HIV Knowledge among African Americans Living with HIV in the Rural South: Implications for Improving HIV Prevention and Care Outcomes.

PURPOSE: This study examines the HIV knowledge of people living with HIV (PLWH) and its implications for improved healthcare outcomes. METHODS: The study design was a descriptive cross-sectional study, and a total of 41 PLWH were recruited from a larger faith-based anti-stigma study. Data was collected using a semi-structured self-administered questionnaire and analyzed using SAS. In addition, a literature review was conducted using search engines to gauge existing literature from 2013 to 2022 in areas of HIV knowledge and healthcare outcomes among PLWH. RESULTS: The 41 PLWH enrolled consisted of 51% males and 49% females. Sixteen (39%) were aged ≥ 51 years, 17 (41%) had been living with HIV for > 10 years, 15 (37%) had < high school diploma, and 100% were currently in HIV care. HIV knowledge scores were below average for 20 (49%) of the PLWH. Substantial knowledge deficits were noted in areas of HIV transmission and risk reduction strategies. Lower scores were not significantly associated with the participant's gender, education level, or length of time being HIV-infected. The results of the literature review showed limited research in this area. CONCLUSIONS: The study and literature review results show that HIV knowledge and health literacy may contribute to racial disparities in retention in care leading to poor health outcomes. Healthcare providers and health facilities in rural areas should be equipped with culturally tailored HIV educational tools to strengthen ongoing care for PLWH, foster patient-provider relationships, and eliminate internalized stigma detrimental to improved healthcare outcomes among PLWH.

Feasibility and Acceptability of a Group Counseling Intervention for Opioid Use Disorder: An Exploratory Study.

The goal of the current exploratory study was to examine the feasibility and acceptability of an evidence-based group counseling intervention for individuals with opioid use disorders (OUD) reporting mental health issues and using medications for OUD. The intervention combines motivational interviewing and cognitive-behavioral therapy. Qualitative research methodology, specifically focus group interviewing, with seven individuals was used to examine the feasibility and acceptability of the intervention. Qualitative analysis of the focus group yielded four themes: Intervention Format, Group Counseling Factors, Comorbid Mental Health Issues, and Counselor Factors. The intervention proposed was found to be acceptable and feasible for addressing OUD and co-occurring mental health conditions, specifically depression, anxiety, and stress. [Journal of Psychosocial Nursing and Mental Health Services, 60(6), 7-10.].

Stigma Surrounding the Use of Medically Assisted Treatment for Opioid Use Disorder.

PURPOSE: This study sought to determine whether certain factors influenced public stigma toward the use of medication to treat opioid use disorders (MOUD). Method: In a series of 3 studies using between-subjects designs, hypothetical MOUD patients matched in age and educational status with the participants were varied in systematic ways to determine whether certain factors influenced stigmatizing views of the patients. Results: Study 1 (n = 142) determined that stigma levels were elevated for hypothetical patients receiving agonist medication for OUD compared to other medications or no medication at all. Study 2 (n = 144) found that hypothetical patients receiving opioid agonist medication for either heroin or pain pills were equally stigmatized and stigmatized more than hypothetical patients on nicotine agonist medication. Study 3 (n = 151) showed that stigmatizing attitudes did not change as a result of enhanced treatment services for hypothetical MOUD patients (i.e. therapy as a supplement to medication). Conclusions/Importance: Results indicate that patients receiving agonist medication for an OUD may be the target of public stigma. Public education on the efficacy of agonist medications for OUD is urgently needed to help reduce such stigma, which may facilitate treatment delivery, treatment adherence, and treatment success.

Depression and intimate partner violence among urban Kenyan caregivers of children with disabilities.

WHAT IS KNOWN ON THE SUBJECT?: Caregivers of children with disabilities are at increased risk of experiencing interpersonal violence and its consequences; however, there is limited research targeting this population. This problem is understudied in Sub-Saharan Africa. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Study examines intimate partner violence and depression among men and women caregivers of children with disabilities. Study findings showed that while a higher proportion of women caregivers of children with disabilities than men reported experiencing intimate partner violence and were at increased risk depression, the differences were not statistically significant. Participants reporting any form of violence (i.e. psychological aggression or physical assault) were at increased risk for depression, with those experiencing a combination of physical assault and psychological aggression having the highest risk for depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professionals working families of individuals with disabilities should be cognizant of the added stress and comorbid factors associated with caring for a child with a disability. Future research should examine whether there is a causal relationship between intimate partner violence and depression among caregivers of children with disabilities and compare this relationship with the general population. ABSTRACT: Introduction Mental health correlates of intimate partner violence (IPV) victimization are well documented. However, caregivers of children with disabilities (CCWDs) are underrepresented in empirical investigations and may have an increased risk of experiencing IPV and its consequences. This is particularly important in Sub-Saharan Africa where this problem is understudied. Method The present study estimated the prevalence of IPV victimization and examined the association between IPV and depression in a sample of CCWDs living in Nairobi, Kenya. Results Nearly half (49.8%) of the participants experienced some form of IPV and more than half (51.8%) were at risk of depression. Participants reporting psychological and physical violence were 1.76 and 4.81 times more likely to be at risk for depression, respectively. Those experiencing a combination of physical and psychological violence were 4.85 times more likely to be at risk for depression. Discussion Both men and women CCWDs are at an increased risk for IPV and depression. Social-cultural factors are also important in the prediction of depression risk and should be taken into account when working with CCWDs. Implications Mental health professionals should be cognizant of the added stress of being a CCWD, and the link between CCWDs and comorbid mental health outcomes.

Depression and Intimate Partner Violence Among African American Women Living in Impoverished Inner-City Neighborhoods.

Mental health correlates of intimate partner violence (IPV) victimization including negative physical and mental health outcomes are well documented. However, certain subgroups of African American women, such as those living in impoverished, urban communities, are underrepresented in most studies and may experience IPV at higher rates. Furthermore, the circumstances of this women including poverty makes them at risk to IPV and its consequences. The present study estimated the prevalence of IPV victimization and its association with depression in a sample of low-income African American women participating in the Mobile Youth and Poverty Study. Participants in this study were caregivers of adolescents living in extremely impoverished conditions and were part of the Mobile Youth Survey, a community-based, longitudinal, multiple cohort survey conducted between the years 1998 and 2011. Data for the current study were collected between the years 2001 and 2010. The dependent variable was depressive symptoms as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). The independent variable was IPV measured using a subsample of items from the Conflict Tactics Scale. Nearly three quarters (73.6%, n = 489) of the sample experienced some form of IPV and 49.1% (n = 326) had a CES-D depression score of 16 or greater indicating mild to severe depression symptoms. The highest proportion of women who met the CES-D criteria for depression were those experiencing the most severe IPV irrespective of category (i.e., physical, psychological, or combined). Logistic regression analyses showed that women reporting the most severe abuse, irrespective of category, were significantly more likely to meet the CES-D criteria for depression. In addition, low education and receipt of economic assistance were significantly associated with depressive symptoms. The combination of poor economic conditions and IPV may predispose African American women living in impoverished, urban communities to mental health outcomes such as depression.

Associations Among Depressive Symptoms, Wellness, Patient Involvement, Provider Cultural Competency, and Treatment Nonadherence: A Pilot Study Among Community Patients Seen at a University Medical Center.

Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient's perception of a provider's cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.

Engagement of African Americans with Rapid HIV Testing and HIV Care.

INTRODUCTION/BACKGROUND: African Americans and Blacks experience the greatest human immunodeficiency virus (HIV) burden of any racial group in the US and globally. A number of challenges contribute to the higher rates of HIV infection among African Americans, including a lack of awareness of HIV status. African Americans account for nearly 50% of the newly estimated HIV/acquired immunodeficiency syndrome (AIDS) diagnoses, with the majority being tested only after developing symptoms of AIDS. Moreover, African Americans are more likely to postpone medical care after finding out that they are HIV positive. PURPOSE: The aim of this study was to describe African Americans' likelihood of using salivary rapid testing (SRT) methods and entry into healthcare if HIV positive. METHODS/DESIGN: Focus groups were conducted among 38 African Americans. The purpose of this study was to (1) describe personal factors, social resources, socio-demographic factors, cognitive appraisal, and health and coping behaviors which predict or influence the likelihood of African Americans' participation in SRT and, if positive, subsequent entry into healthcare and (2) to evaluate HIV Testing Survey items and modify them to be culturally and linguistically appropriate. A modified Comprehensive Health Seeking and Coping Paradigm guided the study (CHSCP). RESULTS: Of the 38 African American adults who participated in the study, 16 were female between the ages of 18-49 and the mean age was 23 years and there were 22 males, aged between 18-49 and the mean age was 29.5 years. Eight themes emerged from the data: familiarity, stigma, fear, access, immediacy, ease, degree of responsibility, and trust. Gender specific themes were health maintenance (women) and illness management (men). Sub-themes within gender-specific themes were stoicism (women) and anger (men). IMPLICATIONS: Identifying the factors that influence the likelihood of HIV testing uptake can provide information on which to base development of interventions to facilitate HIV testing and earlier linkage to healthcare.

Sociocultural and Victimization Factors That Impact Attitudes Toward Intimate Partner Violence Among Kenyan Women.

This study investigates the association between acceptance of intimate partner violence (IPV) and reported IPV victimization among Kenyan women, taking into consideration select sociocultural factors that may also influence acceptance of IPV. Data from a nationally representative, cross-sectional, household survey conducted between November 2008 and February 2009 in Kenya were analyzed. Hierarchical multiple regression was conducted to estimate the effect of select sociodemographic characteristics and reported IPV victimization on acceptance of IPV. The results showed that while both sociodemographic characteristics and reported IPV victimization were significantly associated with IPV acceptance, sociocultural factors had a greater impact. Programs aimed at empowering women and culturally competent IPV prevention strategies may be the key elements to reducing IPV.

Gender differences in HIV-related stigma in Kenya.

Stigma associated with HIV/AIDS directly and indirectly drives HIV transmission. We examined how factors associated with HIV-related stigma differed by gender, using data from the 2008-2009 Kenya Demographic and Health Survey (KDHS). Descriptive, bivariate and multinomial logistic regression analyses were conducted on selected HIV-related stigma indicators for men and women. Bivariate analyses showed significant gender differences in the overall HIV Stigma index with a higher proportion of women than men presented at the highest stigma level (4.9% vs 2.7%, p < 0.01). Women were more likely to express higher stigmatic attitudes for all components of stigma measured than men. Multivariate analyses showed that HIV-related knowledge had significant inverse dose-response for both men and women. For instance, compared to women in the first HIV-related knowledge quartile, a 1 unit increase in HIV-related knowledge among women at the third HIV-related knowledge quartile was expected to lead to a 63.8% decrease in HIV-related stigma (95% CI [0.21, 0.63]) for women with high stigma, 57.8% decrease for similar women with medium stigma (95% CI [0.33, 0.55]) and 28.4% decrease for those with low stigma (95% CI [0.57, 0.90]). Acceptance with the statement "a husband is justified to hit or beat his wife if she refuses to have sex with him" was a significant risk factor for expression of stigmatising attitudes at all levels for women (High: OR = 1.49, 95% CI [1.02, 2.17]), Medium: OR = 1.47, 95% CI [1.18, 1.82], Low: OR = 1.38, 95% CI [1.10, 1.73]) and men at medium stigma (OR = 2.02, 95% CI [1.38, 2.95]). Other notable gender differences were found in employment, marital status, ethnicity, region of residence, wealth and media exposure. Our results showed that women in the general Kenyan population had higher stigmatic attitudes than men. This was associated with differences in risk factor profile and confirmed previous literature on complexity of social-cultural factors associated with HIV-related stigma.