Psychosocial Differences Between Whites and African Americans Living With HIV/AIDS in Rural Areas of 13 US States

CONTEXT: Acquired immunodeficiency syndrome (AIDS) prevalence rates are increasing rapidly in rural areas of the United States. As rural African Americans are increasingly affected by human immunodeficiency virus (HIV), it is important to identify psychosocial factors unique to this group so that AIDS mental health interventions can be culturally contextualized to meet their unique needs. PURPOSE: The current study characterized psychosocial functioning in 43 rural African Americans living with HIV/AIDS and compared their levels of functioning to those of 196 HIV-infected rural white persons. METHODS: All participants were recruited through AIDS service organizations in 13 US states. Surveys were completed as part of a preintervention phase of a randomized clinical trial evaluating 2 mental health interventions for HIV-infected rural persons. FINDINGS: Compared to their white counterparts, fewer African Americans had progressed to AIDS. African American participants also reported higher levels of coping self-efficacy, more support from family members, and marginally fewer depressive symptoms, and they engaged in more active coping. African Americans who had greater HIV disease severity also received less support from family members and experienced more loneliness. CONCLUSIONS: Study findings caution that rural African Americans and whites living with HIV disease should not be considered a homogeneous group.     

泰安市艾滋病病毒感染者/艾滋病患者生存状况

目的了解泰安市HIV/AIDS患者的生存状况,为制定相关的救治救助政策和干预措施提供科学依据。方法使用自行设计的调查问卷、焦虑自评量表、抑郁自评量表和社会支持评定量表对本地区能随访到的全部HIV/AIDS患者进行面对面的问卷调查。结果调查的36例HIV/AIDS患者感觉自己生活质量很好或较好的仅占22.22%,4/36评定有焦虑,13/36评定有抑郁,家庭收入低于当地农民平均水平;年龄小于30岁、最近1个月参与社交活动多、最近1次CD4细胞检测结果高、没有接受抗病毒治疗的HIV/AIDS患者自我感觉生活状况较好,差异有统计学意义(P<0.05)。结论HIV/AIDS患者自我感觉生活状况差,部分存在心理问题,经济收入较低,应进一步加大心理支持和社会救助。     

HIV感染者与AIDS患者感知歧视与应对方式、希望水平的相关性

目的　了解HIV感染者与AIDS患者感知歧视、应对方式、希望水平的现状和三者的相关性。方法　选取2017年9月至12月在成都市某传染病医院就诊的112例HIV感染者与AIDS患者进行Berger HIV感知歧视量表、医学应对问卷及Herth希望指数量表调查。结果　HIV感染者与AIDS患者感知歧视得分为（113.30±16.11）分,主要表现为担心病情公开;应对方式以屈服应对为主（61例,54.5%）;面对维度得分低于常模,回避和屈服维度得分高于常模,差异均有统计学意义（P＜0.001）。希望得分为（36.24±4.85）分。Pearson相关分析显示,感知歧视总分及各维度得分与屈服维度得分均呈正相关（均P＜0.05）,与面对和回避维度得分均无相关性（均P＞0.05）;除担心公开维度得分与希望得分无相关性（均P＞0.05）外,其余各维度得分及感知歧视总分与希望得分均呈负相关（均P＜0.001）。结论　HIV感染者与AIDS患者存在感知歧视,且与其应对方式和希望水平相关,应采取针对性的干预措施,降低其歧视感。     

Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia

ObjectivesThis study aimed to identify the behaviors associated with discrimination towards people living with HIV/AIDS (PLHA) in Indonesia and to determine the factors affecting discrimination.MethodsSecondary data from the 2017 Indonesia Demographic and Health Survey were analyzed using a cross-sectional design. Discrimination was assessed based on the questions (1) “Should children infected with HIV/AIDS be allowed to attend school with non-infected children?” and (2) “Would you buy fresh vegetables from a farmer or shopkeeper known to be infected with HIV/AIDS?” Multivariable logistic regression was used to determine the factors affecting discrimination, with adjusted odds ratio (aOR) and 95% confidence interval (CIs) used to show the strength, direction, and significance of the associations among factors.ResultsIn total, 68.9% of 21 838 individuals showed discrimination towards PLHA. The odds of discrimination were lower among women (aOR, 0.63; 95% CI, 0.55 to 0.71), rural dwellers (aOR, 0.81; 95% CI, 0.75 to 0.89), those who understood how HIV is transmitted from mother to child (aOR, 0.81; 95% CI, 0.73 to 0.89), and those who felt ashamed of their own family’s HIV status (aOR, 0.56; 95% CI, 0.52 to 0.61). The odds were higher among individuals who knew how to reduce the risk of getting HIV/AIDS (aOR, 1.27; 95% CI, 1.15 to 1.39), how HIV/AIDS is transmitted (aOR, 3.49; 95% CI, 3.09 to 3.95), and were willing to care for an infected relative (aOR, 2.78; 95% CI, 2.47 to 3.13). A model consisting of those variables explained 69% of the variance in discrimination.ConclusionsGender, residence, knowledge, and attitudes related to HIV/AIDS were explanatory factors for discrimination against PLHA. Improvements in HIV/AIDS education programs are needed to prevent discrimination.     

布拖县艾滋病病毒感染者/艾滋病患者综合管理模式

目的 探索少数民族农村贫困地区艾滋病病毒感染者/艾滋病患者的综合管理模式.方法 2009年在中国-默沙东艾滋病项目的支持下,选择布拖县九都乡作为试点,开展对艾滋病病毒感染者/艾滋病患者的综合防治工作,采取重心下沉,关口前移,属地化管理,全面落实政府主导、目标考核管理、分级分类管理责任制,经过摸索、总结经验后,在全县30个乡镇全面铺开.结果 艾滋病病毒感染者/艾滋病患者的流调率2009年93.3％,2010年的91.6％,均较高;艾滋病病毒感染者/患者的随访干预比例从2009年的45.34％上升到2010年的90.67％;艾滋病病毒感染者/艾滋病患者CD4检测比例从2009年的15.14％上升到2010年的37.75％;新报告HIV/AIDS配偶HIV检测率从2009年的37.16％上升到2010年的68.9％,既往HIV/AIDS的非HIV阳性配偶的HIV检测率从2009年的21.43％上升到2010年的92.53％.结论 在少数民族农村地区开展重心下沉,关口前移,属地化管理,全面落实政府主导、目标考核管理责任制,可以有效管理传染源,减少新发感染的发生.     

Mental Health Differences Between Rural and Urban Men Living with HIV Infection in Various Age Groups

Despite the disproportionate increase in rural, Southern residents and older persons during the third era of the HIV/AIDS epidemic, no known study has examined whether older, rural men living with HIV infection face a double jeopardy and have poorer psychosocial profiles than other subgroups of men. We investigated whether area of residence (rural, urban), age (young, middle-age, old), and the interaction of residence and age would be related to mental health factors by using two measurement methods to categorize rural and urban residence (US Census Bureau classification and The Office of Rural Health Policy’s, Rural Urban Commuting Area Codes [RUCAs]). We conducted 2–3 hour-long, face-to-face interviews with all but 43 patients who met the study criteria and kept their clinic appointments at three different types of healthcare facilities (i.e., VA, university clinic, public health department) over a 20-month period. The sample consisted of 226 men living in the southeastern US. Rural and urban men of various age groups did not differ in socioeconomic factors, travel distance to clinics, use of medications, satisfaction with care, types of severe stressors, and confidentiality concerns. Using two methods to categorize area of residence, we found that rural men as compared to urban men had similar levels of total stress, AIDS-related stress, social support, active coping and avoidance coping, but higher rates of risk for depression. Rural men had higher levels of non-AIDS-related stress only when the US Census Bureau’s categorization was used, which highlights the importance of carefully selecting and describing methods to categorize rural versus urban residence.     

Rural and Urban Older African Caregivers Coping With HIV/AIDS are Nutritionally Compromised

This article describes the nutritional status of a group of rural and urban free living African older surrogate parents caring for HIV/AIDS orphans and grandchildren. Multiple sources of data collection were used, including anthropometry, biochemical analyses, and quantitative questionnaires. The diets of these older participants were marginal. The rural to urban geographical transition in these older persons is characterized by a better micronutrient and trace element intake; however, urban dwellers also had higher fat intakes, increasing the risk for cardiovascular disease. These results suggest that to be a surrogate grandparent provides a special meaning to the life of men that needs to be better understood. However, the diets of these older people caring for HIV/AIDS-affected children were more compromised than those of non-caregivers.     

Food Insufficiency and Medication Adherence Among People Living with HIV/AIDS in Urban and Peri-Urban Settings

Food insufficiency is associated with medication non-adherence among people living with HIV/AIDS. The current study examines the relationship between hunger and medication adherence in a US urban and peri-urban sample of people living with HIV/AIDS. Men (N = 133) and women (N = 46) living with HIV/AIDS were recruited using snowball sampling and small media in Atlanta, Georgia. Participants completed computerized behavioral interviews that included measures of demographics, food insufficiency, social support, depression, and substance use, and provided blood specimens to determine HIV viral load. Participants also completed monthly unannounced pill counts to prospectively monitor medication adherence over 8 months. Results indicated that 45% of participants were less than 85% adherent to their medications and that food insufficiency was related to non-adherence; nearly half of non-adherent participants reported recent hunger. Geocoding of participant residences showed that 40% lived more than 5 miles from the city center. Multivariable logistic regression controlling for demographics and common factors associated with adherence showed that the interaction between distance from downtown and experiencing hunger significantly predicted non-adherence over and above all other factors. Medication adherence interventions should address access to food, particularly for people living outside of urban centers.     

Social Support and the Management of Uncertainty for People Living With HIV or AIDS

People with chronic and acute illnesses experience uncertainty about their prognoses, potential treatments, social relationships, and identity concerns. In a focus group study of people living with HIV or AIDS, we examined how social support may facilitate or interfere with the management of uncertainty about health, identity, and relationships. We found that support from others helps people with HIV or AIDS to manage uncertainty by (a) assisting with information seeking and avoiding, (b) providing instrumental support, (c) facilitating skill development, (d) giving acceptance or validation, (e) allowing ventilation, and (f) encouraging perspective shifts. Respondents also reported a variety of ways in which supportive others interfered with uncertainty management or in which seeking support imposed costs. Problems associated with social support and uncertainty management included a lack of coordination in uncertainty management assistance, the addition of relational uncertainty to illness uncertainty, and the burden of others' uncertainty management. Our study reveals strategies respondents used to manage costs and complications of receiving support, including developing an active or self-advocating orientation, reframing supportive interactions, withdrawing from nonproductive social situations, selectively allowing others to be support persons, and maintaining boundaries.     

Challenges Experienced by Rural Women in India Living With AIDS and Implications for the Delivery of HIV/AIDS Care

Researchers explored the barriers to AIDS care for rural women living with AIDS, and they investigated alternative delivery models to increase the women's adherence to antiretroviral therapy (ART). Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a primary health center (PHC) near Chennai, India, and with nurses, physicians, and Accredited Social Health Activists (Ashas), who are lay health care workers. The most prevalent barriers expressed by the women were sickness-related, psychological, financial issues with childcare, and distance, or transportation to the site. Women living with AIDS reviewed Ashas favorably.     

艾滋病感染者和患者配偶调查结果分析

目的了解艾滋病感染者和患者配偶的艾滋病感染率和抗体阳转率等,为制定有针对性的防控措施提供依据。方法对409名艾滋病感染者和患者的配偶进行基线调查,收集社会人口学资料、艾滋病相关知识、性行为等信息,采血检测HIV抗体,并进行宣教咨询、发放安全套等干预。半年后对138名基线调查中HIV抗体检测为阴性的配偶进行随访调查。结果基线时调查对象艾滋病知识知晓率为69.9%;80.3%最近半年与配偶发生过性行为,50.2%未每次使用安全套;艾滋病抗体检测阳性率为34.7%。随访时调查对象的艾滋病知识知晓率上升为98.6%;84.1%最近半年与配偶发生过性行为,其中仅有2名随访调查对象未每次使用安全套;138名随访调查对象HIV抗体阳转率为0.7%。结论宣传干预与随访管理,在预防艾滋病经婚内性途径传播起着积极的作用,同时要加强单阳配偶抗病毒治疗,以降低配偶间传播的风险。     

Where to Seek Care: An Examination of People in Rural Areas With HIV/ AIDS

Though HIV/AIDS has spread to rural areas, little empirical evidence is available on where patients living in these areas receive care. This article presents estimates of rural residents in care for HIV/AIDS, their demographic and health-related characteristics, information about whether they receive care in a rural or urban setting, and data on the drug therapies prescribed. The estimates come from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults receiving care in the contiguous United States. Regardless of the definition used--enrollment site, usual source of HIV care, or site of most recent hospitalization--almost three quarters of rural residents with HIV/AIDS obtained their health care in urban areas. The authors find that differences in the demographic characteristics of those using urban vs. rural care do not drive the decision on where to obtain care, with the primary difference being that people with a rural provider tend to be older. Rural residents with an urban usual source of HIV care incurred significant inconvenience in obtaining care--the majority said their care was not conveniently located, they had substantially longer mean travel times, and over 25% had put off obtaining care in the past 6 months because they did not have a way to get to their provider. Given the considerable burden this places on a chronically ill population,further research is needed to explore how provider supply and provider experience affect the decision to travel for care and how quality of care is affected.     

Satisfaction with Dental Case Management Among People Living with HIV/AIDS

We evaluated access to and satisfaction with dental services for people living with HIV/AIDS receiving services from a dental case manager (DCM). People living with HIV/AIDS who had received dental services at two Community Dental Centers on Cape Cod, Massachusetts were eligible to participate in a mailed, anonymous return, Dental Satisfaction Survey (N = 160). Overall, respondents were satisfied with the dental care they had received. Most patients (58%) were new to the practice and were more likely to report that they had not been seen by a dental provider for more than 12 months (OR 3.0, P = 0.044). The majority of respondents reported that they heard about the clinic from local agencies. Of respondents recognizing they had a DCM, almost all answered that their DCM had helped them receive the care they needed. Respondents who agreed that they sometimes avoided going to the dentist due to pain were significantly more likely to report that they had a dental case manager than patients who disagreed (OR 3.42, P = 0.027). When patients were asked how their DCM had helped them, themes identified included: assisting with access to dental care, conducting a needs assessment, and providing comfort. People living with HIV/AIDS often have unmet needs regarding dental care. The addition of the DCM to the dental facility appears to facilitate access to dental care for those connected to medical care through community outreach/partnerships and provides some respondents with an identified dental advocate.     

Operational Fidelity to an Evidence-Based HIV Prevention Intervention for People Living with HIV/AIDS

Evidence-based interventions are often disseminated in public health education with little known about their operational fidelity. This study examined the delivery of intervention components (operational fidelity) of a widely disseminated HIV prevention program designed for people living with HIV/AIDS named Healthy Relationships. Two hundred ninety-nine agencies that had been trained in the intervention by the Centers for Disease Control and Prevention were contacted, and 122 (41%) completed confidential interviews. Among the 93 agencies that implemented the program, 39 (40%) adapted at least one core element activity, and 21 (23%) dropped an activity. Most adaptations were intended to improve the community fit of the intervention. Agencies believed that funders demand that they implement the intervention with fidelity. Models of technology transfer that emphasize behavior change processes rather than specific curriculum content may advance prevention program dissemination.     

HIV感染者／病人心理状态与需求调查

目的了解HIV感染者的心理与生活状况以及社会需求。方法通过面对面交谈方式,完成预先设计好的调查表。结果感染者普遍存在心理压力大,社会歧视严重,生活贫困和就医困难等问题。结论感染者需要得到社会的关爱,感染者的生活质量应引起社会的重视。     

大连市HIV阳性者心理健康状况调查分析

目的:了解HIV阳性者的心理健康状况。方法:采用大连市HIV阳性者生存状态调查问卷及症状自评量表(SCL-90)中文版,对150名HIV阳性者进行调查。结果:研究显示SCL-90量表中总分、阳性症状均分和躯体化等9个因子均分均高于全国常模,差异有统计学意义(P=0.000)。各因子均分高于2分的阳性检出率均超过30.00%,抑郁因子高于2分阳性检出率高达62.00%,高于3分的百分比均超过10.00%,抑郁因子高于3分阳性检出率高达30.00%。HIV阳性者不同文化程度的患者各项评分间两两比较后,在强迫、抑郁、敌对因子中高中或中专文化程度均分高于其他文化程度。结论:暴露于HIV因子的人群存在较明显的心理问题,需加强健康教育和心理干预。     

Housing Status,Medical Care,and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

Background. Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking “upstream” economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual’s control that affect housing and residential environments and the health resources or risk exposures such contexts provide.Objectives. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation.Search methods. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature.Selection criteria. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure.Data collection and analysis. Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding.Results. Searches yielded 5528 references from which we included 152 studies, representing 139 757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics.Conclusions. Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.     

Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis

BackgroundMany countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA.ObjectiveThis study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA.MethodsThe study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy.ResultsAmong 1735 participants, 41.61% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making.ConclusionsCOVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA’s trust of medical professionals.