Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men.

Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it.     

Internet use among people living with HIV/AIDS: association of health information, health behaviors, and health status.

The telecommunications revolution provides open access to health information that can inform and empower people living with chronic illnesses. However, many people living with HIV may not access the Internet and are not benefiting from available health information. This study investigated Internet access among people living with HIV/AIDS and its relation to health. Results of a survey of men (n = 175) and women (n = 84) living with HIV/AIDS recruited from infectious disease clinics and community-based AIDS services showed that 51% (n = 116) of participants reported ever using the Internet, of which 59% (n = 68) had used the Internet to access health-related information. As expected, Internet users were significantly more likely to be better educated and of higher incomes. Internet users, including those who used the Internet for general purposes and those who reported health-related use, also demonstrated significantly greater knowledge of HIV disease and greater confidence in their ability to adhere to medications. Persons who used the Internet for general purposes were more likely to have an undetectable viral load compared to persons who had not used the Internet. The disparities in Internet use identified in this study suggest that individuals who access the Internet, particularly for health information, are among the better resourced and healthier persons living with HIV/AIDS.     

Clients' perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa

Qualitative research was conducted with HIV-positive women and men of reproductive age attending HIV/AIDS care and treatment services at a public health clinic in Cape Town, South Africa. Focus group discussions were held with women (n = 4) and men (n = 4), and in-depth interviews were held with four men to explore perceptions and experiences of HIV/AIDS care and treatment and sexual and reproductive health (SRH) care. Respondents praised their HIV/AIDS care and treatment, reflected on how it improved their quality of life and contrasted this with suboptimal care at other public health facilities, including SRH services. Women wanted integrated services, especially for contraception and to reduce stigma. HIV-positive men's lack of experience with SRH services and antipathy towards attending "women's" health services were highlighted. Challenges to involving men in HIV/AIDS care and treatment and SRH services and measures to address this were identified.     

General and health-related Internet use among an urban,community-based sample of HIV-positive women: implications for intervention development

Internet-based HIV interventions are increasingly common, although little focus has been on HIV-positive women. To understand the feasibility of using the Internet to deliver behavioral interventions to HIV-positive women, we sought to describe patterns of Internet use for general and health-related purposes and to explore differences between Internet-using and non-using women. From February 2014 to April 2014, 103 women were recruited at six community-based organizations in the Bronx, NY that provide services to HIV-positive persons. Women completed a 30-minute interview and answered a brief survey of socio-demographic factors, risk behavior and clinical characteristics. We performed χ² and Kruskal-Wallis tests to compare Internet users and non-users. Sixty-one percent of participants were current Internet users, most of whom used a personal electronic device (e.g., cellphone/smartphone) to access the Internet. While higher proportions of Internet users were passively engaged (e.g., signed up to receive email updates [42.9%] or watched an online video [58.7%] for health-related purposes), smaller proportions (12.7–15.9%) were involved in more interactive activities such as posting comments, questions, or information about health-related issues in an online discussion or a blog. A majority of Internet non-users (60.0%) expressed interest in going online. Lack of computer or Internet access (37.5%) and Internet navigation skills (37.5%) were the primary reasons for non-use. Compared with non-users, Internet users were more likely to be younger, to have higher socioeconomic status, and to report low health-related social support. Despite having a lower proportion of Internet users in our study than the general population, Internet-using women in our study had relatively high levels of online engagement and went online for both general and health-related purposes. However, Internet-based interventions targeting HIV-positive women will likely need to include providing computer and/or Internet access as well as training participants in how to navigate the Internet.     

Relationships of perceived stress to coping, attachment and social support among HIV-positive persons

The purpose of this study was to examine the relationships of coping, attachment style and perceived social support to perceived stress within a sample of HIV-positive persons. Participants were 147 HIV-positive persons (80 men and 67 women). Multiple regression analysis was used to examine the relationships of the demographic variables, AIDS status, three coping styles, three attachment styles and perceived quality of general social support with total score on the Perceived Stress Scale (PSS). PSS score was significantly associated with less income, greater use of behavioural and emotional disengagement in coping with HIV/AIDS, and less secure and more anxious attachment styles. These results indicate that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.     

Psychosocial Variables Associated with Coping of HIV-Positive Women Diagnosed During Pregnancy

To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of 2 years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women’s ability to cope and enhance their health and that of their infants.     

Acculturation,Coping Styles,and Health Risk Behaviors Among HIV Positive Latinas

This study examined the relationships among acculturation, coping styles, substance use, sexual risk behavior, and medication non-adherence among 219 Latinas living with HIV/AIDS in Los Angeles, CA. Coping styles were hypothesized to mediate the link between acculturation and health risk behaviors for HIV positive Latinas. Structural equation modeling revealed that greater acculturation was related to less positive coping and more negative coping. In turn, negative coping was associated with more health risk behaviors and more non-adherence. Positive coping was associated with less substance use as reflected in use of cigarettes and alcohol and less non-adherence. Coping styles mediated the relationship between acculturation and health risk behaviors. Findings echo previous works examining the Hispanic Health Paradox wherein more acculturated Latinos exhibit increased risk behavior and maladaptive coping styles. HIV/AIDS interventions need to be mindful of cultural differences within Hispanic populations and be tailored to address these differences.     

Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life

HIV-related stigma and the effect on quality of life is an on-going public health concern despite decades of education, prevention, and intervention efforts. The main purposes of this study were to examine the mediating role of four coping styles and the moderating role of gender on the relationship between HIV-positive status disclosure concerns and eight health-related quality of life outcomes. Data were collected from 346 women and men living with HIV. Results indicated that two coping styles – acquiring social support and positive reframing – mediated the negative relationship between disclosure concerns and health-related quality of life outcomes. There was no support for a moderated mediation. Interventions aimed at helping people living with HIV should focus on identifying and acquiring coping styles that transform perceptions of HIV-related stigma to support disclosure and improve health-related quality of life.     

HIV/AIDS knowledge, beliefs, and behavior among women of childbearing age in India.

This study investigated the relationships of health beliefs and HIV/AIDS knowledge with frequency of condom use among women of childbearing age in four major Indian cities. Surveys were completed by 210 women attending six primary health care centers. Among the sexually active women (N = 139), 68% noted rare or no use of condoms during intercourse. Perceived benefits (p < .05) and normative efficacy in requesting condom use (p = .01) were related to a greater frequency of condom use. About 54% of women knew that breast milk could transmit HIV, but fewer than a third were aware that an HIV-positive mother does not always infect her infant at delivery. Most participants endorsed HIV testing for women prior to pregnancy. Approximately three fourths of participants advocated abortion for HIV-seropositive pregnant women. Intervention efforts may benefit from dispelling misconceptions about AIDS (particularly regarding vertical transmission), emphasizing perceived benefits and women's efficacy in requesting condom use, increasing the availability of HIV testing, and highlighting choices for seropositive women of reproductive age as alternatives to abortion.     

Emotional Support and Affect: Associations with Health Behaviors and Active Coping Efforts in Men Living with HIV

The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients’ affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.     

Sexual Behavior as a Function of Stigma and Coping with Stigma Among People with HIV/AIDS in Rural New England

The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed.     

Gender differences in behavioural and psychosocial predictors of HIV testing and return for test results in a high-risk population

We assessed gender differences in psychosocial and behavioural predictors of HIV testing and returning for results in a high-risk sample of 1,049 predominately minority, impoverished, homeless and/or drug-abusing women (n = 621) and men (n = 428). Predictors included latent variables representing injection drug use, self-esteem, social support, AIDS knowledge, poor access to health services, perceived risk for AIDS, sexual risk behaviour and the mediators of positive and negative coping styles. Significant predictors of test and return for women included injection drug use, greater social support, more AIDS knowledge, a higher perceived risk for AIDS and a positive coping style. Significant predictors for the men included injection drug use, greater AIDS knowledge, a higher perceived risk for AIDS and a positive coping style. Although greater social support was not significant for the men, the significant predictors of HIV testing and return were generally similar for the men and women. However, the men evaluated their risk of AIDS significantly lower than the women, although they reported more sexual risk behaviours and equally risky injection drug use behaviours. Results suggest that interventions designed to increase AIDS knowledge, to raise the perception of risk and to promote a positive coping style would be effective in encouraging more HIV testing for both men and women, but raising perceptions of what constitutes personal risk behaviours may need special emphasis when delivering prevention programmes to men.     

Substance Abuse and Medication Adherence Among HIV-Positive Women with Histories of Child Sexual Abuse

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.     

Concerns and coping with HIV: comparisons across groups

To develop scales measuring major concerns about being HIV-positive and how people would cope with diagnosis, items were selected from the Ways of Coping Scale (Folkman et al., 1986)and generated by county health department HIV counsellors. Psychometric scale development involved two diverse samples of HIV test clients. Study I (health department, N = 272) yielded five Concerns with HIV scales and nine Coping with HIV scales. Factor structures did not differ between gay/bisexual men, heterosexual women or heterosexual men. In Study II (private non-profit gay-identified community HIV clinic, N = 227), LISREL confirmatory factor analyses cross-validated the Study I factor structures with no notable differences found. Some mean differences between genders and by sexual orientation were explained by different numbers of HIV-positive people known. Concern and Coping with HIV Scales (CCHIVS) are discussed for HIV/AIDS research and clinical use.     

Psychosocial Characteristics and Sexual Behaviors of People in Care for HIV Infection: An Examination of Men Who Have Sex with Men, Heterosexual Men and Women

Few studies have examined the psychosocial factors associated with sexual transmission behaviors among HIV-positive men who have sex with men (MSM), heterosexual men (MSW) and women. We enrolled 1,050 sexually active HIV-positive patients at seven HIV clinics in six US cities as part of a clinic-based behavioral intervention. We describe the sexual transmission behaviors and examine demographic, clinical, psychosocial, and clinic prevention variables associated with unprotected anal or vaginal intercourse (UAVI). Twenty-three percent of MSM, 12.3% of MSW and 27.8% of women engaged in UAVI with partners perceived to be HIV-negative or of unknown serostatus. Among MSM and MSW, having multiple partners and lower self-efficacy were associated with increased odds of UAVI. Self-rating one’s health status as excellent/very good was a risk factor for UAVI among MSM. Among women, binge drinking and stressful life events were associated with UAVI. These findings identify variables that warrant attention in targeted interventions.     

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.     

Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa

Since the primary mode of HIV transmission in sub-Saharan Africa is heterosexual, research focusing on the sexual behaviour of men who have sex with men (MSM) is scant. Currently it is unknown how many people living with HIV in South Africa are MSM and there is even less known about the stigmatisation and discrimination of HIV-positive MSM. The current study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa. Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others. HIV-positive MSM reported experiencing greater social isolation and discrimination resulting from being HIV-positive, including loss of housing or employment due to their HIV status, however these differences were not significant. Mental health interventions, as well as structural changes for protection against discrimination, are needed for HIV-positive South African MSM.     

Sexual dysfunction, HIV, and AIDS in men who have sex with men

HIV infection is associated with sexual dysfunction. Using validated instruments, we investigated the relationship between HIV/AIDS and sexual function in a contemporary cohort of men who have sex with men (MSM). An anonymous Internet-based survey was disseminated to MSM via organizations and social networking sites that cater to this population. Information on ethnodemographic variables, health status (including HIV status, disease stage, and other health conditions), and sexual behavior was collected. Men were categorized as HIV-negative, HIV-positive/AIDS-negative, or HIV-positive /AIDS-positive. A modified validated version of the International Index of Erectile Function (IIEF) for use in MSM and the Premature Ejaculation Diagnostic Tool (PEDT) were used to stratify risk of sexual dysfunction. The study cohort included 1361 men (236 of whom were HIV-positive) who provided complete data on HIV status, IIEF, and PEDT. There was a significant trend toward greater prevalence of erectile dysfunction (ED) in men with progressive HIV infection 40-59 years of age relative to age matched HIV-negative men (p=0.02). In a logistic regression model controlling for other variables, HIV infection without AIDS was not associated with greater odds of ED; however, HIV infection with AIDS was associated with greater odds of ED (p=0.006). In a separate logistic regression model, HIV infection with or without AIDS was not significantly associated with greater odds of premature ejaculation (p>0.05). Use of phosphodiesterase 5 (PDE5) inhibitor drugs was much more common in HIV-infected men. HIV infection is a risk factor for poorer sexual function primarily due to higher risk of erectile dysfunction in men with AIDS.     

Internet use among low-income persons recently diagnosed with HIV infection

Patients are increasingly using the Internet to obtain health-related information, communicate with providers and access research. Use of the Internet to obtain health-related information by low-income patients recently diagnosed with HIV infection has not been examined. In 2005, we surveyed 126 low-income patients diagnosed with HIV infection within the last three years. Eighty-five percent of the patients were<50 years old, 63% were male, 68% were minority race, 27% were Hispanic and 61% acquired HIV through heterosexual intercourse. Twenty-eight percent never completed high school and 74% earned<$15,000 in 2004. While 89% indicated they would like to use the Internet to access information about HIV, 52% had never used the Internet, 28% had never used it to obtain health-related information and only 18% had done so at least monthly for the last six months. Two-thirds of the population studied would need instruction on how to use the Internet. In multivariable regression, 2004 income > or =$15,000 predicted monthly Internet use to obtain health-related information. Older age, heterosexual intercourse as HIV risk factor and inadequate health literacy were independent predictors of needing instruction. The low-income population with HIV infection lags behind the general population in Internet access and may not benefit from Internet-dependent advances in health communication, including HIV-related interventions.     

Seeking information about HIV/AIDS: a qualitative study of health literacy among people living with HIV/AIDS in a low prevalence context

People living with HIV/AIDS in rural and low HIV prevalence areas face a number of challenges including stigma, limited access to specialized medical care, lack of an HIV/AIDS specialist and fear which may interfere with their ability to find and use information to manage their health. With a large number of HIV cases located in non-metropolitan and rural areas in the US, more research is needed to better understand the health seeking behaviors of individuals living in this context. This study examined how 16 individuals living with HIV sought out information to meet their health needs. In qualitative semi-structured interviews, we explored participants' primary sources of information, types of information sought, and barriers to accessing information. The sample was comprised of people living with HIV/AIDS (PLWHA) who resided in a predominantly rural area with low HIV prevalence. The majority of participants relied on a combination of sources including their HIV/AIDS physician, the Internet, a Ryan-White caseworker and a staff member of a community-based support organization to meet their informational needs. Information sought focused primarily on drug regimens, drug side effects, or drug research. Participants shared barriers to accessing information including stigma, fear, concern about disclosure, and feelings of futility and anger. Findings point to a need to expand health literacy research and interventions to address broader social and structural barriers to health improvement for PLWHA, especially among those living in rural and low HIV prevalence areas.