Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study.

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.

Patterns of HIV Disclosure and its Impact on the HIV Care Continuum Among Black Men who Have Sex With Men in South Carolina.

Addressing the psychosocial concerns of Black men who have sex with men (MSM), such as HIV disclosure, is critical for effective HIV treatment efforts. Black MSM living with HIV experience multiple psychosocial challenges, such as "triple stigma" due to their sexual orientation, racial minority status, and HIV status, which hinder their HIV disclosure and subsequent HIV care-seeking behavior. Our study sought to examine the HIV disclosure patterns and their impact on the HIV care continuum among Black MSM using a qualitative approach. Semi-structured interviews were carried out among 28 Black MSM aged ≥18 years old living in South Carolina. A thematic analysis process was employed for data analysis. The emerging themes of facilitators of HIV disclosure included the sense of personal responsibility to disclose one's HIV status within the context of a relationship and having other family members living with HIV, while the barriers included fear of family rejection or religious reasons. A few participants preferred to disclose to friends due to the less shame in sharing their status to friends than other confidants (e.g., family members). HIV disclosure was found to be a facilitator for linkage to care and retention in care through social support obtained from disclosure confidants. Helping patients to identify a single person (e.g., family member) to share their HIV status may offer equivalent benefits to wider disclosure. Interventions occurring at multiple levels (e.g., targeting religious groups) and within multiple contexts are needed to promote HIV disclosure and improve clinical outcomes in the Black MSM community.

Coping and ART adherence self-efficacy among people living with HIV in South Carolina.

In the US, more than 50% of new HIV infections are reported in southern states. Besides, the incidence rate of HIV in South Carolina is 17 per 100,000 population. Regardless of improved quality of life with the advent of ART, coping with stressors may influence ART adherence self-efficacy. This study assessed the association between coping strategies and ART adherence self-efficacy among people living with HIV (PLWH) in South Carolina. Cross-sectional data were obtained from 402 PLWH attending a large immunology center in South Carolina in 2018. Unadjusted and adjusted linear regression models were used to determine the association between coping strategies and ART adherence self-efficacy. Alcohol or drug use was negatively associated with ART adherence self-efficacy (b = -0.170, 95% CI [-0.255, -0.085], p = 0.0001). Religiosity was positively associated with ART adherence self-efficacy (b = 0.101, 95% CI [0.017, 0.185], p = 0.019). Overall coping and self-motivation were not significantly associated with ART adherence self-efficacy. Accentuating religiosity and attenuating alcohol or drug use as a means of coping may improve ART adherence self-efficacy among PLWH.