Gender, Age and COVID-19 Vaccination Status in African American Adult Faith-Based Congregants in the Southeastern United States.

OBJECTIVES: The COVID-19 pandemic has revealed significant differences in COVID-19 vaccination rates, with African Americans reporting lower rates compared to other racial and ethnic groups. The purpose of these analyses was to assess whether COVID-19 vaccination status differed according to age in a sample of 1,240 African American adult congregants of faith-based organizations ages 18 years or older, and to examine whether this association was moderated by gender. DESIGN: We developed and administered a 75-item cross-sectional survey, the Triad Pastor's Network COVID-19 and COVID-19 Vaccination survey, to assess experiences and perceptions regarding the COVID-19 virus and vaccines. We assessed the association between age and having received > 1 dose of a COVID-19 vaccine using unadjusted and multivariable binary logistic regression models, and the interaction of age and gender with COVID-19 vaccination status in a multivariable model. RESULTS: Approximately 86% of participants reported having received ≥ 1 dose of a COVID-19 vaccine. The mean age (standard deviation) of the sample was 51.33 (16.62) years, and 70.9% of the sample was comprised of women. The age by gender interaction term in the multivariable model was significant (p = 0.005), prompting additional analyses stratified by gender. In women, increased age was significantly associated with higher odds of COVID-19 vaccination (odds ratio = 1.09; 95% Confidence Interval 1.06, 1.11; p < 0.001). In men, the association was not significant (p = 0.44). CONCLUSIONS: Older age was positively associated with COVID-19 vaccination in African American women, but not African American men, which may inform strategies to increase vaccination rates.

Sociodemographic factors affecting viral load suppression among people living with HIV in South Carolina.

Adherence to antiretroviral therapy (ART) enables people living with HIV (PLWH) to reach and maintain viral suppression. As viral suppression significantly reduces risk for secondary transmission, this study aimed to examine sociodemographic factors associated with viral suppression among PLWH in South Carolina (SC). We analyzed cross-sectional data collected from 342 PLWH receiving HIV care from a large clinic in SC and provided complete information on most recent viral load, ART adherence, and sociodemographic factors. Bivariate analysis examined associations between key variables, and logistic regression was used to calculate the odds of viral suppression among select sociodemographic groups and adherence levels. Results indicated that approximately 82% of participants reported achieving viral suppression. PLWH who were older, male, and employed full-time had higher odds of being virally suppressed compared to those who were younger, female, and unemployed. PLWH with medium (adjusted Odds Ratio [aOR]: 3.79; 95% CI: 1.15-12.48) and high (aOR: 3.51; 95% CI: 1.21-10.24) levels of adherence were more likely to report viral suppression than those with low adherence. Targeted interventions are warranted for groups at-risk of low ART adherence, and healthcare providers should also be aware of contextual factors that serve as barriers to adherence for PLWH.

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.

The Effects of Trauma, Violence, and Stress on Sexual Health Outcomes Among Female Clinic Clients in a Small Northeastern U.S. Urban Center.

Background: Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. Methods: A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (i.e., childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (i.e., lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). Results: In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Conclusion: Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.

Community perspectives of South African adolescents' experiences seeking treatment at local HIV clinics and how such clinics may influence engagement in the HIV treatment cascade: a qualitative study.

Despite having the largest antiretroviral treatment (ART) program in the world, only 14% of South African adolescents living with HIV (ALWH) are on ART. The purpose of this study was to identify aspects of the clinic environment that either improve or inhibit ALWH's ability to engage in HIV care. We conducted fifty-nine semi-structured, in-depth interviews with ALWH (n = 20; 13-19 years of age), their caregivers (n = 19), and local stakeholders (n = 20) in Cape Town, South Africa. Data were coded and analyzed using inductive and deductive approaches to content analyses. Codes were grouped into positive and negative aspects of the HIV clinic environment, and into suggestions on how clinic practices could be improved to facilitate ALWH treatment retention and ART adherence. Positive clinic factors included: community co-location; familiarity with clinic staff; and adolescent only/adolescent-friendly clinic spaces. Negative clinic factors included: clinic visit frequency; overcrowding and long wait times; discrimination and stigma; lack of confidentiality; inflexible appointment-scheduling; and staff attitudes. ALWHs' clinic experiences affect their ability to remain in care and adhere to their treatment regimens. These findings support a call for innovative approaches that improve ALWH's clinic experiences and support them as they progress along the HIV treatment cascade.

Improving the Youth HIV Prevention and Care Cascades: Innovative Designs in the Adolescent Trials Network for HIV/AIDS Interventions.

Dramatic decreases in HIV transmission are achievable with currently available biomedical and behavioral interventions, including antiretroviral therapy and pre-exposure prophylaxis. However, such decreases have not yet been realized among adolescents and young adults. The Adolescent Medicine Trials Network (ATN) for HIV/AIDS interventions is dedicated to research addressing the needs of youth at high risk for HIV acquisition as well as youth living with HIV. This article provides an overview of an array of efficient and effective designs across the translational spectrum that are utilized within the ATN. These designs maximize methodological rigor and real-world applicability of findings while minimizing resource use. Implementation science and cost-effectiveness methods are included. Utilizing protocol examples, we demonstrate the feasibility of such designs to balance rigor and relevance to shorten the science-to-practice gap and improve the youth HIV prevention and care continua.

Resilience resources among African American women living with HIV in Southern United States.

OBJECTIVES: African American women living with HIV (WLH) often face various challenges to access to and benefit from healthcare across the HIV treatment cascade. Despite experiencing multiple forms of ongoing adversity, some African American WLH are able to adapt and stand strong. The current study aims to identify resources at various socioecological levels that facilitate resilience and explore how these resources interact with each other. DESIGN: Guided by the theories of resilience, we collected qualitative data through in-depth interviews with 14 African American WLH in South Carolina, United States. METHODS: Participants were purposely recruited and interviewed in private settings in 2016. With appropriate consent, each interview was recorded and was transcribed verbatim. Data analysis was conducted using NVivo 11.0. RESULTS: The participants described six major resilience resources including first, internal strength; second, religion and spirituality; third, hopefulness about life and future; fourth, self-awareness and self-care; fifth, social support from family and community; and sixth, HIV-related health facilities. The themes that occurred in qualitative data also show how resilience resources at the family/community level and institutional level affected individual resources, and how these resources collaborated with each other. CONCLUSION: The findings suggest that resilient African American WLH maintain hope in the face of adversity and seek out and obtain social support. Self-care, social support, and health facilities are particularly critical resources for African American WLH. Comprehensive interventions are needed to integrate these resources across multiple socioecological levels to enhance resilience and treatment outcomes in African American WLH.

A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South.

The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.

The Inner Working of Trauma: A Qualitative Assessment of Experiences of Trauma, Intergenerational Family Dynamics, and Psychological Well-Being in Women With HIV in South Carolina.

Women with HIV are more likely to have a history of traumatic and stressful life experiences. The current study examines experiences of traumatic and stressful life events, issues co-occurring with experiences of trauma, and intergenerational family dynamics regarding trauma and psychological well-being in women with HIV. The study was guided by the theoretical approach of an integrative translational model that incorporates trauma-related factors into a psychosocial framework. Data were collected from interviews with 20 women with HIV and analyzed for thematic categories. Thematic analysis indicated that traumatic life events of women with HIV included experiences of loss, sexual assault, and homelessness. Women with HIV also experienced issues co-occurring with trauma, including substance use and mental illness. The current study adds to the existing body of research by including an analysis of intergenerational family dynamics and psychological well-being. Implications for health care professionals and recommendations for translating research into practice are also discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 23-31.].

HIV/STI interventions targeting women who experience forced sex: A systematic review of global literature.

Women are disproportionately affected by HIV in many regions of the world and they represent the fastest growing demographic in the HIV epidemic. In addition, sexual violence against women is a global public health issue which increases women's vulnerability of HIV/STI acquisition. However, the relationship between sexual violence and HIV/STI risk are complex and contribute to the growing epidemic of women infected with HIV/STIs. Our purpose for this review is to examine existing HIV/STI interventions that target women who experience forced sex. Interventions designed to address women's unique needs in HIV/STI prevention are critical in reducing women's vulnerability to HIV/STIs.