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1.
Womens Health Issues ; 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34801349

RESUMO

BACKGROUND: Since 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes. METHODS: We created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects. RESULTS: Among 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1-SD increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04-0.45; p < .01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12-2.35; p < .05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01-0.25; p < .05). CONCLUSION: Variation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions.

2.
AIDS Behav ; 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34642834

RESUMO

In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.

3.
BMC Health Serv Res ; 21(1): 1139, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34686197

RESUMO

BACKGROUND: To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States. METHODS: Using a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects. RESULTS: Among 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive. CONCLUSION: Findings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities.


Assuntos
Grupos Étnicos , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Políticas , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33917408

RESUMO

Abortion funds are key actors in mitigating barriers to abortion access, particularly in contexts where state-level abortion access restrictions are concentrated. Using 2017-2019 case management data from a regional abortion fund in the southeastern U.S., we described the sociodemographic and service use characteristics of cases overall (n = 9585) and stratified by state of residence (Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee). Overall, cases represented people seeking abortion fund assistance who predominately identified as non-Hispanic Black (81%), 18-34 years of age (84%), publicly or uninsured (87%), having completed a high school degree or some college (70%), having one or more children (77%), and as Christian (58%). Most cases involved an in-state clinic (81%), clinic travel distance under 50 miles (63%), surgical abortion (66%), and pregnancy under 13 weeks' gestation (73%), with variation across states. The median abortion fund contribution pledge was $75 (interquartile range (IQR): 60-100), supplementing median caller contributions of $200 (IQR: 40-300). These data provide a unique snapshot of a population navigating disproportionate, intersecting barriers to abortion access, and abortion fund capacity for social care and science. Findings can inform abortion fund development, data quality improvement efforts, as well as reproductive health, rights and justice advocacy, policy, and research.


Assuntos
Aborto Induzido , Administração Financeira , Alabama , Criança , Feminino , Florida , Georgia , Humanos , Mississippi , Gravidez , South Carolina , Tennessee , Estados Unidos
5.
AMA J Ethics ; 23(2): E156-165, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33635196

RESUMO

Black women living with HIV (BWLWH) contend with injuries of injustice, which manifest in restricted reproductive autonomy and decision-making power in social and medical settings. Mitigating threats to reproductive autonomy calls for innovations that consider patients' needs and offer insights on how historically situated marginalization influences today's institutional, political, and economic systems and shapes reproductive decision making. In addition to cross-disciplinary expertise and collaboration, integrating structural competency into reproductive health care requires demonstrating respect for the autonomy, lived experiences, and preferences of BWLWH.


Assuntos
Afro-Americanos , Infecções por HIV , Atenção à Saúde , Feminino , Humanos , Reprodução , Saúde Reprodutiva
6.
AIDS Patient Care STDS ; 34(8): 356-366, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757978

RESUMO

Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.


Assuntos
Adaptação Psicológica , Discriminação Psicológica , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Resiliência Psicológica , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Grupos Minoritários , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
PLoS One ; 15(7): e0235971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32678861

RESUMO

OBJECTIVE: The purpose of this study is to explore Protestant religious leaders' attitudes towards abortion and their strategies for pastoral care in Georgia, USA. Religious leaders may play an important role in providing sexual and reproductive health pastoral care given a long history of supporting healing and health promotion. METHODS: We conducted 20 in-depth interviews with Mainline and Black Protestant religious leaders on their attitudes toward abortion and how they provide pastoral care for abortion. The study was conducted in a county with relatively higher rates of abortion, lower access to sexual and reproductive health services, higher religiosity, and greater denominational diversity compared to other counties in the state. Interviews were audio-recorded, transcribed verbatim, and analyzed by thematic analysis. RESULTS: Religious leaders' attitudes towards abortion fell on a spectrum from "pro-life" to "pro-choice". However, most participants expressed attitudes in the middle of this spectrum and described more nuanced, complex, and sometimes contradictory views. Differences in abortion attitudes stemmed from varying beliefs on when life begins and circumstances in which abortion may be morally acceptable. Religious leaders described their pastoral care on abortion as "journeying with" congregants by advising them to make well-informed decisions irrespective of the religious leader's own attitudes. However, many religious leaders described a lack of preparation and training to have these conversations. Leaders emphasized not condoning abortion, yet being willing to emotionally support women because spiritual leaders are compelled to love and provide pastoral care. Paradoxically, all leaders emphasized the importance of empathy and compassion for people who have unplanned pregnancies, yet only leaders whose attitudes were "pro-choice" or in the middle of the spectrum expressed an obligation to confront stigmatizing attitudes and behaviors towards people who experience abortion. Additionally, many leaders offer misinformation about abortion when offering pastoral care. CONCLUSION: These findings contribute to limited empirical evidence on pastoral care for abortion. We found religious leaders hold diverse attitudes and beliefs about abortion, rooted in Christian scripture and doctrine that inform advice and recommendations to congregants. While religious leaders may have formal training on pastoral care in general or theological education on the ethical issues related to abortion, they struggle to integrate their knowledge and training across these two areas. Still, leaders could be potentially important resources for empathy, compassion, and affirmation of agency in abortion decision-making, particularly in the Southern United States.


Assuntos
Aborto Induzido/psicologia , Atitude Frente a Saúde , Cristianismo/psicologia , Liderança , Princípios Morais , Assistência Religiosa/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Int J Equity Health ; 19(1): 115, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631424

RESUMO

BACKGROUND: Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied. METHODS: We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis. RESULTS: Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness). CONCLUSIONS: Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.


Assuntos
Afro-Americanos , Atitude , Comportamento do Consumidor , Infecções por HIV/etnologia , Equidade em Saúde , Hispano-Americanos , Qualidade da Assistência à Saúde , Adulto , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Infecções por HIV/terapia , Humanos , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , New England , Participação do Paciente , Segurança do Paciente , Pesquisa Qualitativa , Sudeste dos Estados Unidos , Saúde da Mulher
9.
Ethn Health ; 25(3): 354-366, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-29278922

RESUMO

Objective: Given that studies have consistently demonstrated increased risk of stillbirth with increasing maternal age as well as race-ethnic disparities in stillbirth, the primary research question is how stillbirth risks within and between race-ethnic groups change with age.Design: Using fetal death (stillbirth) and live birth data from the National Center for Health Statistics 2007-2014. We calculated crude stillbirth rates (per 1,000 deliveries). Using multivariable logistic regression, we calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for stillbirth across age groups to examine disparities in stillbirth among non-Hispanic blacks (blacks) and non-Hispanic whites (whites).Results: Rates and risks of stillbirth increased as maternal age increased; however, the magnitude of risk varies by race-ethnicity. Compared to women less than 20, black women age 40+ had a risk of almost 3.5 times (aOR = 3.47, 95% CI = 3.24-3.70) whereas among white women age 40+, the risk was more than 2.5 times (aOR = 2.68, 95% CI = 2.55-2.82). The risk of stillbirth among blacks compared to whites increased, peaking at ages 30-34 (aOR = 2.64, 95% CI = 2.56-2.73). At age 35 and beyond, the disparity in risks declined.Conclusion: As age increased, the risk of stillbirth increased for both blacks and whites. Because the disparity in risk between blacks and whites did not continue to increase with age, stillbirth does not seem to reflect the weathering hypothesis as other perinatal outcomes do.


Assuntos
Grupos de Populações Continentais/etnologia , Grupos Étnicos/estatística & dados numéricos , Idade Materna , Natimorto/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Gravidez , Adulto Jovem
10.
J Health Care Poor Underserved ; 30(4S): 116-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31735725

RESUMO

African American women living with HIV (WLWH) in the U.S. South encounter heightened marginalization due to the complex intersections of race, gender, poverty, and HIV status. Social vulnerabilities experienced by individuals and communities in daily life have the potential to sharpen ethical tensions in the context of research. Thus, conducting ethical research requires attention to the contextual challenges and concerns of diverse research populations to tailor participant protections to a particular sociocultural context. Using principles from the Belmont Report, the present report draws on data from a qualitative study with 42 African American WLWH in the South by highlighting the first author's accounts of ethical challenges that emerged during data collection. Findings suggest that engaging participants in their natural environments can inform the development of ethical research strategies germane to women's lived experiences. Study findings also contribute to empirical guidance for investigators engaging marginalized populations in scientific research.


Assuntos
Afro-Americanos , Ética em Pesquisa , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Temas Bioéticos , Feminino , Humanos , Pobreza , Pesquisa Qualitativa , Estados Unidos
11.
AIDS Behav ; 23(11): 2966-2979, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297683

RESUMO

Limited studies to date assess barriers to and facilitators of PrEP uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. We examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama. Participants were 32 years old on average, 66% Black, 66% gay or lesbian, 70% male, and 66% single. Perceived barriers to PrEP access included: lack of PrEP awareness and advertisement; sexuality-related stigma; time and resource constraints; and concerns about the adequacy and technical quality of PrEP services. Perceived facilitators to PrEP access were: PrEP-related information gathering and sharing; increased dialogue and visibility around PrEP; social, programmatic, and clinical support; and, lastly, self-preservation; personal motivation; and treatment self-efficacy. Results point to opportunities to address complex barriers to equitable PrEP access using multilevel and multimodal solutions.


Assuntos
Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Profilaxia Pré-Exposição/métodos , Comportamento Sexual , Estigma Social , Adulto , Afro-Americanos , Alabama , Conscientização , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Autoeficácia
12.
AIDS Patient Care STDS ; 33(4): 184-195, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30932700

RESUMO

Among places where people living with HIV experience and anticipate HIV-related stigma, stigma in health care settings may be particularly harmful. Utilizing an exploratory sequential mixed methods approach, we conducted interviews (n = 76) and questionnaires (N = 460) with older adult women living with HIV enrolled in the Women's Interagency HIV Study in Birmingham, AL; Jackson, MS; Atlanta, GA; and San Francisco, CA. Interviews addressed facilitators and barriers to HIV treatment adherence, including HIV-related stigma. Qualitative data were coded using thematic analysis. Questionnaires assessed self-reported antiretroviral therapy (ART) adherence and experienced and anticipated HIV-related stigma from various sources (i.e., health care personnel, family, partner, and community). Covariate-adjusted logistic regression analyses examined total and mediated effects of stigma on ART adherence. Interviewees described fears and experiences of stigma in health care settings; including privacy violations, disrespect for patient autonomy, and reproductive coercion; and how these influenced their adherence to HIV treatment recommendations. Experienced and anticipated HIV-related stigma in health care settings were associated with suboptimal (or <95%) ART adherence in separate models controlling for experienced or anticipated stigma, respectively, from other sources. When entered together, only anticipated stigma in health care settings was associated with suboptimal ART adherence, controlling for anticipated and experienced stigma from other sources. The effect of anticipated stigma in health care settings on suboptimal ART adherence may work through the pathways of lower adherence self-efficacy, higher depressive symptoms, and higher coping by substance use. These findings indicate that interventions should promote cultures of acceptance within health care settings and resilience-based strategies for women to combat stigma and promote life-sustaining behaviors.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Cooperação do Paciente/psicologia , Estigma Social , Adaptação Psicológica , Idoso , Depressão , Medo , Feminino , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Cooperação do Paciente/etnologia , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
13.
AIDS ; 33(3): 571-576, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30702521

RESUMO

OBJECTIVE: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]). CONCLUSION: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.


Assuntos
Antirretrovirais/uso terapêutico , Depressão/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/estatística & dados numéricos , Estigma Social , Adulto , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estados Unidos
14.
Soc Sci Med ; 208: 9-17, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29753137

RESUMO

Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.


Assuntos
Infecções por HIV/psicologia , Percepção , Racismo/psicologia , Sexismo/psicologia , Estigma Social , Adulto , Idoso , Feminino , Infecções por HIV/epidemiologia , Disparidades em Assistência à Saúde , Humanos , Renda/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Marginalização Social/psicologia , Estados Unidos/epidemiologia
15.
J Acquir Immune Defic Syndr ; 78(1): 9-15, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29373394

RESUMO

BACKGROUND: People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. SETTING: Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. METHODS: Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated. RESULTS: The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant. CONCLUSIONS: Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.


Assuntos
Adaptação Psicológica , Aprendizagem da Esquiva/fisiologia , Discriminação Psicológica , Infecções por HIV/psicologia , Uso de Tabaco/psicologia , Adulto , Idoso , Alabama , Feminino , HIV , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Raciais , Comportamento Sexual , Estigma Social , Adulto Jovem
16.
J Acquir Immune Defic Syndr ; 77(3): 257-263, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29140873

RESUMO

INTRODUCTION: There are multiple dimensions of HIV-related stigma that can compromise the mental and physical health of people living with HIV. We focused on the dimension of experienced stigma, defined as exposure to acts of discrimination, devaluation, and prejudice, and investigated its relationship with HIV health and psychosocial outcomes. METHODS: We examined associations between experienced stigma in the community and health care settings and psychosocial and health outcomes for people living with HIV (N = 203) receiving care at an urban HIV clinic in the Southeastern United States. We also investigated whether those effects are unique to experienced stigma or are mediated by other dimensions of HIV-related stigma. RESULTS: Experienced stigma was associated with suboptimal clinical outcomes such as viral nonsuppression, as well as poor affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, and blame coping) and interpersonal outcomes such as social support and physician trust. Furthermore, serial mediation models suggested significant indirect effects of experienced stigma through internalized stigma and anticipated stigma from various theoretically expected sources of stigma (eg, community members, friends and family, and health care workers), with varying effects depending on the source. CONCLUSIONS: These findings suggest nuanced mechanisms for the effects of experienced HIV-related stigma, especially in health care settings, and may be used to inform stigma-reduction interventions. Interventions designed to address experienced stigma in health care settings might be more tailored to specific outcomes, such as depression and physician trust, than interventions designed to address experienced stigma in the community.


Assuntos
Infecções por HIV/psicologia , Instalações de Saúde , Meio Social , Estigma Social , Adulto , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Sudeste dos Estados Unidos , Resultado do Tratamento , População Urbana
17.
Women Health ; 58(10): 1151-1166, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29240532

RESUMO

The role of unintended pregnancy norms and stigma in contraceptive use among young women is understudied. This study investigated relationships between anticipated reactions from others, perceived stigma, and endorsed stigma concerning unintended pregnancy, with any and dual contraceptive use in this population. From November 2014 to October 2015, young women aged 18-24 years (n = 390) and at risk for unintended pregnancy and sexually transmitted infections participated in a survey at a university and public health clinics in Alabama. Multivariable regression models examined associations of unintended pregnancy norms and stigma with contraceptive use, adjusted for demographic and psychosocial characteristics. Compared to nonusers, more any and dual method users, were White, nulliparous, and from the university and had higher income. In adjusted models, anticipated disapproval of unintended pregnancy by close others was associated with greater contraceptive use (adjusted Odds Ratio [aOR] = 1.54, 95 percent confidence interval [CI] = 1.03-2.30), and endorsement of stigma concerning unintended pregnancy was associated with lower odds of dual method use (aOR = 0.71, 95 percent CI = 0.51-1.00). Unintended pregnancy norms and stigma were associated with contraceptive behavior among young women in Alabama. Findings suggest the potential to promote effective contraceptive use in this population by leveraging close relationships and addressing endorsed stigma.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Gravidez não Planejada/psicologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Normas Sociais , Estigma Social , Adolescente , Alabama , Estudos Transversais , Feminino , Humanos , Gravidez , Saúde Reprodutiva , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto Jovem
18.
AIDS Behav ; 21(12): 3431-3439, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29081045

RESUMO

There is insufficient research on the impact of perceived discrimination in healthcare settings on adherence to antiretroviral therapy (ART), particularly among women living with HIV, and even less is known about psychosocial mechanisms that may mediate this association. Cross-sectional analyses were conducted in a sample of 1356 diverse women living with HIV enrolled in the Women's Interagency HIV Study (WIHS), a multi-center cohort study. Indirect effects analysis with bootstrapping was used to examine the potential mediating roles of internalized stigma and depressive symptoms in the association between perceived discrimination in healthcare settings and ART adherence. Perceived discrimination in healthcare settings was negatively associated with optimal (95% or better) ART adherence (adjusted odds ratio (AOR) = 0.81, p = 0.02, 95% confidence interval (CI) [0.68, 0.97]). Furthermore, internalization of stigma and depressive symptoms mediated the perceived discrimination-adherence association: Serial mediation analyses revealed a significant indirect effect of perceived discrimination in healthcare settings on ART adherence, first through internalized HIV stigma, and then through depressive symptoms (B = - 0.08, SE = 0.02, 95% CI [- 0.12, - 0.04]). Perceiving discrimination in healthcare settings may contribute to internalization of HIV-related stigma, which in turn may lead to depressive symptoms, with downstream adverse effects on ART adherence among women. These findings can guide the design of interventions to reduce discrimination in healthcare settings, as well as interventions targeting psychosocial mechanisms that may impact the ability of women living with HIV to adhere to ART regimens.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Depressão/psicologia , Discriminação Psicológica , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Estigma Social , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Humanos , Pessoa de Meia-Idade , Manejo da Dor , Percepção , Adulto Jovem
19.
J Acquir Immune Defic Syndr ; 76(5): 482-487, 2017 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-28885270

RESUMO

BACKGROUND: Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes are unclear. METHODS: Among 196 HIV clinic patients in Birmingham, AL, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariate-adjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence and the mediating role of visit adherence in the association between internalized stigma and ART adherence. RESULTS: Higher internalized stigma was associated with lower visit adherence (B = -0.04, P = 0.04). Black (versus white) race and depressive symptoms were other significant predictors within this model. Mediation analysis yielded no indirect effect through depression in the association between internalized stigma and visit adherence (B = -0.18, SE = 0.11, 95% confidence interval: -0.44 to -0.02) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the effect of internalized stigma on suboptimal ART adherence was mediated by lower visit adherence (B = -0.18, SE = 0.11, 95% confidence interval: -0.44 to -0.02). CONCLUSIONS: Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/psicologia , Infecções por HIV/terapia , Cooperação do Paciente , Estigma Social , Adulto , Idoso , Fármacos Anti-HIV/administração & dosagem , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Am J Public Health ; 107(6): 863-869, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28426316

RESUMO

We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV. HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways. A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.


Assuntos
Adaptação Psicológica , Infecções por HIV/prevenção & controle , Adesão à Medicação/psicologia , Estigma Social , Atitude Frente a Saúde , Infecções por HIV/tratamento farmacológico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Preconceito
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