The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia.

Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.

Attitudes toward a mindfulness-based intervention from African American women living with HIV: A qualitative study.

INTRODUCTION: Mindfulness-based interventions train participants to pay attention to their own emotions in the current moment without judging themselves. This study aims to assess the attitudes toward a mindfulness-based stress reduction intervention among African American women living with HIV. METHODS: We collected qualitative data from three focus group discussions with 18 African American women living with HIV who were purposely recruited from the Palmetto Health-USC Immunology Center in South Carolina, United States. The participants discussed how they coped with stress, and then were given a presentation on mindfulness-based stress reduction and a sample mindfulness-based stress reduction mini workshop with follow-up discussion about their thoughts and opinions on the information presented to them. RESULTS: Participants said that mindfulness could be a useful technique and they were interested in participating in a mindfulness-based stress reduction program. Their main concerns included physical ability to perform some of the mindfulness techniques (e.g. yoga) and logistic barriers, such as schedule constraints. They also provided some suggestions to further tailor the mindfulness-based stress reduction, such as modifying yoga, using familiar terms, and combining both in-person and online components. These results suggest that African American women living with HIV showed strong interest in mindfulness-based stress reduction and a high level of willingness to participate in mindfulness-based stress reduction, but the existing mindfulness-based stress reduction program needs to be tailored to address challenges and barriers these women may face for attendance and completion. CONCLUSION: The next step is to further test the feasibility, acceptability, and efficacy through a pilot study for African American women living with HIV to practice a tailored mindfulness-based stress reduction for this group.

Perceptions of functional wellness in women living with HIV in South Carolina, United States: Voices from both patients and providers.

Functional wellness refers to optimal functioning across multiple domains of health and wellbeing (e.g., physical, psychological, social, spiritual), and posits that wellness goes beyond traditional physical/biological health outcomes to include behavioral and social dimensions of health. Its application could contribute to developing integrated care and improving self-management for HIV patients including women living with HIV (WLH). In order to explore the perceptions of functional wellness from the perspectives of both healthcare providers (HCPs) and WLH, we conducted in-depth interviews among a purposive sample of 20 WLH and 10 HCPs in South Carolina. Most of the WLH were African American, older, living in urban setting and diagnosed over five years ago. The HCPs were dominantly female and represented different types of healthcare providers. Qualitative analysis was guided by the ground theory and conducted using the software NVivo 11. The WLH and HCPs had some common perceptions on wellness. To achieve functional wellness, WLH should be living and functioning in their daily life, be able to take care of themselves and develop resilience, be engaged in social activities, and prevent themselves from comorbidities (e.g., chronic disease, mental health issues) by receiving holistic service in response to the needs of womanhood.