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1.
AIDS Patient Care STDS ; 35(11): 441-448, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34739336

RESUMO

Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.


Assuntos
Infecções por HIV , Confiança , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação , Estigma Social
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.
AIDS Behav ; 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34581951

RESUMO

Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.

4.
J Infect Dis ; 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174074

RESUMO

BACKGROUND: Persistent immune activation due to gut barrier dysfunction is a suspected cause of morbidity in HIV, but the impact of menopause on this pathway is unknown. METHODS: In 350 women with HIV from the Women's Interagency HIV Study, plasma biomarkers of gut barrier dysfunction (intestinal fatty acid binding protein; IFAB), innate immune activation (soluble CD14 and CD163; sCD14, sCD163), and systemic inflammation (interleukin-6 and tumor necrosis factor receptor 1; IL-6, TNFR1), were measured at 674 person-visits spanning ≤2 years. RESULTS: Menopause (post- vs. pre-menopausal status) was associated with higher plasma sCD14 and sCD163 in linear mixed-effects regression adjusting for age and other covariates (B [95% CI]=161.89ng/mL [18.37, 305.41] and 65.48 ng/mL [6.64, 124.33], respectively); but not with plasma IFAB, IL-6, or TNFR1. In piece-wise linear mixed-effects regression of biomarkers on years before/after the final menstrual period, sCD14 increased during the menopausal transition by 250.71 ng/mL per year (95% CI: 16.63, 484.79; p=0.04), but not in the pre-menopausal or post-menopausal periods. CONCLUSIONS: In women with HIV, menopause may increase innate immune activation, but data did not support an influence on the gut barrier or inflammation. Clinical implications of immune activation during the menopausal transition warrants further investigation.

5.
J Acquir Immune Defic Syndr ; 86(4): 406-412, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620176

RESUMO

BACKGROUND: Research on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns). SETTING/METHODS: One hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma. RESULTS: Disclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect. CONCLUSIONS: Findings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV-1 , Estigma Social , Adulto , Revelação , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Adulto Jovem
6.
J Assoc Nurses AIDS Care ; Publish Ahead of Print2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33427766

RESUMO

ABSTRACT: Few interventions have targeted resilience resources in people living with HIV (PLWH). We tested the acceptability of an existing resilience intervention in middle-age and older PLWH. Fourteen PLWH attended one 3-hr group session, which included videos, quizzes, and written activities. Participants provided quantitative and qualitative feedback. The mean acceptability rating was 8.71 (1.27) on a 10-point scale. A majority of participants reported that the intervention was an appropriate length; that it improved their resilience, mood, and ability to manage HIV; and that they would likely continue using the tools. Average content retention accuracy was 75% (12.66). Qualitative feedback suggested addressing HIV-specific stressors, including disclosure concerns, stigma, health concerns, and treatment adherence. The resilience intervention was deemed highly acceptable among older PLWH. Uptake may increase by addressing HIV-specific stressors and improving comprehensibility. Future research should further refine and test the efficacy of a modified version of the intervention.

7.
AIDS Patient Care STDS ; 34(11): 491-497, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33147084

RESUMO

There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Depressão/complicações , Depressão/psicologia , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Isolamento Social/psicologia , Estigma Social , Adulto , Depressão/epidemiologia , Discriminação Psicológica , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Autoimagem , Autoeficácia , Apoio Social , Estereotipagem , Estados Unidos/epidemiologia
8.
AIDS ; 34 Suppl 1: S73-S82, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32881796

RESUMO

OBJECTIVE: Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles. DESIGN: The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm. METHODS: Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined. RESULTS: The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame. CONCLUSION: The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.


Assuntos
Adaptação Psicológica , Depressão/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/psicologia , Estigma Social , Adolescente , Adulto , Depressão/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários , Estados Unidos
9.
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
10.
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
11.
AIDS Behav ; 24(12): 3482-3490, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32418165

RESUMO

Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women's Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.


Assuntos
Depressão , Infecções por HIV , Estigma Social , Adulto , Idoso , Depressão/epidemiologia , Feminino , Infecções por HIV/complicações , Humanos , Pessoa de Meia-Idade , Dor , Fatores de Risco , Estados Unidos/epidemiologia
12.
Chronic Obstr Pulm Dis ; 7(2): 107-117, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32324982

RESUMO

Introduction: Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use. Materials and Methods: Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model. Results: We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV1]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06-5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25-15-45) compared to high-income + low-stress group. Conclusions: Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress.

13.
PeerJ ; 8: e8402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002332

RESUMO

Purpose: In variety of settings cortisol and testosterone are positively "coupled." That is, within-person fluctuations of cortisol and testosterone levels occur in parallel-increases and decreases in one hormone are associated with corresponding increases and decreases in the other. The present report explored hormone coupling in women athletes in two studies selected because they included measurements of salivary levels of cortisol, testosterone, and estradiol-a hormone that has been only infrequently studied in the context of competitive athletics. Methods: Consenting members of Emory University's varsity volleyball and soccer teams gave saliva samples on multiple occasions in the run-up to and over the course of two different intercollegiate contests. Results: Volleyball and soccer players showed remarkably similar hormone-specific patterns of increase in relationship to the different stages of competition-before warm-up, after warm-up, and after competition. For both the volleyball and soccer team, Hierarchical Linear Model (HLM) analyses showed estradiol as being significantly coupled with testosterone which was also coupled with cortisol. Conclusions: This is, apparently, the first report of significant within-person coupling between estradiol and testosterone in the context of competitive athletic stress. These two hormones may be coupled in a wide variety of circumstances not limited to ones involving sport competition, and results reported here should encourage exploration of the extent to which coordinated fluctuations in estradiol, testosterone, and cortisol levels are present in other, more neutral settings and the ways in which the coordination of these fluctuating hormone levels may benefit human performance.

14.
J Acquir Immune Defic Syndr ; 83(4): 340-344, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32097193

RESUMO

BACKGROUND: Depression plays a key role in suboptimal HIV outcomes, possibly mediated by adherence self-efficacy beliefs and antiretroviral treatment (ART) adherence behavior. Applying social-cognitive theory, we examined a longitudinal sequential path model of the association between depressive symptoms and viral nonsuppression in women with HIV (WWH) through these mediating mechanisms. METHODS: This was an observational longitudinal study using data from the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. WWH (N = 375) completed measures of depressive symptoms, adherence self-efficacy, and ART adherence. Viral load was measured through blood draw. We examined a longitudinal sequential path model spanning 3 time points at least 6 months apart between 2015 and 2017. Indirect effects were assessed of depressive symptoms at time 1 (T1) on viral nonsuppression at T3 through adherence self-efficacy at T2 and ART adherence at T3. Covariates included age, income, recreational drug use, race, and months on ART. RESULTS: Depressive symptoms were associated with subsequent viral nonsuppression through its association with adherence self-efficacy and ART adherence [indirect effect: adjusted odds ratio = 1.004, 95% confidence interval: (1.001 to 1.008)]. Months on ART and recreational drug use were also significantly associated with viral nonsuppression at T3. CONCLUSIONS: Our findings support depressive symptoms' association with adherence self-efficacy that in turn lead to suboptimal ART adherence and ultimately to viral nonsuppression for WWH. Tailoring of interventions aimed at addressing depressive symptoms, substance use, and adherence self-efficacy among WWH is needed to help close the gap between ART prescription and viral suppression on the HIV care continuum.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Transtorno Depressivo/etiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo/prevenção & controle , Feminino , Infecções por HIV/psicologia , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Autorrelato , Inquéritos e Questionários , Carga Viral
15.
J Acquir Immune Defic Syndr ; 83(5): 441-449, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31914006

RESUMO

BACKGROUND: Older people living with HIV (PLWH) experience poorer outcomes than seronegative counterparts. Allostatic load (AL) markers have shown utility as indicators of cumulative wear-and-tear of stress on biological systems. However, little is known about correlates of AL in PLWH. METHODS: Ninety-six PLWH aged 50+ completed a comprehensive neurobehavioral assessment and blood draw. Select AL markers (ie, 10 blood markers) were available for a subset (n = 75) of seronegative controls. AL was operationalized as a sum of markers in the highest risk quartile for: cortisol, DHEA, IL-6, TNF-alpha, C-reactive protein, glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, albumin, systolic and diastolic blood pressure, and body mass index. RESULTS: PLWH had higher risk levels than seronegatives with small-medium effect sizes for several biomarkers. Among HIV+ African Americans (84% of PLWH), higher AL was associated with lower psychological resilience (rho = -0.27, P = 0.02), less physical activity (rho = -0.29, P < 0.01), poorer neurocognitive functioning (rho = -0.26, P = 0.02), greater basic activity of daily living complaints (P < 0.01), and diabetes (P < 0.01). Multivariable regressions within African American PLWH for significant AL-outcome associations (ie, neurocognitive function, basic activity of daily living complaints, diabetes) showed that associations with AL remained significant when adjusting for relevant covariates. Mediation analysis suggested that the association between socioeconomic status and neurocognitive function was mediated by AL. CONCLUSIONS: These exploratory findings are consistent with the larger aging literature, suggesting that lower AL may serve as a pathway to better health and functional outcomes, particularly in African American PLWH. Furthermore, resilience and physical activity may reduce AL in this population.


Assuntos
Alostase/fisiologia , Infecções por HIV/complicações , Afro-Americanos , Idoso , Biomarcadores , Índice de Massa Corporal , Proteína C-Reativa , Colesterol , Desidroepiandrosterona/sangue , Feminino , Infecções por HIV/psicologia , Humanos , Hidrocortisona/sangue , Interleucina-6 , Masculino , Pessoa de Meia-Idade , Resiliência Psicológica , Triglicerídeos/sangue , Fator de Necrose Tumoral alfa/sangue
16.
J Assoc Nurses AIDS Care ; 31(2): 208-218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31714367

RESUMO

The role of HIV disclosure and its influence on engagement in HIV care after initial linkage to care is not well understood. We conducted 28 in-depth interviews with patients newly entering HIV care. Gaining access to social support was a key reason that many patients disclosed their HIV status. For some, HIV disclosure improved support networks related to engagement in care at the time of care entry, in the form of appointment reminders, emotional support, and confidence to disclose more widely. However, some participants cited anticipated stigma as a barrier to disclosure, as they feared rejection or further disclosure without their permission. Early access to social support and skill building related to stigma reduction and coping can be useful resources to help patients manage HIV, as they initiate care. In addition, incorporating support for smart disclosure decisions into interventions may improve access to social support, ultimately improving engagement in care.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Autorrevelação , Estigma Social , Apoio Social , Cooperação e Adesão ao Tratamento/psicologia , Revelação da Verdade , Sorodiagnóstico da AIDS , Adulto , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Discriminação Psicológica , Medo , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Entrevistas como Assunto , Masculino , Preconceito , Pesquisa Qualitativa , Discriminação Social , Estados Unidos/epidemiologia
17.
Soc Sci Med ; 245: 112683, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760320

RESUMO

Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017-July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants' disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity-a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state-we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.


Assuntos
Efeitos Psicossociais da Doença , Insegurança Alimentar , Infecções por HIV/complicações , Estigma Social , Mulheres/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Georgia , Infecções por HIV/psicologia , Humanos , Pessoa de Meia-Idade , North Carolina , Pobreza/psicologia , Estudos Prospectivos , Pesquisa Qualitativa , São Francisco , Fatores Socioeconômicos , Estados Unidos
18.
AIDS Care ; 32(6): 681-688, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31167537

RESUMO

Entering HIV care is a vulnerable time for newly diagnosed individuals often exacerbating psychosocial difficulties, which may contribute to poor health-related quality of life (HRQOL) ultimately influencing health behaviors including ART adherence, the driver of viral load suppression. Understanding HRQOL in people newly entering HIV care is critical and has the potential to guide practice and research. This exploratory cross-sectional study examined demographic, clinical, and psychosocial factors associated with limitations in four specific domains of HRQOL among persons initially entering outpatient HIV care at four sites in the United States (n = 335). In the unadjusted analysis, female gender was significantly associated with sub-optimal HRQOL with women having increased odds of reporting HRQOL challenges with pain, mood, mobility, and usual activity when compared to men. The adjusted models demonstrated attenuation of parameter estimates and loss of statistical significance for the associations with impaired HRQOL observed among women in unadjusted analyses, suggesting psychosocial factors related to HRQOL are complex and interrelated. Findings are consistent with a robust literature documenting gender-related health disparities. Programs aimed at improving HRQOL for persons initially entering HIV care are warranted generally, and specifically for women, and must address modifiable psychosocial factors via mechanisms including coping and social support.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Adulto , Estudos Transversais , Depressão , Feminino , Infecções por HIV/terapia , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estigma Social , Apoio Social
19.
Clin Infect Dis ; 71(10): 2592-2598, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31758196

RESUMO

BACKGROUND: Retention in care (RIC) leads to reduced HIV transmission and mortality. Few studies have investigated clinic services and RIC among people living with HIV (PLWH) in the United States. We conducted a multisite retrospective cohort study to identify clinic services associated with RIC from 2010-2016 in the United States. METHODS: PLWH with ≥1 HIV primary care visit from 2010-2016 at 7 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) were included. Clinic-level factors evaluated via site survey included patients per provider/trainee, navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder methods, and stigma support services. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (31 December 2016), or loss to follow-up (censoring at first 12-month interval without a visit with no future visits). Poisson regression with robust error variance, clustered by site adjusting for calendar year, age, sex, race/ethnicity, and HIV transmission risk factor, estimated risk ratios (RRs) and 95% confidence intervals (CIs) for RIC. RESULTS: Among 21 046 PLWH contributing 103 348 person-years, 67% of person-years were retained. Availability of text appointment reminders (RR, 1.13; 95% CI, 1.03-1.24) and stigma support services (RR, 1.11; 95% CI, 1.04-1.19) were associated with better RIC. Disparities persisted for age, sex, and race. CONCLUSIONS: Availability of text appointment reminders and stigma support services was associated with higher rates of RIC, indicating that these may be feasible and effective approaches for improving RIC.


Assuntos
Infecções por HIV , Retenção nos Cuidados , Estudos de Coortes , HIV , Infecções por HIV/epidemiologia , Humanos , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
Stigma Health ; 4(4): 487-494, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31768417

RESUMO

Accurate measurement of HIV-related stigma is key in understanding and reducing stigma for people living with HIV (PLWH). Experience sampling method (ESM) measures "state"-level phenomena and may improve understanding of daily stigma experiences of PLWH. In 109 men living with HIV, we examined: 1) associations between questionnaire (Q) and ESM internalized and enacted stigma measures; 2) psychosocial predictors (e.g., coping style, perceived HIV community stigma, helplessness) of discrepancies between Q and ESM internalized and enacted stigma; 3) whether Q or ESM measures better predict HIV outcomes. Hierarchical Linear Modeling showed moderate associations between ESM and Q measures of both internalized and enacted stigma. A majority of the psychosocial measures were associated with larger differences between both Q- and ESM-internalized stigma and enacted stigma, respectively. ESM measures were stronger predictors of visit adherence than Q measures. ESM may be advantageous in understanding moment-to-moment changes in stigma and associated processes in PLWH, particularly those with maladaptive psychological traits.

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