Gender-based stigma and the prevention and treatment of HIV/AIDS among older women: A scoping review protocol

INTRODUCTION

The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women.

MATERIALS AND METHODS

We will use the framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form.

RESULTS

We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication.

DISCUSSION

To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.

DEVELOPMENT OF SOCIAL CONVOYS: TRAJECTORIES OF CONVOY STRUCTURE AND COMPOSITION FROM CHILDHOOD THROUGH ADULTHOOD

This study examines stability and change in social convoys from childhood to adulthood and variation in trajectories of convoy characteristics by gender and race. Multilevel models for convoy structure and composition were estimated using longitudinal data spanning 23 years. Respondents included a sample of 193 children aged 8 to 12 in Wave 1 (1992) who were surveyed again in their 20s (Wave 2) and 30s (Wave 3). Changes in composition, proximity, and contact frequency were observed at each wave. Between Waves 1 and 2, changes reflected age-normative trends toward network diversification typical of the transition to adulthood. Between Waves 2 and 3, changes were consistent with those expected as young adults settle into stable roles. We also identified convoy characteristics that differed between men and women and between Black and White individuals, emphasizing the importance of personal characteristics to fully understand form and function of social relations across the lifespan.

SUPPORT NEEDS AND RESOURCES OF OLDER WOMAN LIVING WITH HIV

People living with HIV are at increased risk for social isolation and sparse support networks, making it difficult to navigate complex caregiving needs as they age. This study aimed to identify the support needs and resources of older women living with HIV, an understudied population in this field, and their association with well-being. Participants included 217 heterosexual women aged 50 to 77 (Mage=59) from the ROAH 2.0 Study. Almost half of the sample (47.7%) had never required assistance because of HIV or other illness or disability, whereas the remainder required current or past assistance. Preliminary findings controlling for sociodemographics indicated that availability of emotional support, but not practical support (i.e., having someone to count on for activities of daily living), was associated with lower depressive symptomology. Identifying sources and types of support will help older women leverage existing social ties or form new ones to promote successful aging with HIV.

Maternal Stress, Familial Ties, and Children’s Well-Being Across 23 Years

According to the family stress model, parental stress impacts child well-being through several mechanisms, which may be amplified in ethnic/racial minority families given increased experiences of stress. We extend this model to examine associations between maternal stress and child well-being at three points spanning 23 years, beginning when children were aged 8-12 years and mothers were aged 24-59 (n=193 dyads). Preliminary results indicate that maternal stressors are associated with increased depressive symptoms in childhood (B=3.56, p<0.001), and this association was stronger among Black children compared to White (B=4.12, p<0.001). Effects of maternal stress on children’s depressive symptoms strengthened among White children with proportionally larger kin networks (B=0.05, p<0.001). However, this association weakens as children enter adulthood. Future work will focus on identifying social resources that account for changes in the intergenerational effects of stress.

EXPECTATIONS, ROLES, AND EXPERIENCES OF GRANDPARENT-CAREGIVERS OF CHILDREN WITH RARE DISEASE

Grandparenting can be a rewarding and health-promoting experience for older adults. However, grandparent-caregivers often experience greater stress and poorer health relative to non-caregiving grandparents. Further, little is known about grandparents caring for a child with a rare, chronic illness. This study aimed to extend knowledge of the expectations, roles, and experiences of grandparents providing care to a child affected with an inherited metabolic condition. The sample included 23 grandparent-mother dyads from the Inherited Diseases, Caregiving, and Social Networks Study. The grandparent sub-sample ranged from 49 to 79 years of age (Mage = 64), the majority were female (83%) and married (74%), and almost half (48%) were retired. Social network assessments were analyzed to determine concordance between mother- and grandparent-reports of grandparents’ role in the child’s caregiving network. Fifteen mother-grandparent dyads (65%) agreed on grandparents’ role in the child’s network, with the majority of those (93%) considering the grandparent to be very close and important (versus less close or excluded from the caregiving network). Grandparents whose self-reports of their role in their child’s caregiving networks were consistent with mother-reports appeared more likely to report that they spend enough time caregiving than those whose reports were inconsistent. Content analysis of grandparents’ interviews provided supporting information about the joys and regrets of their grandparenting experience and perspectives on caregiving expectations. This research leverages multi-informant social network and qualitative data to illuminate grandparents’ role in the caregiving networks of chronically ill children and adaptation to non-normative grandparenting experiences.