The Impact of Intersectional Discrimination and Stigma on HIV Care for African, Caribbean, and Black Women Living With HIV During the COVID-19 Pandemic in British Columbia: A Descriptive Study.

ABSTRACT: African, Caribbean, and Black women living with HIV (ACB WWH) in British Columbia experience discrimination on the basis of their race, sex, gender identity, sexual orientation, and HIV status. The various forms of stigma that ACB WWH experience intersect to create a uniquely marginalized experience that has negative consequences for quality of life and overall well-being. Eighteen semistructured interviews were completed with ACB WWH in British Columbia. Interviews were conducted by phone, Zoom, or in-person at the participant's request. Participants consistently reported experiences of various forms of discrimination. There was additional stigmatization due to COVID-19 pandemic that negatively influenced the lives of ACB WWH. Interventions and resources are needed to support ACB WWH in navigating how to work through the multifaceted impacts of intersectional stigmatization. Efforts are needed to identify ways to continue the delivery of resources like social support groups throughout future pandemics.

A Manifesto for transformative action on HIV among Black communities in Canada.

Black communities bear a hugely disproportionate share of Canada's HIV epidemic. Black persons annually represent up to one quarter of new diagnoses, while in contrast, diagnoses have been falling among white Canadians for the past two decades. There has been a notable lack of urgency and serious debate about why the trend persists and what to do about it. For too long, public institutions have reproduced hegemonic white supremacy and profoundly mischaracterized Black life. Consequently, Black communities suffer policies and programs that buttress systemic anti-Black racism, socio-economically disenfranchise Black communities, and in the process marginalize knowledgeable, experienced, and creative Black stakeholders. The Interim Committee on HIV among Black Canadian Communities (ICHBCC) is a group of Black researchers, service providers, and community advocates who came together in early 2022 to interject urgency to the HIV crisis facing Black communities. Specifically, the ICHBCC advocates for self-determined community leadership of research, policies, and programs, backed by access to appropriate resources, to change the trajectory of HIV among Black Canadian communities. In this article, we introduce the wider community to the Black HIV Manifesto that we developed in 2022.

RéSUMé: Les communautés noires constituent une part très disproportionnée de l'épidémie de VIH du Canada. Les personnes noires représentent annuellement jusqu'au quart des nouveaux diagnostics, tandis que les diagnostics diminuent chez les Canadiennes et les Canadiens de race blanche depuis 20 ans. Il y a une absence notable d'urgence et de débat sérieux sur la raison de la persistance de ces tendances et sur ce qu'il faudrait y faire. Pendant trop longtemps, les institutions publiques ont reproduit l'hégémonie de la suprématie blanche et extrêmement mal caractérisé les vies noires. Par conséquent, les communautés noires souffrent de politiques et de programmes qui soutiennent le racisme anti-Noirs systémique, privent les communautés noires de leurs droits socioéconomiques et marginalisent ainsi les connaissances, l'expérience et la créativité des parties prenantes noires. Le comité intérimaire sur le VIH dans les communautés noires du Canada (ICHBCC) est un groupe de chercheurs et de chercheuses, de prestataires de services et de porte-parole communautaires de race noire qui se sont regroupés au début de 2022 pour mettre l'accent sur le caractère urgent de la crise du VIH dans les communautés noires. Plus précisément, l'ICHBCC plaide en faveur d'un leadership communautaire autodéterminé de la recherche, des politiques et des programmes, appuyé par un accès aux ressources nécessaires, pour changer la trajectoire du VIH dans les communautés noires du Canada. Dans cet article, nous présentons à l'ensemble de la communauté le « manifeste noir sur le VIH ¼ que nous avons élaboré en 2022.

Teen pregnancy involvement among African, Caribbean and Black adolescent boys and girls: a scoping review protocol.

INTRODUCTION: African, Caribbean and Black (ACB) adolescents are disproportionately affected by teen pregnancy in North America. Teen pregnancy poses risks to the quality of life of adolescent boys and girls, including physical, psychosocial and socioeconomic risks. Our review aims to explore this public health concern for ACB adolescents within North America. We aim to identify and analyse available evidence on the incidence and prevalence of, associated factors of and interventions to curtail teen pregnancy involvement (TPI) among ACB adolescent boys and girls in North America. This review will explore TPI, rather than teen pregnancy, to ensure a review of men' involvement in teen pregnancy outcomes. METHODS AND ANALYSES: Health literature databases such as CINAHL, OVID (Medline and Embase) and CAB direct. Searches will be conducted for evidence published from 2001 to October 2021. Search results will be exported to Covidence for subsequent steps of the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines will be used to ensure reproducibility and transparency. We will include all study designs focused on ACB boys and girls between 10 and 19 years old, residing in North America. Studies with a mixed racial sample will be included if sample consists of greater than 50% ACB individuals. ETHICS AND DISSEMINATION: TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed.

Social Correlates of HIV-Risky Behaviours among African Canadian Adolescents Living in British Columbia, Canada: A Secondary Data Analysis.

Studies have linked HIV-risky behaviours among young people to several socio-contextual factors. However, the social factors that might increase African Canadian adolescents' exposure to HIV-risky behaviours, including unprotected sex and forced or multiple-sexual partnerships, have received little or no attention in the literature. Using data from the British Columbia Adolescent Health Surveys (2003-2018) and guided by intersectionality and socio-ecological frameworks, we examined the social determinants of HIV-risky behaviours (HRB) among African Canadian adolescents in British Columbia. We observed a general decline in HRB from 2008 to 2018. However, more than half (54.5%) of the 1042 who were sexually experienced in 2018 reported having 2 or more sexual partners, and nearly half reported condom-less sex. Our results demonstrate an important need to evaluate the impacts of several social factors on health outcomes for a unique, marginalized population.

How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women.

The COVID-19 pandemic resulted in disruption in healthcare delivery for people living with human immunodeficiency virus (HIV). African, Caribbean, and Black women living with HIV (ACB WLWH) in British Columbia (BC) faced barriers to engage with HIV care services prior to the COVID-19 pandemic that were intensified by the transition to virtual care during the pandemic. This paper aims to assess which factors influenced ACB WLWH's access to, utilization and affordability of, and motivation to engage with HIV care services. This study utilized a qualitative descriptive approach using in-depth interviews. Eighteen participants were recruited from relevant women's health, HIV, and ACB organizations in BC. Participants felt dismissed by healthcare providers delivering services only in virtual formats and suggested that services be performed in a hybrid model to increase access and utilization. Mental health supports, such as support groups, dissolved during the pandemic and overall utilization decreased for many participants. The affordability of services pertained primarily to expenses not covered by the provincial healthcare plan. Resources should be directed to covering supplements, healthy food, and extended health services. The primary factor decreasing motivation to engage with HIV services was fear, which emerged due to the unknown impact of the COVID-19 virus on immunocompromised participants.

Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States.

AIM: Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV. METHOD: Quantitative, research methodology. DESIGN: We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum. RESULTS: The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement. CONCLUSION: This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. IMPACT: The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized. PATIENT/PUBLIC CONTRIBUTION: This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.

Racism as a social determinant of health: Link to school-related psychosocial stressors in a population-based sample of African adolescents in Canada.

BACKGROUND: Racism is a social determinant of health that links to the health and well-being of racial/ethnic marginalized populations. However, perceived racism among African Canadian adolescents has not been adequately addressed, especially the link between racism and psychosocial stressors in school settings. AIM: The aim of the current study was to assess racism and the link to school-related psychosocial stressors in a population-based sample of African Canadian adolescents. DESIGN: Secondary analysis of the population-based 2018 British Columbia Adolescent Health Survey dataset. METHODS: Logistic regression and generalized linear models tested the link between racism and psychosocial stressors among African Canadian adolescents (n = 942), adjusting for sociodemographic factors. RESULTS/FINDINGS: More than 38% of the adolescents reported racism in the year preceding the survey. Regardless of gender and birthplace, and controlling for covariates, those who experienced racism were significantly more likely to report peer victimization, which includes teasing, social exclusion, cyberbullying and sexual harassment, and they felt less safe and connected to their schools compared to those who did not experience racism. With gender and birthplace differences, those who reported racism had higher odds of having been physically assaulted, stayed away from school, reported negative emotional responses and used avoidant behaviours to evade racism. CONCLUSION: African Canadian adolescents are a visible racialized ethnic group in British Columbia, who are at heightened risk of racism and the associated psychosocial stressors. IMPACT: These findings demonstrate the influences of racism on psychosocial stressors and related emotional responses among African Canadian adolescents. Nurses and other healthcare providers should be cognizant of racism and the psychological impacts when providing care to "at-risk" populations. Promoting positive and inclusive school climates and addressing racism at all levels of the society will foster better social integration, as well as improve the health and academic achievement of African Canadian adolescents. PATIENT OR PUBLIC CONTRIBUTION: We presented the research and preliminary results of the data analysis to the African community (parents and adolescents who self-identify as African). The African community who attended the gathering corroborated the link between racism and health and reiterated that addressing these psychosocial stressors can promote adolescent health and well-being. The attendees accepted all the variables that we included in the analysis. However, they emphasized the need for more African representation among school staff and teachers to foster trust, feelings of safety and connectedness, and to promote African students' academic achievement and well-being. They stressed the need to train and build the capacities of the school staff and teachers so that they can assist students regardless of race. They emphasized the need to promote cultural awareness and cultural sensitivity among all healthcare providers. We included the recommendations in the appropriate sections of the manuscript.

Impact of the COVID-19 pandemic on the HIV care continuum: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this systematic review is to synthesize evidence on the impact of the COVID-19 pandemic on the HIV care continuum for persons living with or at risk of living with HIV. INTRODUCTION: The COVID-19 pandemic affected the self-management and care of people living with HIV. Self-regulation to acquire recurring treatment for HIV is essential for managing symptoms as well as viral suppression. Therefore, this review will systematically appraise and synthesize primary literature on the impact of the COVID-19 pandemic on all phases of the HCC for people living with, or at risk of acquiring, HIV. INCLUSION CRITERIA: This systematic review will include quantitative, qualitative, and mixed methods studies. The search will be limited to studies reporting findings from March 2020. Selected studies must focus on one or more steps of the HIV care continuum, which are diagnosis of HIV infection, linkage to care, retention in care, adherence to antiretroviral therapy, and viral suppression. There are no age, gender, or geographic location restrictions for this review. Studies that examined the impact on other diseases as well as HIV will be included only if the data for HIV can be extracted separately. METHODS: The JBI methodology for convergent integrated mixed methods systematic reviews will guide this review. The following databases will be searched: MEDLINE (Ovid), CINAHL (EBSCOhost), CAB Direct, and Embase. Articles will be screened by 2 independent reviewers. In the case of a disagreement between reviewers, a third independent reviewer will resolve the conflict. Articles will be appraised for methodological quality and their data extracted using an original extraction tool created for the study's purpose. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021285677.

Prosocial behavior and youth mental health outcomes: A scoping review protocol.

INTRODUCTION: This review aims to explore the existing literature about the virtue of helping others and its association with youth mental health. Mental health of youth is rooted in their social environment. Helping others or engaging in prosocial behavior are activities that youth may participate in. The notion of helping others and its association with individual mental well-being have been well-studied for adults and older adults and to some extent in youth, however, no review has been conducted to understand the intersection of helping others and mental health in the youth population. METHODS: This review will consider all study designs that examine helping others and mental health of youth. The inclusion criteria for the review will include young individuals aged 10-24-year-old, living in any geographic location, of all gender identities, and with or without mental health issues. Grey literature and studies that only speak to outcomes related to physical well-being will be excluded. A search will be conducted in CINAHL, MEDLINE and PsycINFO. Studies published in the English language will be included with no restriction on publication time period. Articles will be screened against the inclusion criteria onto a single software by two independent reviewers. In the case of any disagreement, a third independent reviewer would resolve the conflict. FINDINGS: Data will be extracted and presented in a tabular or diagrammatic form supported by a summary. We will report our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). The findings of this review will provide evidence-based recommendations for promoting youth mental health and a basis for future research.

A Qualitative Study on the Social Determinants of HIV Treatment Engagement Among Black Older Women Living With HIV in the Southeastern United States.

ABSTRACT: Black older women living with HIV (BOWLH) in the United States are disproportionately affected by HIV infection and poor treatment engagement rates, often caused by multiple social determinants of health. In this descriptive qualitative study, we interviewed 17 BOWLH to investigate the facilitators and barriers to HIV treatment engagement. Data were analyzed using the socioecological framework. Findings demonstrate the positive influences of supportive social networks, perceived benefits, HIV-related knowledge, raising HIV awareness in communities, and impact of HIV state laws. The highlighted barriers were mainly low income, substance use, HIV-related stigma, influence of stereotypes and assumptions about older women living with HIV, and health insurance. Religion, managing comorbidities, attitude toward, HIV disclosure, and caregiving roles had both positive and negative influences on engagement. These findings illuminate factors of HIV treatment engagement that might be culturally founded; disseminating these factors to health care professionals is a critical intervention to support this population.

The significance of breastfeeding practices on postpartum depression risk.

OBJECTIVE: Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD. DESIGN: A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model. RESULTS: Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates. CONCLUSIONS: Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Being Lost to Follow-Up to Healthcare Appointments: A Concept Analysis.

The concept of being lost to follow-up is very common in healthcare. Though its meaning might seem literal, its use, particularly in healthcare, requires detailed analysis, to understand factors surrounding its incidence and ways of curtailing its detrimental consequences. Walker and Avant's eight-step concept analysis was used to identify the antecedents, attributes, empirical referents, and consequences of this concept. The attributes of the concept include a clinical starter event suffered by a patient that requires ongoing evaluation by an event tracker at a given location and frequency. However, despite a mutual agreement between the patient and the event tracker, the evaluation suffers a hiatus due to several modifiable and nonmodifiable risk factors (antecedents of the concept), consequences which might include morbidity and death. Early identification and intervention are critical to avoid the occurrence of being lost to follow-up, and nurses need to be cognizant of such knowledge.

Social determinants of peripartum depressive symptoms among Black peripartum women living with HIV.

HIV infection during pregnancy, may present risk of developing depression during pregnancy and postpartum. This psychiatric mood disorder, and many others such as anxiety and HIV-related post-traumatic stress disorder (PTSD) have been reported prevalent among pregnant and non-pregnant women living with HIV (WLWH). Multiple studies have found associations between social determinants of health and depressive symptoms in this population. However, despite deleterious effects on mother and child which may include suicidal ideations and infant death, only very few studies have examined this phenomenon for peripartum women, particularly Black women- a population prone to living in poor social and economic environments. Therefore, guided by the socio-ecologic model, this study examined predictors of peripartum depressive symptoms among Black peripartum WLWH. The study was a secondary data analysis of 143 Black women seen at special prenatal and women's health clinics in Miami, South Florida, USA. More than half of the women who experienced peripartum depressive symptoms (PDS) (n = 81, 57%) were of low socio-economic status. Low income was associated with increased odds of experiencing PDS. Women who endorsed intimate partner violence/abuse (IPV/A) were 6.5 times more likely to experience PDS; and compared to women with 1 or no childcare burden, women with 2 children-care burden were 4.6 times more likely to experience PDS. These findings demonstrate the negative impact of social factors on the psychological health of Black peripartum WLWH. Burdensome interpersonal relationships may have deleterious effects and trigger PDS among these women. Implications for nursing practice, education and research are also discussed.

HIV Testing Among Heterosexual Hispanic Women in South Florida.

PURPOSE: The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women. DESIGN: This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study. METHODS: Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression. FINDINGS: The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it. CONCLUSIONS: Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women. CLINICAL RELEVANCE: Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

Immigrant latino couples and postpartum contraception: Attitudes, perceptions, and sexual decision-making

BACKGROUND: The number of Latinos in the US is increasing, and they are at higher risk for unintended pregnancies and short interpregnancy intervals. PURPOSE: This study examined immigrant Latino couples' attitudes and perceptions towards contraception in relation to sexual decision-making. METHODS: Pregnant Latinas and their partners (n=40 couples) were recruited from prenatal care clinics in the southeastern US. This was amixed-method study with a concurrent embedded strategy. Descriptive statistics, paired t-tests, interclass correlation, and the Actor-Partner Interdependence Model (APIM) were used to analyze the quantitative data. Data from open ended questions were analyzed with content analysis. RESULTS: On the group-level analysis, men's Contraceptive Attitudes and Perception Scale scores were significantly different from women's in four key dimensions: partner (comfort in communicating with partner and partner's attitude), side effects, hassle, and cost (p<0.002, 0.046, 0.018, and 0.02). On the dyad-level analysis (between individual couples), no significant correlations were identified. In the dyad analysis using the APIM, only men's contraceptive attitudes and perceptions were negatively associated with women's sexual decision-making (ß=−0.158, p = 0.005). Nearly two-thirds of the couples disagreed on postpartum contraceptive methods. Seven overlapping categories emerged as rationales for choosing specific postpartum contraceptive methods among men and women. CONCLUSIONS: Understanding the dyad-level influence on contraceptive attitudes/perceptions, sexual decision-making helps researchers,and practitioners design evidence-based, culturally tailoredinterventions to assist couples in choosing the best postpartum contraceptives for their family. Decreasing men's contraceptive barriers by providing correct information may be the first step in mediating the dyad-level factor.

TRASFONDO: El número de Latinos en EEUU está creciendo, y ellos tienen alto riesgo de embarazo sin intención y corto intervalo. PROPÓSITO: Este estudio examinó actitudes y percepciones sobre anticonceptivos (APSA) de parejas Latinas inmigrantes relacionado con la toma de decisiones sexuales. MÉTODOS: Latinas embarazadas y sus parejas (n=40 parejas) fueron parte del estudio. Se utilizó el método mixto con la estrategia de concurrente empotrado. Se utilizó la estadística descriptiva, examen de t, correlación entre-clase, y el Modelo de Interdependencia Actor-Pareja (MIAP) para analizar datos cuantitativos. Las preguntas abiertas fueron analizadas con el método de análisis contento. RESULTADOS: En el análisis del nivel grupal, marcas de los APSA de los hombres fueron significativamente diferente de los de mujeres en cuatro dimensiones: parejas, efectos secundarios, molestia, y costo (p<0.002, 0.046, 0.018, y 0.02). En el análisis del MIAP, solo APSA de los hombres fueron asociados negativamente con tomas de decisiones de las mujeres (ß=−0.158, p = 0.005). Casi dos tercios de las parejas estaban en desacuerdo con los métodos anticonceptivos después del parto. Siete categorías surgieron como razones para escoger los métodos anticonceptivos después del parto. CONCLUSIONES: Entender la influencia de APSA y toma de decisiones entre parejas ayudará a los investigadores y enfermeros a diseñar intervenciones basados en evidencia y culturalmente diseñados para ayudar a parejas a escoger anticonceptivos post-parto. Reducir las barreras que tienen los hombres a los anticonceptivos proveyendo información correcta será el primero paso en afectar el factor en el nivel entre parejas.