ABSTRACT
Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.
Subject(s)
Child Abuse, Sexual , Crime Victims , HIV Infections , Child , Humans , Aged , South Carolina/epidemiology , Quality of Life , Child Abuse, Sexual/psychology , HIV Infections/epidemiology , HIV Infections/psychology , Crime Victims/psychologyABSTRACT
Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16-29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme-the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities.
ABSTRACT
Findings on the association between childhood sexual abuse (CSA) and antiretroviral therapy (ART) adherence have been varied, with some studies showing a relationship, or a lack thereof. However, to our knowledge, no study has examined this association among older adults living with HIV (OALH). Therefore, the purpose of this study was to examine the association between CSA and ART adherence among OALH using a mixed methods approach. This study, which involved a concurrent design, had two phases. The first phase comprised in-depth, semi-structured interviews of 24 adults aged 50 and older living with HIV in South Carolina. The second phase included data from 91 OALH. Thematic analysis and multivariable regression models, adjusting for age, gender, race, and income, were used to determine the association between CSA and ART adherence. The main theme emerging from the qualitative data was that CSA was not linked with ART adherence. However, contrastingly, quantitative analyses revealed a negative statistically significant association between CSA and ART adherence (adjusted ß: -3.35; 95% CI: -5.37, -1.34). This difference in findings could be due to the hidden impact of trauma and/or the use of different study populations. Future research should assess mediating pathways between CSA and ART adherence.
Subject(s)
HIV Infections , Sex Offenses , Humans , Child , Middle Aged , Aged , HIV Infections/drug therapy , Anti-Retroviral Agents/therapeutic use , Gender Identity , Medication AdherenceABSTRACT
PURPOSE: Despite recommendations for cancer survivors to participate in routine physical activity (PA), offering programs that fit both survivors' needs and sponsoring organizations' resources remains a challenge. The purpose of this study is to explore the perspectives of cancer survivors and organizational stakeholders with the intent of developing PA peer-led programs that organizations can implement into their programming. METHODS: This study explored cancer survivors' (n = 11) and cancer care organizational stakeholders' (n = 27) perspectives on the design and feasibility of PA programs targeted for cancer survivors. Semi-structured interview guides were developed for survivors and stakeholders; interviews lasted approximately 30 min. Two analysts used a thematic analysis approach and independently conducted a line-by-line coding of each transcript. With guidance from a senior analyst, the codes were collapsed into themes and subthemes. RESULTS: The qualitative analysis of the interview data resulted in seven major themes relating to PA program development and success. Survivor-related themes included the following: (1) developing PA programs based on cancer survivors' characteristics and experiences; (2) perceived value and importance of accessible, face-to-face instruction; (3) ensuring success based on physical abilities and limitations of the survivor; and (4) the value of physician recommendation for PA participation. Organization-related themes included the following: (1) incorporating participant and community input into program offerings; (2) program feasibility and sustainability; (3) incorporating organizational experience when adopting new program initiatives. CONCLUSION: These findings highlight the challenges of developing viable PA programs for cancer survivors and may guide organizations in future program development and implementation.
Subject(s)
Cancer Survivors , Neoplasms , Humans , Exercise , Survivors , Program Development , Qualitative Research , Neoplasms/therapyABSTRACT
ABSTRACTMonitoring cancer trends and risk is critical as cancer remains a growing problem in persons living with HIV (PLWH). Recent population-based data are limited regarding the cancer trends among PLWH. Our study examined the prevalence and trends in the rate of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and their risk factors in PLWH in South Carolina. Utilizing linked population-based HIV data (2005-2020), time-dependent proportional hazards model was used to identify associated risk predictors of developing cancer in PLWH. Among 11,238 PLWH, 250 individuals developed ADC and 454 developed NADC. The median time from HIV diagnosis to cancer diagnosis was 1.9 years for ADC and 3.8 years for NADC. Individuals who developed ADC or NADC were more likely to be older, male, use substances, have hepatitis infection, hypothyroidism, hypertension, and renal disease. Individuals with viral load >100,000 copies/ml were more likely to develop ADC while those with CD4 count >350 cells/mm3 were less likely to develop ADC or NADC. Our findings suggest that long-term viral suppression may contribute to risk reduction for cancer in PLWH. Early HIV diagnosis along with viral load suppression should be a part of ongoing cancer prevention efforts.
Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Neoplasms , Humans , Male , HIV Infections/epidemiology , South Carolina , Cohort Studies , Prevalence , Incidence , Neoplasms/complications , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
People living with HIV often have complex identities and histories. Understanding how these experiences influence adherence to treatment and quality of life are critical to the HIV care. The experiences of older adults living with HIV are uniquely embedded within biology and aging as well as gender. This study described the gendered strategies for coping with HIV among older adults who are childhood sexual abuse survivors. Audio-recorded semi-structured interviews were performed with 24 adults who are 50 years and older from a clinic in South Carolina. Thematic analysis approach was used to discuss key concepts, reconcile codes, and name emergent themes. Overall, the participants used a spectrum of coping strategies including spirituality, seclusion, social support, substance use, engagement in HIV care, information acquisition and sharing, and cognitive reframing. Our findings suggest the potential for growth and recovery is heightened if the interplay of HIV diagnosis, aging, coping, and mental health is considered. Healthcare providers should assess the ways in which individuals interpret their HIV diagnosis and other lived experiences to better understand their patients' mental health. Knowledge of gender-based coping strategies used in HIV-relevant outcomes can be translated into more effective treatment plans to improve the overall quality of life.
Subject(s)
HIV Infections , Sex Offenses , Humans , Child , Aged , HIV Infections/psychology , Quality of Life , Adaptation, Psychological , Survivors/psychology , Qualitative ResearchABSTRACT
Older adults living with HIV (OALH) undergo challenges such as comorbidities, social isolation, and "double stigma" associated with their HIV and aging statuses. Simultaneously, research has shown that experiences of childhood sexual abuse (CSA) continue to impact the quality of life across the lifespan and may pose unique hardships for older adults. Despite the high prevalence of trauma among people living with HIV, research examining the psychosocial challenges of OALH with a CSA history is scant. To address this gap in the literature, this study aimed to explore psychosocial challenges among OALH who are CSA survivors using a qualitative approach. Twenty-four in-depth, semi-structured interviews were completed with OALH (age 50 years and older) who reported histories of CSA. Multiple coders and an inductive coding process were employed for data analysis. Four main themes regarding psychosocial challenges emerged from the analysis: (1) depression and suicidal ideation, (2) fear and anxiety, (3) social support issues, and (4) memory issues. The authors discuss the implications of these findings and the importance of trauma-informed treatment for these individuals.
Subject(s)
Child Abuse, Sexual , HIV Infections , Sex Offenses , Humans , Aged , Middle Aged , Child , HIV Infections/psychology , HIV , Quality of Life , Aging , Survivors/psychology , Child Abuse, Sexual/psychologyABSTRACT
OBJECTIVES: The influence of childhood sexual abuse (CSA) may be seen immediately or across the life course. CSA is also associated with increased HIV-risk behavior, and greater likelihood of an HIV/STI diagnosis. The aim of this study was to explore the perspectives of CSA among older adults living with HIV. METHODS: Twenty-four adults living with HIV aged 50 to 67 years (mean age = 58.5 years), with a history of CSA, receiving care from an HIV clinic in South Carolina, participated in the study. In-depth semi-structured interviews were conducted, audio recorded and analyzed using a thematic analytic approach. The iterative analytic process included a three-step approach: discussion of initial thoughts and key concepts, identification and reconciliation of codes, and naming of emergent themes. RESULTS: Four themes emerged: Psychological issues due to CSA, relationship challenges due to CSA, self-blame, and reliving childhood trauma (subtheme: lack of influence of CSA today). Some participants reported feeling the influence of CSA several years after the event while others noted that that there was a lack of influence of CSA at present. CONCLUSIONS: Trauma-informed intervention programs are needed for older adults living with HIV who still experience the influence of their CSA experience. Future research should delve into the design and feasibility of implementing these programs.
Subject(s)
Adverse Childhood Experiences , Child Abuse, Sexual , HIV Infections , Sexually Transmitted Diseases , Humans , Aged , Child , HIV Infections/psychology , South Carolina , Sexual BehaviorABSTRACT
OBJECTIVES: Childhood sexual abuse (CSA) prevalence estimates range from 8-11% among older adults and may range from 16 to 22% among older adults living with HIV (OALH). CSA experiences can still impact the quality of life of older adults. To the best of our knowledge, however, there are no CSA-focused interventions tailored for OALH. Using a qualitative approach, this study characterized the desired components of a trauma-focused intervention for OALH who are CSA survivors. METHODS: Twenty-four (24) adults aged 50 years of age or older who were living with HIV and had experienced CSA were recruited from a large HIV immunology center in South Carolina. Participants completed in-depth, qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. RESULTS: Three main themes emerged: program format and modality, program content, and program coordinator. Most participants expressed a desire for a trauma-focused intervention program in which the CSA experience was addressed and they could talk to someone either individually, as a group, and/or both. CONCLUSION: A trauma-focused intervention addressing CSA may be helpful for OALH who are CSA survivors. Future research should focus on designing and implementing age-appropriate interventions addressing the CSA experience, increasing resilience, and developing adaptive coping skills.
Subject(s)
HIV Infections , Sex Offenses , Humans , Aged , Child , Quality of Life , Survivors , Surveys and QuestionnairesABSTRACT
ABSTRACT: Undetectable = Untransmittable (U = U) means that people with HIV who achieve and maintain an undetectable viral load have effectively zero risk of sexually transmitting the virus to others. However, research on how U = U is perceived by older adults living with HIV (OAH) is currently lacking. This study explored U = U views among OAH. From October 2019 to February 2020, we conducted open-ended interviews with 24 OAH recruited at an HIV clinic in South Carolina. Interviews were audio-recorded and transcribed. We employed thematic analysis in this study. Three themes emerged from the analysis: (a) Conflicting beliefs in U = U; (b) Use condoms regardless; and (c) Fear of HIV reinfection. Despite strong scientific evidence supporting U = U, some OAH do not believe in U = U. This lack of belief could deprive OAH of the benefits U = U offers. Therefore, it is vital to educate OAH about U = U to enhance their understanding and belief in U = U.
Subject(s)
HIV Infections , Qualitative Research , Humans , South Carolina , HIV Infections/psychology , Female , Male , Middle Aged , Aged , Health Knowledge, Attitudes, Practice , Viral Load , Condoms/statistics & numerical data , Interviews as Topic , Sexual Behavior/psychologyABSTRACT
Objective: Human immunodeficiency virus (HIV) remains a critical public health challenge and disproportionately affects young adults, racial minorities, and residents of the Southern United States. This study aimed to investigate HIV knowledge, risk perception, and testing behaviors among a sample of college students in South Carolina (SC). Participants: Undergraduate students (N = 256) from a large public university in SC. Methods: Participants completed a cross-sectional survey on HIV knowledge, testing behaviors, and attitudes. Results: More than one-third of participants displayed misunderstanding about HIV transmission. Less than 20% perceived themselves to be at-risk for HIV, and only 8% reported having ever been tested for HIV. In addition, a majority of participants (83%) reported they would feel ashamed if they acquired HIV. HIV knowledge was negatively correlated with HIV testing. Conclusions: Results indicate the need for HIV education among college students in SC to clear misconceptions, minimize knowledge gaps, reduce HIV-related stigma, and promote HIV testing.
Subject(s)
HIV Infections , HIV , Young Adult , Humans , United States , HIV Infections/diagnosis , HIV Infections/prevention & control , South Carolina , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Students , Universities , Surveys and Questionnaires , PerceptionABSTRACT
Objective: Half of new human papilloma virus ( (HPV)) infections occur between the ages of 15 and 24. As preventive measures are underutilized globally; international university students are at particular risk for HPV infection and sequelae. The study aim was to explore HPV knowledge and preventive behaviors in this population. Participants: Eighty-one undergraduate and graduate international university students (49 females, 32 males) at a southeastern university. Methods: Exploratory sequential mixed methods guided by the Health Belief Model. Results: Integrated qualitative/quantitative data revealed four themes mapped to relevant HBM constructs: Perceived susceptibility to HPV; Perceived benefits/Perceived barriers to HPV prevention; Cues to Action; and Likelihood of Engaging in Health-Promoting Behavior. Over half believed they were not at risk for HPV/sequelae. Only a quarter had received HPV vaccination. Conclusions: International university students represent an important catch-up population for HPV screening/vaccination. Results can be used to design and tailor interventions for this vulnerable population.
Subject(s)
Papillomavirus Infections , Papillomavirus Vaccines , Adolescent , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Papillomaviridae , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/therapeutic use , Patient Acceptance of Health Care , Students , Universities , Vaccination , Young AdultABSTRACT
We assessed the feasibility and acceptability of examining breast/chest feeding attitudes among African Americans in South Carolina using an explanatory sequential, mixed methods approach. We surveyed 50 pregnant African American women during their ob-gyn appointment (Phase I), followed by qualitative interviews with four African American couples (N = 8) (Phase II), and integrating quantitative-qualitative data through joint display (Phase III). Phase I supported the feasibility of recruiting pregnant African American women for our study. However, for Phase II, more research is needed to support the feasibility of recruiting couples from the quantitative phase. The Iowa Infant Feeding Attitude Scale demonstrated moderate reliability (α = 0.68). Participants intending to exclusively breastfeed (M = 65, SD = 5.79) had higher scores than those intending to exclusively use formula (M = 50, SD = 4.37, p < .001). The six qualitative themes (Phase II) and data integration (Phase III) identified cultural considerations for future research.
Subject(s)
Black or African American , Breast Feeding , Feasibility Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Infant , Mothers , Pregnancy , Reproducibility of ResultsABSTRACT
ABSTRACT: HIV disclosure is an important consideration for people living with HIV. The prevalence of childhood sexual abuse (CSA) may range from 16% to 22% among older adults living with HIV. There is a dearth of research on HIV disclosure among older CSA survivors. Therefore, the aim of this study was to qualitatively examine HIV disclosure among older CSA survivors living with HIV. Twenty-four CSA survivors living with HIV (aged 50-67 years) participated in in-depth, semistructured interviews. Data were analyzed thematically, and the iterative coding and analytic process included discussion of initial thoughts and key concepts, identification and reconciliation of codes, and naming of emergent themes. Four themes emerged: (a) secrecy/not planning to disclose HIV; (b) disclose HIV regardless; (c) disclose HIV depending on the person; and (d) disclose HIV depending on the circumstance. Lack of disclosure may be due to HIV-related stigma. HIV disclosure intervention programs may be beneficial for this population.
Subject(s)
HIV Infections , Sex Offenses , Aged , Disclosure , Humans , South Carolina , SurvivorsABSTRACT
CONTEXT: Despite improvements in reproductive health indicators among women living in Sub-Saharan Africa, the persistence of poor outcomes underscores the need to examine recent interventions to inform future research, programming and policy. Because men in this context have an outsize role in reproductive decision making, assessing their involvement in reproductive health programs is an important step in meeting men's needs, supporting women's health and improving family health. METHODS: A scoping review was conducted to identify relevant literature and assess evidence of the impact of male involvement in reproductive health interventions. Seven databases were searched using terms related to male involvement and reproductive health; searches were limited to research conducted in Sub-Saharan Africa and published in English between 2007 and 2018. Remaining studies were assessed by participant characteristics, settings, research design, theoretical frameworks, outcome measures and findings. RESULTS: Searches identified 18 studies conducted in eight countries. Interventions engaged participants by using such strategies as community health workers, written invitation, peers, community or religious leaders and media campaigns. Results show that men are willing to participate in reproductive health programs and that their involvement is associated with increased uptake of family planning services, and HIV counseling and testing; reduction in risk behaviors; and improved maternal health and spousal communication. CONCLUSIONS: Given the findings that male involvement is positively associated with improved reproductive health outcomes in Sub-Saharan Africa, health providers and program planners should consider including men in reproductive health interventions, when feasible.
RESUMEN Contexto: A pesar de las mejoras observadas en los indicadores de salud reproductiva en las mujeres que viven en África subsahariana, la persistencia de malos resultados subraya la necesidad de examinar intervenciones recientes para sustentar futuras investigaciones, programas y políticas. Debido a que los hombres en este contexto tienen un papel enorme en la toma de decisiones reproductivas, evaluar su participación en los programas de salud reproductiva es un paso importante para responder a las necesidades de los hombres, apoyar la salud de las mujeres y mejorar la salud familiar. Métodos: Se realizó una revisión de alcance para identificar bibliografía relevante y evaluar la evidencia del impacto de la participación masculina en las intervenciones de salud reproductiva. Se realizaron búsquedas en siete bases de datos utilizando términos relacionados con la participación masculina y la salud reproductiva; las búsquedas se limitaron a investigaciones realizadas en África subsahariana y que fueron publicadas en inglés entre 2007 y 2018. Los estudios restantes se evaluaron según las características de los participantes, los entornos, el diseño de la investigación, los marcos teóricos, las medidas de resultado y los hallazgos. Resultados: Las búsquedas identificaron 18 estudios conducidos en ocho países. Las intervenciones involucraron a los participantes mediante estrategias tales como la labor de trabajadores de salud comunitarios, invitaciones por escrito, interacción con pares, líderes comunitarios o religiosos y campañas en los medios. Los resultados muestran que los hombres están dispuestos a participar en programas de salud reproductiva y que su participación está asociada con una mayor aceptación de los servicios de planificación familiar, así como de consejería y pruebas de VIH, reducción de comportamientos de riesgo, y mejor salud materna y comunicación conyugal. Conclusiones: Con base en los hallazgos que indican que la participación masculina se asocia positivamente con mejores resultados de salud reproductiva en el África subsahariana, los proveedores de servicios de salud y los planificadores de programas deberían considerar incluir a los hombres en las intervenciones de salud reproductiva cuando sea posible.
RÉSUMÉ Contexte: Malgré l'amélioration des indicateurs de santé reproductive chez les femmes d'Afrique subsaharienne, la persistance de résultats défavorables souligne la nécessité d'examiner les interventions récentes en vue d'éclairer la recherche, la programmation et les politiques futures. Étant donné, dans ce contexte, l'immense rôle des hommes dans les décisions ayant trait à la reproduction, l'évaluation de leur participation aux programmes de santé reproductive représente une étape importante en termes de réponse aux besoins des hommes, de soutien de la santé des femmes et d'amélioration de la santé des familles. Méthodes: Un examen de portée a été effectué pour identifier la littérature pertinente et évaluer les signes de l'impact de la participation masculine aux interventions de santé reproductive. La recherche a été menée dans sept bases de données au moyen de termes associés à la participation masculine et à la santé reproductive; elle s'est limitée aux études effectuées en Afrique subsaharienne et publiées en anglais entre 2007 et 2018. Les études restantes ont été évaluées d'après les caractéristiques des participants, les contextes, le plan de recherche, les cadres théoriques, les mesures de résultat et les observations. Résultats: La recherche a identifé 18 études menées dans huit pays. Les interventions engageaient les participants au moyen de stratégies recourant, notamment, aux agents de santé communautaire, aux invitations écrites, aux pairs, aux dirigeants communautaires ou religieux et aux campagnes médiatiques. Les résultats montrent que les hommes sont disposés à participer aux programmes de santé reproductive et que leur participation est associée à une adoption accrue des services de planification familiale et du conseil et dépistage du VIH, à la réduction des comportements à risques et à l'amélioration de la santé maternelle et de la communication au sein du couple. Conclusions: Face au constat de l'association positive entre la participation masculine et l'amélioration des résultats de santé reproductive en Afrique subsaharienne, il convient que les prestataires de santé et les planificateurs de programmes incluent si possible les hommes dans les interventions de santé reproductive.
Subject(s)
Contraception Behavior/statistics & numerical data , Contraceptive Devices, Male/statistics & numerical data , Decision Making , Family Planning Services/organization & administration , Adult , Africa South of the Sahara , Contraceptive Agents, Male/therapeutic use , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand/statistics & numerical data , Humans , Male , Reproductive Health , Socioeconomic FactorsABSTRACT
BACKGROUND: Population health is a critical component of Doctor of Nursing Practice (DNP) education, providing the foundation for clinical prevention, health equity, responsible policy, and practice change. Many DNP learners enter population health courses focused on individual patient care in microsystems. Transformative learning broadens learners' perspectives about health determinants and implications for health system transformation. METHOD: Transformative learning strategies were imbedded in a 10-week, online population health course. Students engaged with readings and multimedia content and wrote anonymous reflective analyses about population health determinants. Qualitative survey data were explored for transformative content using line-by-line content analysis. The stages of transformative learning were used as a priori codes. RESULTS: Learners questioned their own beliefs and epistemologies and demonstrated all aspects of transformative learning, although not equally across course topics. CONCLUSION: To achieve the promised outcomes of DNP education, population health content should be professionally transformative and integrated across the curriculum. [J Nurs Educ. 2019;58(8):481-484.].