that predispose this region to experience a greater impact of HIV. The manuscript focuses on a specific Southern region, the Deep South, which has been particularly affected by HIV. Epidemiologic data from the Centers from Disease Control and Prevention indicate that the Deep South had the highest HIV diagnosis rate and the highest number of individuals diagnosed with HIV (18,087) in 2014. The percentage of new HIV diagnoses that were female has decreased over time (2008-2014) while increasing among minority MSM. The Deep South also had the highest death rates with HIV as an underlying cause of any US region in 2014. Despite higher diagnosis and death rates, the Deep South received less federal government and private foundation funding per person living with HIV than the US overall. Factors that have been identified as contributors to the disproportionate effects of HIV in the Deep South include pervasive HIV-related stigma, poverty, higher levels of sexually transmitted infections, racial inequality and bias, and laws that further HIV-related stigma and fear. Interventions that address and abate the contributors to the spread of HIV disease and the poorer HIV-related outcomes in the Deep South are warranted. Funding inequalities by region must also be examined and addressed to reduce the regional disparities in HIV incidence and mortality.
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Affiliation(s)
- Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA. .,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Donna Safley
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | | | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive, Durham, NC, 27708, USA.,Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
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Feyissa GT, Lockwood C, Woldie M, Munn Z. Evaluation of a guideline developed to reduce HIV-related stigma and discrimination in healthcare settings and establishing consensus. PLoS One 2018; 13:e0198781. [PMID: 30052634 PMCID: PMC6063398 DOI: 10.1371/journal.pone.0198781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/14/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Developing guidelines and policies is critical to address HIV-related stigma and discrimination (SAD) in healthcare settings. To this end, a multidisciplinary panel developed a guideline to reduce SAD. This project evaluated the appropriateness of implementing the guideline in the Ethiopian context. METHODS A consensus of the expert panel was established through a modified Delphi technique which was followed by a panel meeting. Initial tentative recommendations were distributed to experts through e-mails to be evaluated using the modified guideline implementability appraisal (GLIA) v.2.0 checklist. RESULTS In the first round of the Delphi survey, all (13) panel members evaluated the guideline. The overall score for the general domain of the modified GLIA checklist was 96.56%. The scores for individual recommendations ranged from 68.33% to 92.76%. Maximum and minimum scores were attained for measurability (97.71%) and flexibility (59.77%) domains respectively. Percentages mean score lower than 75% was obtained for flexibility and validity domains. Participants suggested that additional tools and training should be added to the guideline. In the second round of the survey, all the recommendations received endorsement with scores above 75%. Maximum and minimum scores were attained for measurability (100%) and flexibility (86.88%) domains respectively. During the panel meeting, issues of responsibility for implementing the guideline were discussed. CONCLUSION The project evaluated implementability of a guideline developed to reduce HIV-related SAD in healthcare settings. The Delphi survey was followed by a half-day meeting that helped in further clarification of points.
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Affiliation(s)
- Garumma Tolu Feyissa
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
| | - Mirkuzie Woldie
- Jimma University, Department of Health, Behavior and Society, Jimma, Ethiopia
- Ethiopian Evidence Based Health Care Centre: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Zachary Munn
- The Joanna Briggs Institute, the University of Adelaide, Adelaide, Australia
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9
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Darlington CK, Hutson SP. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS Behav 2017; 21:12-26. [PMID: 27492025 DOI: 10.1007/s10461-016-1504-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.
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Affiliation(s)
- Caroline K Darlington
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA.
| | - Sadie P Hutson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA
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Hergenrather KC, Zeglin RJ, Conyers L, Misrok M, Rhodes SD. Persons Living With HIV/AIDS: Employment as a Social Determinant of Health. REHABILITATION RESEARCH POLICY AND EDUCATION 2016. [DOI: 10.1891/2168-6653.30.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: For persons living with HIV/AIDS (PLWHA), the advent of highly active antiretroviral therapy has increased their longevity and quality of life. As HIV progresses, many PLWHA present declined domains of functioning that impede their ability to work. The authors explore employment as a social determinant of health to identify issues impacting employment outcomes for PLWHA.Methods: The authors reviewed the literature addressing HIV across the domains of mental health functioning, neurocognitive functioning, and physical function and employment.Results: When providing employment services to PLWHA, considerations for rehabilitation practitioners and educators include HIV/AIDS education, functional assessment, social support, considerations for women with HIV, highly active antiretroviral therapy (HAART), HIV/AIDS stigma, and employment resources for PLWHA.Conclusion: With more than 1.2 million PLWHA in the United States, and most of new infections among persons 25–44 years of age, the prevalence of PLWHA seeking employment and inclusive of the U.S. workforce will continue to increase. Proving employment services for PLWHA is a complex process that is best served by an integrative service approach.
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Walcott M, Kempf MC, Merlin JS, Turan JM. Structural community factors and sub-optimal engagement in HIV care among low-income women in the Deep South of the USA. CULTURE, HEALTH & SEXUALITY 2016; 18:682-94. [PMID: 26670722 PMCID: PMC6047529 DOI: 10.1080/13691058.2015.1110255] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study describes the ways in which poverty and other structural factors create a risk environment for sub-optimal engagement in HIV care among low-income women living with HIV in the Southern USA, contributing to existing health disparities. We conducted a qualitative study in 2012, involving in-depth interviews with 14 stakeholders (service providers and representatives of community-based organisations) and 7 focus-group discussions with 46 women living with HIV (89% African American). A thematic approach in the context of the social ecological model guided data analysis. Data were coded and analysed using NVivo qualitative software. The findings suggested that structural community factors, such as poverty, poor employment opportunities, limited access to healthcare resources, stigma, transportation challenges and access to illicit substances, may work independently and in synergy to impact women's health seeking behaviour and decision-making, thereby influencing their ability to engage in HIV care. Interventions designed to improve engagement in HIV care should address structural factors to bolster low-income women's ability to engage in care.
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Affiliation(s)
- Melonie Walcott
- Department of Medicine (Infectious Diseases), University of Alabama at Birmingham, Birmingham, AL
| | - Mirjam-Colette Kempf
- Department of Family, Community & Health Systems, University of Alabama at Birmingham, Birmingham, AL
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica S. Merlin
- Department of Medicine (Infectious Diseases), University of Alabama at Birmingham, Birmingham, AL
| | - Janet M. Turan
- Department of Health Care Organization, University of Alabama at Birmingham, Birmingham, AL
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Behboodi-Moghadam Z, Khalajinia Z, Nasrabadi ARN, Mohraz M, Gharacheh M. Pregnancy through the Lens of Iranian Women with HIV: A Qualitative Study. J Int Assoc Provid AIDS Care 2015; 15:148-52. [PMID: 26156585 DOI: 10.1177/2325957415593636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To explore the experience of pregnancy among Iranian women with HIV, 12 HIV-infected pregnant women who referred to counseling center for behavioral diseases in Imam Khomeini Hospital were recruited through purposive sampling. Data were collected by face-to-face, semi-structured interview and were analyzed using conventional content analysis method. Four main themes emerged from the data: fear and hope, stigma and discrimination, marital life stability, and trust in God. Despite concerns about mother-to-child transmission of HIV, and uncertain life span, HIV-infected women tended to continue their pregnancy, and having children was viewed as a window of hope for them.
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Affiliation(s)
- Zahra Behboodi-Moghadam
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Khalajinia
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Gharacheh
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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13
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Audet CM, Wagner LJ, Wallston KA. Finding meaning in life while living with HIV: validation of a novel HIV meaningfulness scale among HIV-infected participants living in Tennessee. BMC Psychol 2015; 3:15. [PMID: 25945254 PMCID: PMC4419455 DOI: 10.1186/s40359-015-0070-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People living with HIV who maintain a positive outlook on their future may manage stress better than those who do not, leading to improved coping behaviors and better health outcomes. METHODS While studying 125 HIV+ adults participating in two clinical trials of expressive writing we assessed their HIV-specific meaningfulness of life with a short, unidimensional scale (the HIVMS). RESULTS The HIVMS had a strong Cronbach's alpha (0.80) and acceptable test-retest reliability (0.70). HIVMS scores were strongly correlated with measures of perceived control, optimism, and psychological well-being. Participants with lower HIVMS scores had higher probability of non-adherence to antiretroviral medication, suggesting a decreased ability to manage their illness successfully. Neither the control nor expressive writing intervention groups showed increased HIVMS scores. CONCLUSIONS Future research is necessary to determine the effect of HIV meaning on long-term health outcomes and to develop interventions that can significantly improve a person's perception of their meaning in life.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave Suite 750, Nashville, TN 37203 USA
| | - Lois J Wagner
- Nursing and Allied Health, Regents Online Campus Collaborative, Tennessee Board of Regents, Memphis, USA
| | - Kenneth A Wallston
- School of Nursing, Vanderbilt University, 421 Godchaux Hall, Nashville, TN 37240 USA
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Peltzer JN, Domian EW, Teel CS. Infected Lives: Lived Experiences of Young African American HIV-Positive Women. West J Nurs Res 2014; 38:216-30. [PMID: 25239137 DOI: 10.1177/0193945914552167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.
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Affiliation(s)
- Jill N Peltzer
- University of Kansas School of Nursing, Kansas City, USA
| | | | - Cynthia S Teel
- University of Kansas School of Nursing, Kansas City, USA
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15
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Barroso J, Relf MV, Williams MS, Arscott J, Moore ED, Caiola C, Silva SG. A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS Patient Care STDS 2014; 28:489-98. [PMID: 25084499 DOI: 10.1089/apc.2014.0014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.
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Affiliation(s)
- Julie Barroso
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | | | | | - Joyell Arscott
- Duke University School of Nursing, Durham, North Carolina
| | | | | | - Susan G. Silva
- Duke University School of Nursing, Durham, North Carolina
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Piper K, Enah C, Daniel M. Black southern rural adolescents' HIV stigma, denial, and misconceptions and implications for HIV prevention. J Psychosoc Nurs Ment Health Serv 2014; 52:50-6. [PMID: 24530218 DOI: 10.3928/02793695-20140210-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022]
Abstract
The HIV/AIDS epidemic is becoming increasingly concentrated among African Americans who live in the rural South. HIV denial, stigma, and misconceptions have been identified as helping spread the virus among adults. However, little is known about these psychosocial factors among African American rural adolescents. This article presents findings from a study aimed at exploring the role HIV denial, stigma, and misconceptions play in the disproportionate impact of HIV/AIDS on African American adolescents in the rural South. A mixed-method study, which included questionnaires and focus group discussions, was used. Results indicated that the majority of participants had average HIV knowledge levels and that HIV denial, stigma, and misconceptions played a role in the current HIV/AIDS epidemic among rural African American adolescents. Nurses and health care professionals can play a key role in understanding and addressing HIV stigma, denial, and misconceptions among African American adolescents in the rural South to reduce HIV/AIDS health disparities among this population.
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Audet CM, McGowan CC, Wallston KA, Kipp AM. Relationship between HIV stigma and self-isolation among people living with HIV in Tennessee. PLoS One 2013; 8:e69564. [PMID: 23950897 PMCID: PMC3738573 DOI: 10.1371/journal.pone.0069564] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION HIV stigma is a contributing factor to poor patient outcomes. Although HIV stigma has been documented, its impact on patient well-being in the southern US is not well understood. METHODS Thirty-two adults participated in cognitive interviews after completing the Berger HIV or the Van Rie stigma scale. Participant responses were probed to ensure the scales accurately measured stigma and to assess the impact stigma had on behavior. RESULTS Three main themes emerged regarding HIV stigma: (1) negative attitudes, fear of contagion, and misperceptions about transmission; (2) acts of discrimination by families, friends, health care providers, and within the workplace; and (3) participants' use of self-isolation as a coping mechanism. Overwhelming reluctance to disclose a person's HIV status made identifying enacted stigma with a quantitative scale difficult. DISCUSSION Fear of discrimination resulted in participants isolating themselves from friends or experiences to avoid disclosure. Participant unwillingness to disclose their HIV status to friends and family could lead to an underestimation of enacted HIV stigma in quantitative scales.
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Affiliation(s)
- Carolyn M Audet
- Institute for Global Health, Vanderbilt University and Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health 2013; 30:79-88. [PMID: 24383487 DOI: 10.1111/jrh.12032] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. METHODS The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P < .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. RESULTS For 6,714 respondents, bivariate analyses revealed differences (P < .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P < .05) to rural residence (OR = 1.69), male sex (OR = 1.24), younger age (18-34 years OR = 2.34; 35-49 years OR = 2.10), lack of health insurance (OR = 1.43), lack of confidence in personal health care (OR = 2.24), lack of regular provider (OR = 1.49), little trust in physicians (OR = 1.34), and poor provider rapport (OR = 0.94). CONCLUSION The results of this study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes.
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Affiliation(s)
- Angela M Spleen
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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