Training senior service providers about HIV and aging: Evaluation of a multiyear,multicity initiative

ABSTRACT

The Centers for Disease Control and Prevention estimate that in 2015, one half of all people living with HIV in the United States will be older than age 50. Older adults remain sexually active, and 16% of all new HIV diagnoses occur in adults age 50 and older. However, older adults rarely see themselves at risk for HIV/AIDS, and physicians are frequently reluctant to discuss sex. To address the issue of aging and HIV, ACRIA created its National Older Adults with HIV (NOAH) technical assistance and capacity-building program. NOAH targets aging and HIV providers that serve older adults at risk for or living with HIV. Program goals include increasing knowledge, reducing stigma, and creating partnerships between senior service providers (SSPs) and HIV service providers. In its first 4 years, NOAH training was provided to 150 organizations in eight cities across the United States, reaching 332 agency staff. Outcome evaluation found significant increases in knowledge about HIV and aging, and programmatic impact with regard to integration of older adults and HIV information in participating agencies’ activities. Ongoing issues included recruiting SSPs and difficulties in reaching agencies that participated for short- and long-term follow-up. Implications for workforce development are discussed.     

Initial Development of Scales to Assess Self-Efficacy for Disclosing HIV Status and Negotiating Safer Sex in HIV-Positive Persons

Two studies were conducted to develop scales for assessing self-efficacy to disclose HIV status to sex partners and negotiate safer sex practices among people living with HIV/AIDS. Elicitation research was used to derive 4 sets of scenarios with graduated situational demands that serve as stimulus materials in assessing self-efficacy. Two studies demonstrated that the self-efficacy scales for effective disclosure and negotiating safer sex practices were internally consistent, time stable over 1 month, and demonstrated evidence for validity. Self-efficacy scales also demonstrated evidence of criterion-related, convergent, and divergent validity. Reliable and valid instruments for assessing self-efficacy to make effective HIV status disclosure decisions and practice safer sex were therefore developed and these scales can be used in research to explain, predict, and enhance self-efficacy for these important behaviors.     

Measuring HIV-related Stigma Among Chinese Service Providers: Confirmatory Factor Analysis of a Multidimensional Scale

An HIV-related stigma scale for health care workers needs to be multidimensional in that it should encompass attitudes that might be experienced by the general public about people living with HIV/AIDS (PLWHA) (e.g., fear, shame, blame) and, further, specifically capture perceptions of appropriate professional care and medical responsibilities regarding PLWHA. A 17-item, 5-factor multidimensional HIV-related stigma scale was developed and validated using both exploratory and confirmatory factor analysis among 1,101 service providers in China. The sample was divided into a development sample (N = 551) and a validation sample (N = 550). The fit of the final confirmatory factor model with five hypothesized subscales was excellent in both samples. The final stigma subscales included: Discrimination Intent at Work, Opinion about Health Care for HIV/AIDS Patients, Prejudiced Attitudes, Internalized Shame, and Fear of PLWHA.     

Strengthening partnerships between Black Churches and HIV service providers in the United States

Across the United States, Black Churches play a significant role among the Black community and are increasingly being used to deliver Human Immunodeficiency Virus (HIV) prevention services. This study sought to investigate HIV service providers’ strategies for strengthening partnerships with churches to deliver HIV prevention services. Using a community-based participatory research approach, an HIV coalition and an academic institution formed a partnership to address the study aim. Individual interviews (n?=?16) were conducted with providers from medical institutions and HIV social support agencies. A thematic analysis focusing on recommendations for addressing the challenges and benefits of partnership with churches for HIV services was conducted. Participants’ interest in and intention to work with churches, as well as their comfort level discussing sexual health-related topics with religious congregations, was high. Four themes emerged to highlight the different perspectives of service providers’ recommendations for addressing challenges and strengthening partnerships with churches to deliver HIV services including: (1) carefully selecting churches and HIV services to provide, (2) gaining “buy-in” and support of church leadership, (3) taking advantage of conflict with church doctrine, and (4) choosing appropriate delivery strategies. Study findings demonstrate that although challenges exist, heath service providers in this region of the United States may be interested in addressing HIV among faith communities. Study findings also provide concrete solutions to previously documented barriers to HIV prevention in Black Churches. Such information will benefit researchers and practitioners seeking to expand effective HIV prevention efforts with Black Churches in communities who bear a disproportionate burden of HIV infections.     

中盖项目7城市的HIV/AIDS病人对社区小组服务需求调查

目的更好地了解艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人（PLWHA）的状况,及对感染者社区组织提供服务的需求情况,以便为该人群提供更加有针对性的支持提供依据。方法在中盖项目覆盖的7个城市（北京、昆明、南京、天津、武汉、青岛、西安）中,对正在接受当地感染者社区小组所提供服务的PLWHA进行问卷调查。结果 552名被调查对象的家庭年收入普遍偏低,有28.1%的人没有享受到任何医疗保障,60%以上的调查对象认为,感染HIV后给其个人及家庭带来了负面影响;被调查对象希望能够得到多方面的支持,因被调查对象性别、收入水平和传播途径等不同,希望获得的支持和服务内容也不同。结论 PLWHA的基本情况普遍低于一般人群,且需求存在多样化。应结合具体的情况,为其提供有针对性的支持与帮助。     

Front-line service providers’ appraisal of Saskatchewan’s HIV services and strategy: A qualitative study

This qualitative study examined front-line health care providers’ understandings of the Saskatchewan Ministry of Health’s 2010–2014 HIV strategy, their capacity building needs, and perspectives on how well they were implementing HIV services. Providers’ experiences of engaging people living with HIV, community leaders, and communities affected by the epidemic reveal a need to strengthen interprofessional networks. Our findings also indicate the need for HIV services to respond to coexisting challenges, including substance use, violence, and mental health care for people living with HIV. Programs in rural northern Saskatchewan should also address homelessness, disparities in access to care, and HIV stigma issues.     

HIV providers’ likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: a short report

Pre-exposure prophylaxis (PrEP), the antiretroviral treatment regimen for HIV-negative people at high risk of acquiring HIV, has demonstrated efficacy across clinical trials in several patient populations. The Centers for Disease Control (CDC) have released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, including men who have sex with men (MSM), high-risk heterosexuals, and injection drug users (IDUs). Given that much attention in PrEP has focused on MSM patients, the present study used an online survey to assess factors involved in HIV care providers’ (n?=?363) decisions about prescribing PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, IDUs). The efficacy of PrEP was an important factor in providers' decisions about prescribing PrEP, as were considerations about patients’ adherence to the regimen, regular follow-up for care, and medication costs. This survey's findings also suggest that providers’ willingness to prescribe PrEP varies by patient group, with providers most willing to initiate the regimen with MSM who have an HIV-positive partner, and least willing to prescribe to high-risk heterosexuals or IDUs. In the context of the current CDC recommendations for PrEP that include MSM, heterosexuals, and IDUs, examining providers’ rationales for and barriers against supporting this HIV prevention strategy across patient groups merits further attention.     

Measuring HIV-related stigma among healthcare providers: a systematic review

In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.     

Pilot evaluation of the Making Employment Needs [MEN] Count intervention: Addressing behavioral and structural HIV risks in heterosexual Black men

Few community-based HIV interventions exist for Black men at heterosexual risk for HIV. None focus on structural HIV risks such as unemployment and unstable housing. This study involved a pilot evaluation of the MEN (Making Employment Needs) Count HIV intervention, a three session peer counselor-delivered program of HIV risk reduction and gender-equity counseling, and employment and housing case management. A single-arm intervention trial of MEN Count was conducted with Black men recruited from a community men's clinic and social services program. Eligible men were those who reported two or more sex partners in the past six months and current unemployment and/or recent homelessness. Most participants (68%) had a history of incarceration. Participants (N = 50) were surveyed on outcomes at baseline (Time 1), posttest (Time 2; 60–90 days after baseline), and two-month follow-up (Time 3). The majority of participants were retained in the program (86%) and the final follow-up survey (76%). McNemar tests revealed significant reductions in the past 30-day unprotected sex from Time 1 (74%) to Time 2 (47%) and to Time 3 (47%), and in homelessness from Time 1 (58%) to Time 3 (32%). Significant increases in employment from Time 1 (8%) to Time 2 (29%) and Time 3 (32%) were also seen. Participants completed a brief participant satisfaction survey at posttest. Most (n=28, 65%) rated the program as excellent, and an additional 10 (23%) rated it as good. Although there was no significant reduction in multiple sex partners, a trend was observed from Time 1 (56%) to Time 2 (44%) and Time 3 (42%). Findings suggest that the MEN Count model is a feasible and promising HIV prevention program for Black men at heterosexual risk for HIV. Larger scale implementation and more rigorous evaluation of MEN Count are needed to confirm the study findings.     

Voices Less Heard

ABSTRACT

Asthe HIV infectionrate among African American women steadily increases, the body of research focusing on the lives, health, and concerns of HIV-positive African American women remains insufficient. Through primarily qualitative techniques, this study aims to gain insight into the health issues and concerns of HIV-positive African American women. Focus groups with small numbers of HIV-positive African American women were conducted to understand what factors strengthen and weaken medication adherence for women, determine what women's needs are about these issues, and to find out how medical community and service providers can help meet women's needs about adherence. Results from a series of face-to-face interviews with 98 HIV-positive African American women provided insightson how women with HIV and AIDS take care of themselves, and to what extent various life experiences and events influence self-care and adherence. Focus group findings identified factors that weaken and strengthen current medication adherence. Focus group participants also made several recommendations for future adherence strategies and tactics. Face-to-face interviews demonstrate the impact of substance use and past sexual abuse upon women's efforts to adhere to medication and treatment regimens. Implications and recommendations derived from the analysis provide suggestions for enhancing medication adherence strategies. Enhancing methods of increasing adherence rates for medical and human service professionals can improve support services for African American women living with HIV and AIDS.     

My secret: The social meaning of HIV/AIDS stigma

Abstract

This study uses Goffman's [1963. Stigma: Notes on the Management of Spoiled Identity, New Jersey, Prentice-Hall] theory of stigma as an intellectual scaffold to help understand the social meaning of HIV/AIDS stigma from People Living with HIV/AIDS. The study adopts a qualitative approach because of its appropriateness for unravelling subjective phenomena such as the experiences of HIV/AIDS stigma. In-depth interviews were conducted with 10 HIV-positive employees of a retailing company located in the Western Cape province of South Africa who volunteered to participate in the study. The participants with the discreditable stigma internalised society's prejudice towards those living with the virus. As a result, the participants relied on self-isolation and social withdrawal to cope with enacted stigma. Managing information about one's status and deciding whether, who, when, etc., to tell are crucial questions. The participants feared being devalued by family, friends, co-workers and the community. In concurrence with Goffman [1963. Stigma: Notes on the Management of Spoiled Identity, New Jersey, Prentice-Hall] the HIV/AIDS stigma is seen as about relationships.     

High Levels of Risk Behavior Among People Living with HIV Initiating and Waiting to Start Antiretroviral Therapy in Cape Town South Africa

Baseline data were collected in Cape Town during 2006 to study if patients on combination antiretroviral therapy (ART) experience decreased inhibition to avoid risky sexual behavior. A total of 924 HIV-positive individuals were recruited; 520 who initiated ART within 3 months and 404 waiting for ART. Nearly half of men (40.1%) and women (46.3%) reported having unprotected sex their last time. Men and women who did not disclose their HIV status to their partner [Odds ration (OR)=2.57 (95% CI: 1.22-5.50) and 2.84 (95% CI: 1.84-4.39), respectively], and those with ambivalent perception about the relationship between ART and HIV transmission [OR=2.08 (95% CI: 1.00-4.30) and 2.39 (95% CI: 1.50-3.84), respectively], were twice as likely to have had unprotected sex their last time. Results suggest an urgent need to strengthen prevention interventions among HIV-positive individuals on and about to start ART in this setting.     

Guyanese Health Care Providers' HIV-Related Experiences,Attitudes, and Readiness to Provide Care

Abstract

This article reports findings from a qualitative study of HIV-related knowledge and attitudes of Guyanese social service and health care providers. Social service and health care practitioners were asked to comment on beliefs and experiences regarding HIV and stigma, readiness to treat persons with HIV, and observations of cultural norms and prevailing attitudes. Two focus groups and six individual interviews led to insights about cultural and economic realities which support or obstruct education and treatment. Themes emerged in the areas of public attitudes and professional practices regarding HIV. The findings suggest that work is needed in Guyana to educate the public and prepare professionals for a burgeoning HIV pandemic. Educational, service, and political efforts should involve Guyanese people and systems at every Stage.     

Preference for physician vs. nurse-initiated opt-out screening on HIV test acceptance

Provider-initiated opt-out HIV screening suggests that providers should routinely order HIV tests unless a patient declines. However, data on how providers will respond to this new screening model are scarce. Documented concerns from the providers' perspectives have included time constraints of a typical patient encounter, and discomfort with discussing sexual history and risk behavior with patients. To address these potential barriers, nurse-initiated screening has been proposed as an approach to increasing screening rates in general medical and urgent care settings. This study compares patient acceptability of provider-initiated opt-out HIV screening with nurse-initiated opt-out HIV screening among 220 patients between the ages of 18–64 from two publically funded “safety-net” outpatient clinics in Los Angeles County. Our study found that 77% of patients agreed to HIV testing using opt-out screening, and that HIV test acceptance was higher with the physician-initiated opt-out model compared with the nurse-initiated opt-out model (adjusted odds ratios = 2.92; 95% CI = 1.37–6.22). These findings indicate that adding opt-out screening to primary care providers responsibilities may be an acceptable and effective strategy for addressing the perennially low HIV testing rates, particularly among low income, traditionally underserved patient populations among whom the epidemic is expanding most rapidly.     

Transportation vulnerability as a barrier to service utilization for HIV-positive individuals

Research suggests that transportation vulnerability can negatively impact adherence to HIV-related medical treatment. Moreover, transportation can be a barrier to accessing ancillary services which can increase positive health outcomes for HIV-positive individuals. This study examines transportation vulnerability and its impact on HIV-related health and ancillary service utilization in the Mid-South Region. Focus groups and interviews were conducted with service providers and HIV-positive individuals, and survey data were collected from HIV-positive individuals (N=309) using the five A's of access to frame transportation vulnerability: availability, accessibility, accommodation, affordability, and acceptability. Study results indicate that transportation vulnerability can present significant barriers to service utilization for HIV-positive individuals, including insufficient transportation infrastructure, incompatible fit between transportation and health systems, and insensitivity to privacy issues. One consequence of transportation vulnerability is reliance upon weaving together multiple modes of transport to access care and ancillary services, creating additional barriers to service utilization and medical adherence. The research team recommends more investment in public transit systems, expanded services, and innovative approaches to solving procedural problems.     

The Role of Community in Meeting the Needs of African-American HIV-Affected Families

Abstract

Using qualitative methods, university researchers enlisted the participation and collaboration of community residents to assess the service needs of HIV-affected families in an inner-city African-American community with a high seroprevalence of HIV/AIDS. Community members infected with and affected by HIV/AIDSparticipated in interviews and reviewed and refined the preliminary findings. The participants were concerned by the lack of HIV/AIDScommunity services that were family-sensitive, i.e., addressed the stresses and concerns of those people who provide support and care for a person with HIV. Participants identified community awareness and education as critical to serving those infected and affected. Denial and stigma in the community need to be addressed concurrently with the development of specific services for HIV-affected families.     

A systematic review of HIV/AIDS-related stigma and discrimination in India: Current understanding and future needs

HIV/AIDS-related stigma is recognised as a major barrier to HIV prevention efforts and an impediment to mitigating its impact on individuals and communities. This paper reviews the existing research literature on AIDS stigma in India with the objective of documenting the current status of research, highlighting major findings and identifying key gaps remaining. Thirty publications were identified through a careful search of which a majority focused on stigma assessment and very few on stigma measurement, conceptual aspects of stigma or stigma reduction interventions. A few standardised stigma measures are available but more are required to assess causes of stigma among general population and compounded and internalised stigma among positive people. Research exploring linkages between stigma and HIV services uptake or the effect of HIV care and treatment programs on stigma levels are largely missing and need to be prioritised. In addition, more research is needed to advance conceptual understanding of stigma within the cultural context of the country including research on the neglected groups such as, transgender people. Context-specific (health care, community) interventions are needed to address various forms of stigma – enacted, perceived, internalised and layered – including structural approaches besides inter-personal and information-based approaches. A major gap relates to meager research on developing and evaluating stigma reduction interventions and needs priority focus. Overall, the review recommends developing a national agenda on AIDS stigma research and interventions to help realise the government's goal of stigma reduction.     

Treatment Adherence Among Clients in AIDS Service Organizations

ABSTRACT

For social workers in AIDS service organizations (ASOs), helping clients adhere to antiretroviral therapies is a priority, since non-adherence can significantly reduce drug efficacy and lead to drug resistance. This preliminary study examined treatment adherence among HIV-infected individuals receiving services from four ASOs in New York City. Adherence was suboptimal; more than one half of the sample had not taken their medications as prescribed within the past month and 20% had missed taking one or more pills the previous day. Clients who reported greater adherence considered themselves to be in good emotional health, had not used illegal drugs recently, and believed that their ASO was very helpful with regard to treatment adherence. Regular assessment of clients' treatment adherence is essential and social workers should continue to be involved with other health professionals in designing, implementing and evaluating interventions for promoting adherence among clients in ASOs.     

社区卫生服务机构艾滋病防治工作人员的艾滋病知识和歧视态度及相关影响因素的研究

目的了解社区卫生服务机构艾滋病防治工作人员,对艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）的歧视情况及影响因素。方法采用自填式调查问卷,对8个城市40家社区卫生服务机构361名工作人员进行调查。调查内容包括工作人员的一般情况、对HIV/AIDS病人的态度和开展艾防工作意愿等。结果 292人（80.9%）表示能像对待其他患者一样对待HIV/AIDS病人,或者可以为他们提供医疗卫生服务,没有歧视。多因素Logistic回归分析显示,近一年接受培训的天数（3-6天、7-14天和15天以上）、支持社区开展艾滋病防治工作的工作人员对HIV/AIDS病人歧视有显著性差异,比值比（OR）[95%可信区间（CI）]分别为3.96（1.10,14.25）、4.93（1.27,19.19）、10.33（1.86,57.42）、0.25（0.12,0.52）。结论社区卫生服务机构工作人员对HIV/AIDS病人依然存在歧视,当地卫生行政部门和疾控机构需要加强对社区医生的艾滋病防治知识、技能和职业暴露预防的培训,同时要提高其工作待遇,稳定基层防艾队伍。     

三省受艾滋病影响儿童救助政策落实现状分析

目的分析受艾滋病影响儿童的救助政策落实情况,为制定和推动政策落实提供参考。方法采取文献回顾、深入访谈和专题小组讨论等方式,在3个省(自治区)开展调查研究,并对资料进行了定性分析。结果共调查243名受访者,其中深入访谈81人,与162名来自多部门的人员开展了专题小组讨论。调查发现,目前各地各部门针对受艾滋病影响儿童均制定了相关救助政策,开展了关怀救助活动,活动形式多样,内容涉及生活救助、教育支持、卫生保健、心理和职业发展等5方面,基本涵盖了儿童成长相关的各个方面。发现存在非义务教育阶段儿童教育缺乏政策保障、生活救助覆盖人数仍有限、对父母一方或双方存活的受艾滋病影响儿童关注度不够、心理关怀仍十分薄弱等问题。结论各地应针对现有政策制定实施细则或指导方案,进一步完善信息收集、交流和利用机制,提高有关部门和相关人员的政策认知程度,不断加大资源保障力度。