HIV symptom severity and associated factors among young people with HIV in Ghana.

ABSTRACTAdolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18-24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care.

Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study.

Young people living with HIV (YPLH) are at risk for poor treatment adherence. Short message service (SMS) interventions can improve adherence, yet few exist for YPLH. Our study investigated preferences for a game-based SMS intervention among YPLH in Ghana. Thirty-two YPLH, ages 18 to 24, were recruited from an HIV clinic to complete in-depth interviews. Content analysis of interview data revealed areas of technology use relevant to intervention implementation, including mobile communication preferences, internet access, and mobile game use. Participants reported high perceived utility towards intervention features: treatment reminders, gamification components, and involvement of supportive individuals (e.g., providers). Issues with privacy, literacy, and cultural/developmental appropriateness were among concerns raised. Suggestions were made for strengthening basic SMS features (e.g., using code words to protect privacy) and incorporating advanced features (e.g., simplifying game interactions). This novel approach may help engage YPLH in HIV care if carefully developed with attention towards its mechanisms and user preferences.

A Review of Interventions to Enhance HIV Medication Adherence.

PURPOSE OF REVIEW: Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS: There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.

Cultural context matters: Testing the minority stress model among Chinese sexual minority men.

Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Protective Model for Suicidal Behaviors in American and Pakistani College Students.

There is a paucity of cross-national studies evaluating protective models for suicidal behaviors. Thus, using a behavioral framework, the purpose of this study was to examine whether higher levels of life-enhancing behaviors could mitigate or weaken the relation between depressive symptoms and suicidal behaviors in United States and Pakistani college students. A total of 811 students (449 Pakistani and 362 U.S. students) participated in the study. Results indicated that the strength of the relation between depressive symptoms and suicidal behaviors was stronger for U.S. students. In addition, the association between depressive symptoms and suicidal behaviors weakened in the presence of high engagement in life-enhancing behaviors. This effect was comparable in strength for American versus Pakistani students. The results offer preliminary evidence for life-enhancing behaviors as a protective factor for suicide across unique cultural settings and may serve as a valuable area of focus for secondary prevention programs.

Protective parenting practices among mothers living with HIV and their adolescent children: a qualitative study.

Growing up with a mother living with HIV (MLH) is a unique experience for adolescents. Children in these families often thrive; however, many also exhibit behavioral health problems including HIV risk behaviors. Under a lens of youth risk reduction, we examined the role of protective parenting practices in their lives including parent-child communication about sex, parent-child relationship quality, parental monitoring, and mother-to-child HIV disclosure. For this exploratory study, we conducted four focus groups with MLH (n = 15) and 13 in-depth interviews with HIV-negative adolescent children of MLH. Participants were primarily African American and recruited from clinics and non-profit organizations in the southeastern United States. A thematic analysis of focus group and in-depth interview data revealed that mothers' prior experiences with HIV and HIV-related risks often underlie their strengths as parents - for example, confidence in their ability to discuss sexual risk topics with their children as well as enhanced motivation to monitor their children's whereabouts and exposure to risky environments. Nonetheless, many MLH face challenges, including problems with mother-to-child HIV disclosure and relationship disruptions, which likely hinder protective parenting. Implications of our findings include specific recommendations for adapting effective and culturally-informed prevention interventions for families affected by maternal HIV infection.

Predictors of viral suppression among youth living with HIV in the southern United States.

Youth living with HIV (YLH) in the United States (U.S.) face significant problems with achieving viral suppression, especially in the South. To examine this issue, YLH with a detectable viral load (N = 61) were recruited from the southern U.S and assessed over 16 weeks for health and treatment factors. Participants were part of a smartphone-based intervention trial. Analyses focused on predictors of viral suppression controlling for intervention effects. Fifty-three percent achieved suppression. In univariate models, YLH who engaged in condomless sex four to 16 weeks into the study (odds ratio [OR] = 4.00; compared to those who did not) and self-reported ≥ 90% antiretroviral adherence in the first four weeks of the study (OR = 25.00; compared to youth with <90%) had a higher likelihood of suppression. Shifts in adherence-related social support (OR = 4.98) and appointments kept (OR = 2.72) were also associated with suppression. YLH endorsing illicit drug use had a lower likelihood of suppression (OR = 0.16; compared to those without use). Effects (except drug use) remained significant or approached significance in a multivariate model. Adherence promotion efforts should consider this population's adherence-related social support, drug use, and risk for sexually transmitted infections.

Measuring Antiretroviral Adherence Among Young People Living with HIV: Observations from a Real-Time Monitoring Device Versus Self-report.

This report compares self-report (SR) antiretroviral (ARV) adherence data to adherence data collected via Wisepill, a real-time electronic monitoring (EM) device, among young people living with HIV (YPLH) in the southern United States. Participants (n = 66; ages 16 to 26) were followed for 14 weeks. Descriptive analyses were used to compare SR to EM data. Correlations and a linear regression were conducted to explore factors possibly associated with SR-EM discrepancies. We also examined associations between various levels of SR and EM adherence and viral suppression/non-suppression at 14 weeks. Rates of SR adherence were maintained between 87% and 92% while rates of EM adherence declined from 64% to 34%. YPLH who were ARV-experienced, had lower treatment motivation, and reported more frequent recent marijuana use, had a greater discrepancy between their SR and EM adherence levels compared to other YPLH. Higher rates of SR and EM adherence were independently associated with a decline in viral load. A sensitivity analysis also revealed that SR adherence was a better predictor of viral non-suppression, whereas EM adherence was a better predictor of viral suppression. These measurement approaches are discussed in the context of providing clinical care to YPLH.

Correlates of missed clinic visits among youth living with HIV.

Youth living with HIV (YLH) have significant problems with attending their medical appointments. Poor attendance, consequently, predicts viral non-suppression and other negative health outcomes. To identity targets of intervention, this cross-sectional study examined correlates of past-year missed clinic visits among YLH (N = 2125) attending HIV clinics in the United States and Puerto Rico. Thirty-six percent of YLH missed two or more visits in the past year. Several factors were associated with missed visits in our regression model. Among sociodemographic characteristics and HIV disclosure status, females (adjusted odds ratio [OR] = 1.63, compared to males), Black YLH or YLH of mixed racial heritage (AORs = 1.76, 1.71, respectively, compared to White YLH), YLH with an unknown route of infection (AOR = 1.86, compared to YLH with perinatal infection), and YLH endorsing HIV disclosure (AOR = 1.37, compared to YLH not endorsing disclosure) were at greater risk for missed visits. Among behavioral health risks, YLH who endorsed marijuana use (AOR = 1.42), frequent other drug use (AOR = 1.60), or a history of incarceration (AOR = 1.27) had greater odds of missed visits than youth not endorsing these risks. Finally, two social-cognitive resources emerged as protective factors: adherence self-efficacy (AOR = .28) and social support (AOR = .88). We discuss how providers working with YLH can improve this population's retention outcomes.

Validation of a brief measure of HIV health-related anxiety among women living with HIV.

Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health.

South African Adolescents' Neighborhood Perceptions Predict Longitudinal Change in Youth and Family Functioning.

This study examined South African early adolescent youth (aged 10 to 14) and their female caregivers (N = 99 dyads) participating in an HIV prevention intervention over a period of eight months. We examined youth perceptions of neighborhood cohesion, safety, and collective monitoring as they related to concurrent and longitudinal associations with youth (externalizing behavior and hope about the future) and family (parent-youth relationship quality, parental involvement, and parental responsiveness to sex communication) functioning while controlling for baseline characteristics. Neighborhood perceptions were significantly associated (p < .05) with short- and longer-term outcomes. Gender differences suggested a greater protective association of perceived neighborhood conditions with changes in functioning for boys versus girls. Unexpected associations were also observed, including short-term associations suggesting a link between better neighborhood quality and poorer family functioning. We account for the culture of this South African community when contextualizing our findings and conclude with recommendations for interventions targeting neighborhood contexts.

Procrastination and suicide proneness: A moderated-mediation model for cognitive schemas and gender.

This study examined the direct and indirect paths between procrastination and suicide proneness while considering gender differences. Participants included 547 undergraduates from a southeastern university. Procrastination was positively related to suicide proneness for both genders, although this relation was stronger for women. Moderated-mediation analyses with bootstrapping highlighted insufficient self-control schemas as a mediator in the relation between procrastination and suicide proneness. However, indirect pathways did not vary by gender. Results represent an extension of the Procrastination-Health Model by highlighting the contribution of cognitive factors in explaining the relation between procrastination and suicide proneness.

Parent-child conflict and drug use in college women: a moderated mediation model of self-control and mindfulness.

This cross-sectional study examined the association between parent-child conflict and illicit drug use in a sample of female college students (N = 928). The mediating roles of self-control and mindfulness, as well as an interaction between self-control and mindfulness, were examined in a moderated mediation model for the purposes of expanding etiological theory and introducing targets for the prevention and treatment of drug abuse. Whereas deficits in self-control were found to facilitate the positive relation observed between parent-child conflict and the likelihood of experiencing drug-related problems, an interaction between mindfulness and self-control helped explain the association between parent-child conflict and intensity of drug-related problems. Parent-child conflict was related to low mindfulness when self-control was low, and low mindfulness in turn was related to a higher intensity of drug-related problems. This association did not exist for women with high self-control. Findings are consistent with developmental research on the etiology of drug use and the protective properties of mindfulness and self-control. Mindfulness as a potential target of intervention for drug users with low self-control to prevent drug-related problems is explored.

The use of the brief symptom inventory among youth living with HIV: a scoping review.

The brief symptom inventory (BSI), a 53-item measure that assesses psychological distress, is a popular tool for measuring mental health symptoms among youth living with HIV (YLH) in the United States (US); however, it has been used inconsistently with this population. This scoping review summarizes discrepancies in the use of the BSI to identify opportunities to improve systematism and make recommendations for clinicians and researchers, and highlights correlates of psychological distress among YLH as measured by the BSI. Databases searched included PsycINFO, PubMed, and CENTRAL. Eligible studies that assessed psychological distress using the BSI among YLH, were conducted in the US, and were written in English. Of the 237 articles identified, 57 were selected for inclusion. Studies investigated associations between BSI scores and several variables, including pre- versus post-highly active antiretroviral therapy (ART) era, ART adherence, sexual risk behavior, substance use, stigma, social support, self-efficacy, mode of HIV infection, and sexual orientation. There was variation in BSI elements used as outcome measures, sample age ranges, and reporting of mean scores and cutoff t-scores. 89.5% (n = 51) of studies did not report which BSI norms were used in their data analysis, and 68.4% of studies (n = 39) did not report the cut-off t-score value used. Variability in study objectives restricted this study to a scoping review rather than a meta-analysis. Generalizability to non-US settings is another limitation. More consistency in how the BSI is used among YLH is needed to accurately identify distress among YLH and provide tailored interventions to address their unique challenges.

The Impact of Different Parental Figures of Adolescents Living With HIV: An Evaluation of Family Structures, Perceived HIV Related Stigma, and Opportunities for Social Support.

Although antiretroviral therapy (ART) has changed the expected health outcomes for HIV, there are still issues related to stigma, how people living with HIV are perceived, and the availability of social support. The purpose of this study was to explore the associations between family structure and psychosocial wellbeing reflected by perceived HIV stigma and social support among adolescents living with HIV in Kumasi, Ghana. This article used baseline data from two mixed methods studies that evaluated the safety and preliminary efficacy of group-based support programs for ART adherence improvement among adolescents living in Kumasi, Ghana (N = 70, aged 12-18 years). A multivariate linear regression analysis was employed to examine the associations between family structure and the outcomes of stigma and social support. The main variables for family structure were single mothers and female caregivers. We found that single motherhood was a significant determinant of stigma. When compared to other categories of caregiver types, adolescents being raised by their single mothers was associated with a 0.259 decrease in the mean internal HIV stigma score (p = 0.029). Also, for female adolescents, being raised by a female guardian (e.g., mother, aunt, grandmother, and sister) was associated with a 20.92 point increase in the overall support index (p = 0.005). This study shows that the type of parent or guardian, and their gender, influences the perceived stigma and available social support among adolescents living with HIV in Ghana. Vulnerable subgroups of adolescents living with HIV, particularly those raised up by male caregivers, should be provided with additional support.

Unique and Shared Correlates of Sexual Violence Perpetration and Sexual Risk Behavior Among South African Adolescent Boys.

Associations between sexual risk behavior (SRB) and sexual violence perpetration (SVP) contribute to the intersecting HIV and sexual violence epidemics in South Africa. We examined SVP and SRB, and their potential correlates among South African boys (N = 80; ages 15-17). Fifty-one percent endorsed SVP in the past year; 61% engaged in past-3-month SRB. Whereas most unique correlates were socio-structural, family, or community factors, correlates shared across behaviors were behavior-specific social norm perceptions and cognitive factors. In final multivariate models, food insecurity and positive attitudes toward delaying sex were associated with SVP (odds ratios [ORs] = 3.05 and 0.37, respectively), and community violence exposure, gender equitable social norm perceptions, positive attitudes toward delaying sex, and intentions to obtain sexual consent were associated with SRBs (ORs = 1.56-1.57, 0.90-0.38, 0.58-0.60, respectively). Interventions to address HIV/sexual violence risk among adolescents in South Africa should be integrated and multilevel.

Factors associated with PrEP adherence among MSM living in Jackson, Mississippi.

Understanding the determinants of pre-exposure prophylaxis (PrEP) adherence is integral to reducing HIV incidence in the United States, especially for those at highest risk. To this end, the present study explored demographic, psychosocial, and behavioral factors related to adherence among 43 Southern, predominately Black, men who have sex with men (MSM). During the study months, 46% of the sample reported being nonadherent to PrEP. Those with more sexual partners (p = .05), greater self-efficacy for taking PrEP (p = .03), and those who felt condoms were less important (p = .02), were more likely to be adherent to PrEP at six-month follow-up. Further interventions that consider perceived sexual risk, condom use, and adherence self-efficacy are needed to improve PrEP adherence among Southern MSM.

Crack and Cocaine Use among Adolescents in Psychiatric Treatment: Associations with HIV Risk.

Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age=14.9 years) treated in intensive psychiatric treatment settings to understand the relationship between crack/cocaine use and HIV risk. Thirteen percent of youth reported ever using crack or cocaine. Use was not associated with age, gender, race/ethnicity or SES. After controlling for known factors that influence unprotected sex, the odds that those with a history of crack/cocaine use engaged in inconsistent condom use was six times greater than that for those youth who did not ever use. Thus, crack/cocaine use is prevalent even among younger adolescents with psychiatric disorders who are not in drug treatment. Its use is associated with high rates of sexual and other risk behaviors. A history of use should alert clinicians to a wide variety of possible behavioral risks. These results can also inform future adolescent HIV prevention intervention development.

Adherence to HIV Care and Associated Health Functioning among Youth Living with HIV in Sub-Saharan Africa.

Older adolescents and young adults (youth) living with HIV (YLH) in sub-Saharan Africa (SSA) are at high risk for poor HIV treatment adherence and associated negative health outcomes including viral nonsuppression. To describe this risk, we conducted a comprehensive review of studies involving YLH. Eligible studies compared youth adherence or adherence-related health functioning to older or younger samples, examined factors associated with adherence or health outcomes among YLH, or evaluated adherence interventions with YLH. Databases searched included MEDLINE, Web of Science, Global Health, CINAHL, Africa-Wide Information, PsycINFO, and the Cochrane Library. Of the 7054 articles found, 156 were reviewed and 130 were eligible. Across 16 adherence-related behaviors or health outcomes such as lost to follow-up, retention in care, antiretroviral use, CD4 count, viral suppression, and mortality, 73% of studies comparing YLH to other age groups (n = 106) found worse outcomes among YLH. In 22 studies, barriers and facilitators to adherence were identified, some unique to YLH (e.g., conflicting treatment expectations of providers) and some common to other age groups. Finally, of the eight adherence interventions with YLH reviewed, five showed evidence of being effective. Our findings suggest that YLH in SSA faces numerous obstacles to engaging in HIV treatment across a range of shifting social contexts. Accounting for this group's transition to treatment self-management, developmentally tailored and holistic interventions should be the focus of adherence promotion efforts.