Interpersonal violence and other social-structural barriers associated with needing HIV treatment support for women living with HIV

2021 ◽  
pp. 088626052098325
Author(s):  
Margaret Erickson ◽  
Kate Shannon ◽  
Flo Ranville ◽  
Patience Magagula ◽  
Melissa Braschel ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Sexual Health ◽  
Interpersonal Violence ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Art Adherence ◽  
Women Living With Hiv ◽  
Multivariable Logistic Regression ◽  
Gender Based ◽  
Living With Hiv

Women living with HIV (WLWH), experience disproportionate rates of violence, along with suboptimal HIV health outcomes, despite recent advancements in HIV treatment, known as antiretroviral therapy (ART). The objectives of this study were to: (a) describe different types of support needed to take ART and (b) investigate the social and structural correlates associated with needing support for ART adherence among WLWH. Data are drawn from Sexual health and HIV/AIDS: Women’s Longitudinal Needs Assessment, a community-based open research cohort with cisgender and transgender WLWH, aged 14+ who live or access HIV services in Metro Vancouver, Canada (2014–present). Baseline and semi-annual questionnaires are administered by community interviewers alongside a clinical visit with a sexual health research nurse. Bivariate and multivariable logistic regression using generalized estimating equations and an exchangeable working correlation matrix was used to model factors associated with needing supports for ART adherence. Among 276 WLWH, 51% ( n = 142) reported needing support for ART adherence; 95% of participants reported lifetime gender-based violence and identified many interpersonal, structural, community, and clinical supports that would facilitate and support ART adherence. In multivariable logistic regression, participants who were Indigenous (adjusted odds ratio [AOR]: 1.70, 95% confidence intervals [CI]: 1.07–2.72), or otherwise racialized (AOR: 2.36, 95% CI : 1.09–5.12) versus white, experienced recent gender-based physical violence (AOR : 1.54, 95% CI : 1.03–2.31), lifetime post-traumatic stress disorder (AOR : 1.97, 95% CI : 1.22–3.18), and recent illicit drug use (AOR : 2.15, 95% CI : 1.43–3.22), had increased odds of needing support for ART adherence. This research suggests a need for trauma-informed, culturally safe and culturally responsive practice and services for WLWH along the HIV care continuum to support ART adherence. All services should be developed by, with, and for WLWH and tailored according to gender identity, taking into account history, culture, and trauma, including the negative impacts of settler colonialism for Indigenous people.

What women want: social characteristics, gender-based violence and social support preferences in a cohort of women living with HIV

2016 ◽  
Vol 28 (5) ◽  
pp. 486-490 ◽  
Author(s):  
Sally Wielding ◽  
Alison Scott
Keyword(s):  
Sexual Health ◽  
Peer Support ◽  
Hiv Care ◽  
Social Characteristics ◽  
City Centre ◽  
Gender Based Violence ◽  
Group Setting ◽  
Women Living With Hiv ◽  
Gender Based ◽  
Living With Hiv

A total of 229 women attend Chalmers Centre (a city-centre integrated sexual health centre in Edinburgh, Scotland) for their HIV care and treatment. Local third-sector agencies provide peer support, but anecdotally, it is not well utilised and some demographic groups are under-represented. The aim of this study was to gain better understanding of the background social characteristics of these women, to ascertain what issues they are affected by, and to better identify what support is required and how it should be provided/facilitated. An anonymous self-completion questionnaire was developed, and all women attending HIV clinics between July and November 2015 were given the opportunity to participate. Additional data were accessed from the National Sexual Health database on cohort size and gender-based violence enquiries. Forty-four women living with HIV completed the questionnaire. 25% are unemployed. 84.6% had a combined household income of less than £30,000 per annum. 16.7% do not know anyone else, and 59.5% know only one other person, who is living with HIV. 32.6% would like to meet other/more women living with HIV, and 25.5% were unsure if they did or not. Of those who would, 42.9% would prefer a one-to-one setting, 42.9% would prefer a group setting, and 14.3% did not mind. 64.3% would prefer to meet off NHS premises. 26.8% were interested in discussion groups on women’s issues, and 31.7% were unsure. The most popular suggestions for discussion group topics were stress/anxiety (nine women), HIV disclosure (eight women), diet and nutrition (seven women), and pregnancy and childbirth (six women). 26.8% were interested in attending a “women clinic” staffed by female staff, the same number were unsure if they would utilise this service or not. 50% of women had, at some point, experienced gender-based violence, 13.5% were currently experiencing gender-based violence, and four of these women have children living with them. From National Sexual Health records, only 15.7% of the cohort had ever been asked about gender-based violence. Respondents were demographically representative of our whole cohort. 75% are in employment but it appears that the majority of these women are likely to be earning lower than the national average income. To improve holistic support for these women and facilitate peer support, we need to be flexible in our approach. Gender-based violence appears to be disproportionately affecting women living with HIV in Lothian and, as a team, we are failing to routinely enquire about it. Robust referral/signposting pathways should be developed for women after gender-based violence disclosure.

scholarly journals Late antiretroviral refills and condomless sex in a cohort of HIV-seropositive pregnant and postpartum Kenyan women

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254767
Author(s):  
McKenna C. Eastment ◽  
John Kinuthia ◽  
Lei Wang ◽  
George Wanje ◽  
Katherine Wilson ◽  
...  
Keyword(s):  
Partner Violence ◽  
Postpartum Period ◽  
Hiv Treatment ◽  
Adjusted Relative Risk ◽  
Art Adherence ◽  
Condomless Sex ◽  
Women Living With Hiv ◽  
Kenyan Women ◽  
Living With Hiv ◽  
Hiv Seropositive

Introduction The postpartum period can be challenging for women living with HIV. Understanding how the postpartum period impacts ART adherence and condomless sex could inform the development of comprehensive sexual and reproductive health and HIV services tailored to the needs of women living with HIV during this critical interval. Methods In a longitudinal cohort study of HIV-seropositive Kenyan women, late ART refills and self-reported condomless sex were compared between the woman’s pregnancy and the postpartum period. Analyses were conducted using generalized estimating equations and adjusted for alcohol use, depressive symptoms, intimate partner violence (IPV), and having a recent regular partner. Effect modification was explored for selected variables. Results and discussion 151 women contributed visits. Late ART refills occurred at 7% (32/439) of pregnancy visits compared to 18% (178/1016) during the postpartum period (adjusted relative risk [aRR] 2.44, 95% confidence interval [CI] 1.62–3.67). This association differed by women’s education level. Women with ≥8 years of education had late ART refills more during the postpartum period than pregnancy (aRR 3.00, 95%CI 1.95–4.62). In contrast, in women with <8 years of education, late ART refills occurred similarly during pregnancy and the postpartum period (aRR 0.88, 95%CI 0.18–4.35). Women reported condomless sex at 10% (60/600) of pregnancy visits compared to 7% (72/1081) of postpartum visits (aRR 0.76, 95%CI 0.45–1.27). This association differed by whether women had experienced recent IPV. Women without recent IPV had a significant decline in condomless sex from pregnancy to postpartum (aRR 0.53, 95%CI 0.30–0.95) while women with recent IPV had no significant change in condomless sex from pregnancy to postpartum (aRR 1.76, 95%CI 0.87–3.55). Conclusion Improved support for ART adherence during the postpartum period and addressing IPV to limit condomless sex could improve HIV treatment and prevention outcomes for HIV-seropositive women as well as their infants and sexual partners.

scholarly journals An Intervention by and for Transgender Women Living With HIV: Study Protocol for a Two-Arm Randomized Controlled Trial Testing the Efficacy of “Healthy Divas” to Improve HIV Care Outcomes

2021 ◽  
Vol 3 ◽  
Author(s):  
Jae M. Sevelius ◽  
Torsten B. Neilands ◽  
Cathy J. Reback ◽  
Danielle Castro ◽  
Samantha E. Dilworth ◽  
...  
Keyword(s):  
Social Services ◽  
San Francisco ◽  
Controlled Trial ◽  
Transgender Women ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Randomized Controlled ◽  
Women Living With Hiv ◽  
Institutional Review ◽  
Living With Hiv

Introduction: Transgender women (assigned “male” at birth but who do not identify as male) are disproportionately impacted by HIV and experience unique barriers and facilitators to HIV care engagement. In formative work, we identified culturally specific and modifiable barriers to HIV treatment engagement among transgender women living with HIV (TWH), including prioritizing transition-related healthcare over HIV treatment, avoiding HIV care settings due to gender-related and HIV stigma, concerns about potential drug interactions with hormones, and inadequate social support. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, we developed the Healthy Divas intervention to optimize engagement in HIV care among TWH at risk for treatment failure and consequential morbidity, mortality, and onward transmission of HIV.Methods and Analysis: We conducted a 2-arm randomized controlled trial (RCT) of the intervention's efficacy in Los Angeles and San Francisco to improve engagement in care among TWH (N = 278). The primary outcome was virologic control indicated by undetectable HIV-1 level (undetectability = &lt; 20 copies/mL), at baseline and follow-up assessment for 12 months at 3-month intervals.Ethics and Dissemination: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Western Institutional Review Board (20181370). Participants provided informed consent before enrolment in the study. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. We will make our results available to researchers interested in transgender health to avoid unintentional duplication of research, as well as to others in health and social services communities, including HIV clinics, LGBT community-based organizations, and AIDS service organizations.Clinical Trial Registration:Clinicaltrials.gov, identifier NCT03081559.

Psychiatric Aspects of Care Engagement and Medication Adherence in Antiretroviral-Based HIV Treatment and Prevention

2017 ◽  
Author(s):  
Jeffrey J. Weiss ◽  
Michael J. Stirratt
Keyword(s):  
Hiv Infection ◽  
Treatment Adherence ◽  
Psychiatric Illness ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Art Adherence ◽  
Addictive Disorders ◽  
Persons Living With Hiv ◽  
Hiv Care Engagement ◽  
Living With Hiv

Care engagement and treatment adherence are directly related to HIV treatment outcomes and to mortality. Active drug use and psychiatric illness such as depressive and addictive disorders are significant barriers to care engagement and treatment adherence among persons living with HIV and those at high risk for HIV infection and eligible for pre-exposure prophylaxis (PrEP). This chapter addresses (1) psychiatric aspects of PrEP for HIV prevention, (2) the care continuum for individuals living with HIV infection, (3) psychiatric determinants of HIV care engagement, (4) behavioral interventions to improve HIV care engagement, (5) psychiatric determinants of antiretroviral (ART) adherence, (6) interventions to improve ART adherence, and (7) implications of research findings for the medical and mental health clinician working with patients with psychiatric illness who are living with HIV or at risk for infection.

scholarly journals The role of unintended pregnancy in internalized stigma among women living with HIV in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Chace Dwyer ◽  
Aparna Jain ◽  
Wilson Liambila ◽  
Charlotte E. Warren
Keyword(s):  
Unintended Pregnancy ◽  
Hiv Treatment ◽  
Outcome Variable ◽  
Internalized Stigma ◽  
Health Seeking ◽  
Logistic Regression Models ◽  
Stigma And Discrimination ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv

Abstract Background Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV. Methods Baseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored. Results About 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2–2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents’ characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3–2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination. Conclusions Results suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.

Human papillomavirus infection and associated factors for cervical intraepithelial neoplasia in women living with HIV in China: a cross-sectional study

2018 ◽  
Vol 95 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Qian Wang ◽  
Xiaomeng Ma ◽  
Xiaosong Zhang ◽  
Jason J Ong ◽  
Jun Jing ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Human Papillomavirus ◽  
Cervical Intraepithelial Neoplasia ◽  
Sexually Transmitted Infections ◽  
Associated Factors ◽  
Intraepithelial Neoplasia ◽  
Multivariate Logistic Regression ◽  
Sexually Transmitted ◽  
Women Living With Hiv ◽  
Living With Hiv

ObjectiveWomen living with HIV (WLHIV) face disproportionately higher risks of acquiring human papillomavirus (HPV) compared with HIV negative counterparts. We aimed to investigate the prevalence of HPV in WLHIV in Chinese hospital setting and identify associated factors to the progression of late-stage cervical intraepithelial neoplasia (CIN2+) in this population.MethodThis retrospective study collected data from 183 WLHIV on antiretroviral treatment (ART), based on reproductive health questionnaires. Gynaecological examination results including serum (for HIV viral load, CD4 T-cell count, hepatitis B infections, syphilis) and vaginal swabs for common bacterial sexually transmitted infections (STIs). Multivariate-logistic regression was applied to analyze the contributing factors to CIN2+.ResultsHIV coinfection with other Sexually Transmitted Infections (STIs) were observed in 99 participants (54.1%, (99/183)). HPV (43.7% (80/183)) was the most prevalent STI. The three most prevalent HPV subtypes were all high-risk HPV (HR-HPV), including HPV52 (33.8% (27/80)), HPV58 (21.3% (17/80)) and HPV33 (13.75% (11/80)). About a third (37.5%, 30/80) of women with HPV had HR-HPV. Multiple HPV coinfections were common in HIV-HPV coinfected women (41.3%, 33/80). Cytological examinations revealed that 77.5% (62/80) HPV+ women had detectable cervical lesions. In comparison, only 4.9% (5/103) HPV negative womenwith Atypia and 1.0% (1/103) with CIN1 were diagnosed. Multivariate logistic regression revealed that HPV16 (OR=19.04, 2.53 to 122.92; p=0.004) and HPV18 (OR=11.54, 1.45 to 91.64; p=0.021) infections were significantly associated with CIN2+ in HIV-HPV coinfected women.ConclusionA high prevalence of HPV was found in women on ART. HPV16/18 infection are strong associated factors to CIN2+ in HIV-HPV coinfected women.

scholarly journals Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Vasiliki Papageorgiou ◽  
Bethan Davies ◽  
Emily Cooper ◽  
Ariana Singer ◽  
Helen Ward
Keyword(s):  
Systematic Review ◽  
Social Determinants ◽  
Meta Analysis ◽  
Hiv Treatment ◽  
Material Deprivation ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

A model to predict adherence to antiretroviral therapy among people living with HIV

2021 ◽  
pp. sextrans-2021-055222
Author(s):  
Hui Chen ◽  
Rusi Long ◽  
Tian Hu ◽  
Yaqi Chen ◽  
Rongxi Wang ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Poor Adherence ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Snowball Sampling ◽  
Hiv Viral Load ◽  
Temporal Validation ◽  
Suboptimal Adherence ◽  
Living With Hiv

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

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