RESUMEN
BACKGROUND: The number of older women living with HIV in Africa is growing, and their health outcomes may be adversely impacted by social frailty, which reflects deficits in social resources that accumulate over the lifespan. Our objective was to adapt a Social Vulnerability Index (SVI) originally developed in Canada for use in a study of older women living with or without HIV infection in Mombasa, Kenya. METHODS: We adapted the SVI using a five-step process: formative qualitative work, translation into Kiswahili, a Delphi procedure, exploration of potential SVI items in qualitative work, and a rating and ranking exercise. Four focus group discussions (FGD) were conducted (three with women living with HIV and one with HIV-negative women), and two expert panels were constituted for this process. RESULTS: Themes that emerged in the qualitative work were physical impairment with aging, decreased family support, a turn to religion and social groups, lack of a financial safety net, mixed support from healthcare providers, and stigma as an added burden for women living with HIV. Based on the formative FGD, the expert panel expanded the original 19-item SVI to include 34 items. The exploratory FGD and rating and ranking exercise led to a final 16-item Kenyan version of the SVI (SVI-Kenya) with six domains: physical safety, support from family, group participation, instrumental support, emotional support, and financial security. CONCLUSIONS: The SVI-Kenya is a holistic index to measure social frailty among older women in Kenya, incorporating questions in multiple domains. Further research is needed to validate this adapted instrument.
Asunto(s)
Fragilidad , Infecciones por VIH , Anciano , Femenino , Infecciones por VIH/psicología , Humanos , Kenia , Estigma Social , Apoyo Social , Vulnerabilidad SocialRESUMEN
OBJECTIVE: Integration of mental health and chronic disease services in primary care could reduce the mental health treatment gap and improve associated health outcomes in low-resource settings. Low rates of nurse identification and referral of patients with depression limit the effectiveness of integrated mental health care; the barriers to and facilitators of identification and referral in South Africa and comparable settings remain undefined. This study explored barriers to and facilitators of nurse identification and referral of patients with depressive symptoms as part of integrated mental health service delivery in KwaZulu-Natal, South Africa. DESIGN: Triangulation mixed methods study incorporating qualitative and quantitative data. METHODS: Data collection, analysis, and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Participants were professional nurses at ten primary health care facilities in Amajuba, KwaZulu-Natal, South Africa. Qualitative data collection involved semi-structured interviews targeting specific CFIR constructs with high- and low-referring nurses. Deductive and inductive coding were used to derive primary themes related to barriers and facilitators. Quantitative data collection involved a structured questionnaire assessing determinants explored in the interviews. Qualitative comparative analysis was used to identify the necessary or sufficient conditions for high and low nurse referral. RESULTS: Twenty-two nurses were interviewed. Primary themes related to insufficient training, supervision, and competency; emotional burden; limited human and physical resources; perceived patient need for integrated services; and intervention acceptability. Sixty-eight nurses completed questionnaires. Quantitative results confirmed and expanded upon the qualitative findings. Low self-assessed competency was a consistent barrier to appropriate service delivery. CONCLUSIONS: To promote the success of integrated care in a context of severe staff shortages and over-burdened providers, implementation strategies including direct training, structured supervision, and routine behavioral health screening tools are warranted. Interventions to improve mental health literacy of patients as well as emotional support for nurses are also needed.
RESUMEN
Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3-5.1, p < 0.001 and OR 1.3:1.1-1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2-2.9, p < 0.001 and OR 1.4:1.2-1.6, p < 0.001), and cigarette use (OR 1.4:1.2-1.6, p < 0.001 and OR 1.3:1.2-1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Infecciones por VIH/epidemiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Fumar Cigarrillos/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Cocaína Crack , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Uso de la Marihuana/epidemiología , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. METHOD: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social-psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social-psychological resources as a mediator between minority stress and health. RESULTS: The final model demonstrated acceptable fit, χ²(79) = 414.00, p < .05, confirmatory fit index = .93, Tucker-Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social-psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. CONCLUSIONS: Findings indicate a significant impact of minority stressors and social-psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments.
Asunto(s)
Bisexualidad/psicología , Homosexualidad Femenina/psicología , Salud Mental , Grupos Minoritarios/psicología , Estrés Psicológico/psicología , Trastornos Relacionados con Sustancias/psicología , Mujeres/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Persona de Mediana Edad , Salud de las Minorías , Prejuicio , Apoyo Social , Espiritualidad , Encuestas y CuestionariosRESUMEN
Many Native women embrace the term two-spirit to capture their sexuality and gender expression. By analyzing the narratives of five two-spirit women who are Native activists, we explored contemporary understandings of the concept and what it means for Native communities. The incorporation of the identity within indigenous worldviews, its manifestation in terms of (be)coming out, and the triple stressors of heterosexism, racism, and sexism emerged as key themes.
Asunto(s)
Homosexualidad Femenina/etnología , Homosexualidad Femenina/psicología , Indígenas Norteamericanos/psicología , Prejuicio , Identificación Social , Adulto , Antropología Cultural , Femenino , Identidad de Género , Humanos , Persona de Mediana Edad , Relaciones Raciales , Autoimagen , Valores Sociales , Espiritualidad , Población BlancaRESUMEN
A survey of 142 Puerto Rican women living with HIV/AIDS in New York City revealed high Centers for Epidemiological Studies Depression (CES-D) scores, with 66% of the sample scoring above the conventional threshold of possible clinical depression. Most respondents (71%) were Catholic, 29% considered themselves members of a church or other place of worship, and 30% reported attending religious services 1-3 times a month. As predicted, spirituality was high and negatively associated with CES-D scores. A series of simultaneous multiple regression analyses controlling for all potentially confounding medical and sociodemographic variables demonstrated that both mastery and self-esteem scores mediated this relationship. Implications for future research and the provision of services to HIV-positive Puerto Rican women are discussed.
Asunto(s)
Depresión/etnología , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Hispánicos o Latinos/psicología , Espiritualidad , Aculturación , Adaptación Psicológica , Adulto , Catolicismo , Depresión/fisiopatología , Femenino , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Puerto Rico/etnología , Análisis de Regresión , Religión y Psicología , Autoimagen , Salud de la MujerRESUMEN
OBJECTIVES: This article proposes a new stress-coping model for American Indians and Alaska Natives (AIs) that reflects a paradigmatic shift in the conceptualization of Native health. It reviews sociodemographic information on AIs, rates of substance abuse and related health outcomes, and the research supporting the model's pathways. OBSERVATIONS: Although health outcomes among AIs are improving, large disparities with other racial and ethnic groups in the United States remain. Many health-related problems are directly linked to high rates of substance use and abuse. CONCLUSION: Eurocentric paradigms focus on individual pathology. An "indigenist" perspective of health incorporates the devastating impact of historical trauma and ongoing oppression of AIs. The model emphasizes cultural strengths, such as the family and community, spirituality and traditional healing practices, and group identity attitudes.
Asunto(s)
Adaptación Psicológica , Actitud Frente a la Salud/etnología , Etnicidad/psicología , Indígenas Norteamericanos/psicología , Modelos Psicológicos , Trastornos de Estrés Traumático/etnología , Trastornos Relacionados con Sustancias/etnología , Alaska/epidemiología , Características Culturales , Etnicidad/estadística & datos numéricos , Femenino , Infecciones por VIH/etnología , Estado de Salud , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Masculino , Medicina Tradicional , Prejuicio , Salud Pública , Factores de Riesgo , Espiritualidad , Trastornos de Estrés Traumático/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicología , Violencia/etnología , Violencia/psicologíaRESUMEN
This commentary presents an "indigenist" model of Native women's health, a stress-coping paradigm that situates Native women's health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the "soul wound" of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices. Current epidemiological data on Native women's general health and mental health are reconsidered within the framework of this model.