Health-related quality-of-life and receipt of women-centered HIV care among women living with HIV in Canada

ABSTRACT

We measured health-related quality of life (HRQOL) using the SF-12 among women living with HIV (WLWH) in Canada between August 2013 and May 2015. We investigated differences by perceived receipt of women-centered HIV care (WCHC), assessed using an evidence-based definition with a 5-point Likert item: “Overall, I think that the care I have received from my HIV clinic in the last year has been women-centered” (dichotomized into agree vs. disagree/neutral). Of 1308 participants, 26.3 percent were from British Columbia, 48.2 percent from Ontario, and 25.5 percent from Québec. The median age was 43 years (interquartile range = 36–51). Most (42.2 percent) were White, 29.4 percent African/Caribbean/Black, and 21.0 percent Indigenous. Overall, 53.4 percent perceived having received WCHC. Mean physical and mental HRQOL scores were 43.8 (standard deviation [SD] = 14.4) and 41.7 (SD = 14.2), respectively. Women perceiving having received WCHC had higher mean physical (44.7; SD = 14.0) and mental (43.7; SD = 14.1) HRQOL scores than those not perceiving having received WCHC (42.9; SD = 14.8 and 39.5; SD = 14.0, respectively; p < .001). In multivariable linear regression, perceived WCHC was associated with higher mental (β = 3.48; 95 percent confidence interval: 1.90, 5.06) but not physical HRQOL. Improving HRQOL among Canadian WLWH, which was lower than general population estimates, is needed, including examining the potential of WCHC as an effective model of clinical care.     

Examining engagement in care of women living with HIV in South India

Abstract

HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10?years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided.     

Psychological distress among Ugandan adolescents living with HIV: Examining stressors and the buffering role of general and religious coping strategies

HIV infection increases the risk of psychological distress among adolescents living with HIV (ALHIV), which, in turn, increases risky behaviours such as medication non-adherence, substance use, and sexual risk-taking. The majority of studies on psychological distress among ALHIV have been conducted in high-income countries; data on the prevalence and correlates of psychological distress among ALHIV in sub-Saharan Africa (SSA) are scarce, yet over two-thirds of the global population of ALHIV resides in SSA. The purpose of this study was to identify the contextually relevant correlates of psychological distress among Ugandan ALHIV. Utilizing the stress and coping framework, we explored the risk and protective factors for psychological distress in cross-sectional sample of 464 ALHIV (aged 12–19; 53% female) at a large HIV treatment centre in Kampala, Uganda. The stressors associated with psychological distress included daily hassles, major negative life events, HIV-related quality of life, and stigma. Protective factors included psychosocial resources such as religious coping, satisfaction with social support, and general coping style and behaviours. Social support and optimism were significantly associated with psychological distress. Findings underscore the need for mental health services for ALHIV in Uganda and other resource-limited settings.     

Barriers to accessing health care services for West African refugee women living in Western Australia

Help-seeking pathways and barriers to accessing health care services were surveyed in 51 West African refugee women who had settled recently in Perth, Western Australia, and in 100 Australian women. Shame or fear of what family and friends might think, fear of being judged by the treatment provider, fear of hospitalization, and logistical difficulties were significant impediments to accessing health care services for the refugee women. Surprisingly, barriers often were greater for the more-educated refugee women and strengthened with years of residence in Australia. Strategies to help at-risk women overcome these barriers need to be implemented to ensure appropriate access to health care services.     

Long-term continuum of care for people living with HIV/AIDS

The introduction of highly active antiretroviral therapy (HAART), has created new options for those infected and affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Most HIV-infected persons no longer die within months of diagnosis. There is now a long-term continuum of care that can end in misery or relative comfort. The introduction of palliative care in concert with curative therapies throughout the disease trajectory should be the standard of care for all persons. At the very least, the introduction of palliative care and hospice at the end of life is important to the holistic care of persons living with HIV/AIDS.     

COVID-19 among LGBTQ+ individuals living with HIV/AIDS: psycho-social challenges and care options

Prolonged social isolation during the COVID-19 lockdown has adversely impacted the mental, social, and physical wellbeing of the global populace. Coping with mental and physical stressors amidst the global lockdown is especially strenuous for the Lesbian, Gay, Bisexual, Transgender, and more (LGBT+) community, who are frequently subjected to social stigma and minority stress. Systematic stigma and discrimination place LGBT+ individuals at higher risk for deleterious behaviors, such as substance abuse (e.g., injection drug use, smoking, alcohol) and risky sexual practices (e.g., anal/vaginal/oral sex). Maladaptive coping behaviors consequently increase the chances of HIV/AIDS risk among LGBT+ individuals, compared to heterosexual individuals. LGBT+ individuals Living with HIV/AIDS perpetually face higher rates of unemployment, income disparity, and intimate partner violence. Prolonged home confinement, and impaired accessibility to healthcare, legal, and criminal justice services during lockdown may deplete the quality of life of LGBT+ individuals Living with HIV/AIDS. Therefore, it is critical that multidisciplinary service providers, including health professionals, employers, social services providers, educational institutions and community organizations, move toward online service delivery, so that homebound HIV-positive LGBT+ individuals are secured with a wide range of care options. Non-judgemental, tele-counseling may bridge the gap to mental health services. Community clinics catering to HIV-positive and/or LGBT+ clients may consider precociously supplying essential amenities, such as Preexposure (PrEP)/postexposure prophylaxis (PEP), condoms, emergency contraception, and sterile needles. Lastly, efforts directed at the sustenance of at-risk/HIV-positive LGBT+ health should persevere, even after the pandemic.     

Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa

Abstract

In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either ‘actor-oriented’ or ‘systems-oriented’. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems.     

HIV discrimination and the health of women living with HIV

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

Pneumococcal vaccination in people living with HIV

Streptococcus pneumoniae is the leading bacterial opportunistic infection (OI) in HIV positive individuals. Anti-retroviral treatment (ART) reduces their risk of Invasive Pneumococcal Disease (IPD), however, it remains 20- to 40-fold greater than that of the general population. In HIV-infected adults, pneumococcal vaccination (PCV) induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of the baseline CD4+ cell count. National guidelines in the UK recommend vaccination in HIV-infected adults with CD4 count >200 cells/mL and advise that it be considered for those with CD4 count <200 cells/mL³.We report data on IPD from a London HIV cohort of 3500 north-east London patients from 2009 to 2012. IPD was defined as a positive pneumococcal culture from blood, CSF, joint aspirate or pericardial fluid. HIV positive cases were identified by cross-referencing hospital identifiers with a positive HIV Ab/Ag test result or HIV viral load test result on the virology database. There were a total 189 cases of Invasive Pneumococcal Disease identified over the three years. 4.8% (n = 9) were known to be HIV positive at the time of their Invasive Pneumococcal infection. The serotypes of S. pneumoniae in the HIV positive cases included 3, 7F, 10F, 19A (n = 2), 19F and 31. The estimated incidence of IPD in our HIV cohort was 85.7 per 100,000, (based on an overall HIV cohort size of 3500) which is significantly higher when compared to the general population in London (local epidemiological data reported the incidence rate for IPD at 7.5 per 100,000 in London).Given the higher burden of Invasive Pneumococcal Disease in this cohort, low levels of vaccination, and the predominance of vaccine sensitive strains in our cases, vaccination and strategies to improve vaccine uptake is a priority in this at risk group.     

Twenty years of care for persons living with HIV/AIDS in Brazil: the health professionals' perspective

The aim of this study was to describe the meaning ascribed by health professionals to the care they provide for persons with HIV/AIDS. Data were collected through recorded interviews with 10 health professionals providing care to AIDS patients in different institutions in S?o Paulo State, Brazil. Three themes emerged from the analysis: (a) the overall scenario of healthcare provision for AIDS patients; (b) the relationship between healthcare professionals and patients; and (c) ethical aspects related to care. Despite significant advances, the study identified discriminatory behavior in the treatment. Such behaviors were related to feelings of insecurity and fear of infection on the part of healthcare professionals, which could be explained by the lack of appropriate training in general services and hospitals. Specific training for treating the patients mainly targeted health professionals in centers specializing in HIV/AIDS, resulting in difficulties for integrating the care of these patients with other services under the Unified National Health System. The data related to characteristics of professional training in the health field as a whole, leading one to reflect on the skills expected of health professionals in caring for (and relating to) persons with HIV/AIDS, as well as the impact on AIDS prevention.     

Migration and HIV risk: life histories of Mexican-born men living with HIV in North Carolina

Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina, a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early-life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV-prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health.     

Pulmonary tuberculosis among people living with HIV/AIDS attending care and treatment in rural northern Tanzania

Background  

Tuberculosis is the commonest opportunistic infection and the number one cause of death in HIV/AIDS patients in developing countries. To address the extent of the tuberculosis HIV coinfection in rural Tanzania we conducted a cross sectional study including HIV/AIDS patients attending care and treatment clinic from September 2006 to March 2007.