955 results on '"Turan, Janet"'
Search Results
2. Intersectional Stigma, Fear of Negative Evaluation, Depression, and ART Adherence Among Women Living with HIV Who Engage in Substance Use: A Latent Class Serial Mediation Analysis
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Stringer, Kristi Lynn, Norcini Pala, Andrea, Cook, Robert L., Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey E., Tien, Phyllis C., Wingood, Gina, Neilands, Torsten B., Johnson, Mallory O., Logie, Carmen H., Weiser, Sheri D., Turan, Janet M., and Turan, Bulent
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- 2024
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- View/download PDF
3. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV
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Palar, Kartika, Sheira, Lila A, Frongillo, Edward A, Kushel, Margot, Wilson, Tracey E, Conroy, Amy A, Adedimeji, Adebola, Merenstein, Daniel, Cohen, Mardge H, Wentz, Eryka L, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa R, Turan, Janet M, Tien, Phyllis C, and Weiser, Sheri D
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Public Health ,Health Sciences ,Infectious Diseases ,Social Determinants of Health ,Sexually Transmitted Infections ,Clinical Research ,HIV/AIDS ,Women's Health ,Behavioral and Social Science ,Prevention ,Mental Health ,Infection ,Zero Hunger ,Humans ,Female ,HIV Infections ,Anti-Retroviral Agents ,Patient Compliance ,Women ,Food security ,Nutrition ,Adherence ,Engagement in car ,Public Health and Health Services ,Social Work ,Public health - Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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- 2023
4. The role of social support on cognitive function among midlife and older adult MSM
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Henderson, Emmett R, Haberlen, Sabina A, Coulter, Robert WS, Weinstein, Andrea M, Meanley, Steven, Brennan-Ing, Mark, Mimiaga, Matthew J, Turan, Janet M, Turan, Bulent, Teplin, Linda A, Egan, James E, Plankey, Michael W, and Friedman, M Reuel
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Public Health ,Health Sciences ,Clinical Research ,Aging ,Behavioral and Social Science ,Mental Health ,Aetiology ,2.3 Psychological ,social and economic factors ,Male ,Humans ,Aged ,Cohort Studies ,Homosexuality ,Male ,Cross-Sectional Studies ,HIV Infections ,Sexual and Gender Minorities ,Cognition ,Social Support ,cognitive decline ,HIV ,AIDS ,MSM ,psychosocial health conditions ,social support ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveThis study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.DesignWe analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study.MethodsWe conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support.ResultsSocial support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support.ConclusionSocial support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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- 2023
5. Resilience and Optimism as Moderators of the Negative Effects of Stigma on Women Living with HIV
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Turan, Bulent, Budhwani, Henna, Yigit, Ibrahim, Ofotokun, Igho, Konkle-Parker, Deborah J, Cohen, Mardge H, Wingood, Gina M, Metsch, Lisa R, Adimora, Adaora A, Taylor, Tonya N, Wilson, Tracey E, Weiser, Sheri D, Kempf, Mirjam-Colette, Brown-Friday, Janet, Gange, Stephen, Kassaye, Seble, Pence, Brian W, and Turan, Janet M
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Health Services and Systems ,Public Health ,Health Sciences ,Behavioral and Social Science ,Sexually Transmitted Infections ,Mental Health ,HIV/AIDS ,Women's Health ,Infectious Diseases ,Mental Illness ,Depression ,Brain Disorders ,Good Health and Well Being ,Female ,Humans ,Cross-Sectional Studies ,HIV Infections ,Social Stigma ,Surveys and Questionnaires ,HIV ,stigma ,resilience ,depression ,trust ,optimism ,moderation ,provider ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Resilience and optimism may not only have main effects on health outcomes, but may also moderate and buffer negative effects of stressors. We examined whether dispositional resilience and optimism moderate the associations between HIV-related stigma in health care settings and health-related outcomes (trust in HIV health care providers and depression symptoms) among women living with HIV (WLHIV). One thousand four hundred five WLHIV in nine US cities completed validated questionnaires for cross-sectional analyses. Higher self-reported experienced and anticipated stigma and lower resilience and optimism were associated with higher depression symptoms and with lower trust in HIV providers. Importantly, resilience moderated the effects of experienced stigma (but not of anticipated stigma): When resilience was high, the association of experienced stigma with higher depression symptoms and lower trust in HIV providers was weaker compared with when resilience was low. Further, significant moderation effects suggested that when optimism was high, experienced and anticipated stigma was both less strongly associated with depression symptoms and with lower trust in one's HIV care providers compared with when optimism was low. Thus, the effects of experienced stigma on depression symptoms and provider trust were moderated by both resilience and optimism, but the effects of anticipated stigma were moderated only by optimism. Our findings suggest that in addition to their main effects, resilience and optimism may function as buffers against the harmful effects of stigma in health care settings. Therefore, optimism and resilience may be valuable intervention targets to reduce depression symptoms or improve trust in providers among populations that experience or anticipate stigma, such as WLHIV.
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- 2022
6. Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States
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Jain, Jennifer P, Sheira, Lila A, Frongillo, Edward A, Neilands, Torsten B, Cohen, Mardge H, Wilson, Tracey E, Chandran, Aruna, Adimora, Adaora A, Kassaye, Seble G, Sheth, Anandi N, Fischl, Margaret A, Adedimeji, Adebola A, Turan, Janet M, Tien, Phyllis C, Weiser, Sheri D, and Conroy, Amy A
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Prevention ,Health Disparities ,Infectious Diseases ,Substance Misuse ,Drug Abuse (NIDA only) ,Violence Research ,Minority Health ,Social Determinants of Health ,HIV/AIDS ,Sexually Transmitted Infections ,Violence Against Women ,Mental Health ,Behavioral and Social Science ,Women's Health ,Infection ,Gender Equality ,Peace ,Justice and Strong Institutions ,Female ,Gender-Based Violence ,HIV Infections ,Humans ,Illicit Drugs ,Middle Aged ,Substance-Related Disorders ,United States ,Violence ,drug use ,gender-based violence ,heavy drinking and HIV treatment and care ,HIV ,women ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveTo test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US).DesignWe analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS).MethodsFrom 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (
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- 2022
7. Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV
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Pala, Andrea Norcini, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey E, Tien, Phyllis C, Wingood, Gina, Neilands, Torsten B, Johnson, Mallory O, Weiser, Sheri D, Logie, Carmen H, Turan, Janet M, and Turan, Bulent
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Medical Microbiology ,Biomedical and Clinical Sciences ,Health Sciences ,Mental Health ,Behavioral and Social Science ,Social Determinants of Health ,HIV/AIDS ,Infectious Diseases ,Health Disparities ,Sexually Transmitted Infections ,Clinical Research ,Infection ,Anti-Retroviral Agents ,Bayes Theorem ,Cross-Sectional Studies ,Female ,HIV Infections ,Humans ,Medication Adherence ,Social Stigma ,Viral Load ,antiretroviral therapy ,HIV ,intersectional stigmas ,women with HIV ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectivesTo explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV).DesignWe examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data.MethodsParticipants were WHIV ( N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates.ResultsWe identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load.ConclusionThe negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
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- 2022
8. T-cell activation state differentially contributes to neuropsychiatric complications in women with HIV
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Williams, Dionna W, Flores, Bianca R, Xu, Yanxun, Wang, Yuezhe, Yu, Danyang, Peters, Brandilyn A, Adedimeji, Adebola, Wilson, Tracey E, Merenstein, Daniel, Tien, Phyllis C, Cohen, Mardge H, Weber, Kathleen M, Adimora, Adaora A, Ofotokun, Igho, Fischl, Margaret, Turan, Janet, Turan, Bülent, Laumet, Geoffroy, Landay, Alan L, Dastgheyb, Raha M, Gange, Stephen J, Weiser, Sheri D, and Rubin, Leah H
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Biomedical and Clinical Sciences ,Immunology ,Mental Health ,Depression ,Clinical Research ,Neurosciences ,Behavioral and Social Science ,Mental health ,Good Health and Well Being ,Cognition ,HIV ,T-cell function ,Women ,Clinical sciences - Abstract
Neuropsychiatric complications are common among women with HIV (WWH). The pathophysiological mechanisms underlying these complications are not fully known but likely driven in part by immune modulation. We examined associations between T-cell activation states which are required to mount an effective immune response (activation, co-stimulation/normal function, exhaustion, senescence) and neuropsychiatric complications in WWH. 369 WWH (78% HIV RNA undetectable/
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- 2022
9. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV
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Thompson, Emma C, Muhammad, Josh N, Adimora, Adoara A, Chandran, Aruna, Cohen, Mardge H, Crockett, Kaylee B, Goparaju, Lakshmi, Henderson, Emmett, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Kwait, Jennafer, Mimiaga, Matthew, Ofotokun, Igho, Rubin, Leah, Sharma, Anjala, Teplin, Linda A, Vance, David E, Weiser, Sheri D, Weiss, Deborah J, Wilson, Tracey E, Turan, Janet M, and Turan, Bulent
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Health Services and Systems ,Health Sciences ,Sexually Transmitted Infections ,Clinical Research ,Basic Behavioral and Social Science ,Infectious Diseases ,Behavioral and Social Science ,HIV/AIDS ,Mental Health ,Neurosciences ,Women's Health ,Brain Disorders ,Black or African American ,Female ,HIV Infections ,Humans ,Social Stigma ,United States ,Viral Load ,HIV ,stigma ,neurocognitive function ,cognitive decline ,women ,aging ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
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- 2022
10. How Does Poverty Stigma Affect Depression Symptoms for Women Living with HIV? Longitudinal Mediating and Moderating Mechanisms
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Turan, Bulent, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey E., Tien, Phyllis C., Wingood, Gina, Neilands, Torsten B., Johnson, Mallory O., Logie, Carmen H., Weiser, Sheri D., and Turan, Janet M.
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- 2023
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11. Patient Health Literacy and Communication with Providers Among Women Living with HIV: A Mixed Methods Study
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Budhwani, Henna, Gakumo, C Ann, Yigit, Ibrahim, Rice, Whitney S, Fletcher, Faith E, Whitfield, Samantha, Ross, Shericia, Konkle-Parker, Deborah J, Cohen, Mardge H, Wingood, Gina M, Metsch, Lisa R, Adimora, Adaora A, Taylor, Tonya N, Wilson, Tracey E, Weiser, Sheri D, Sosanya, Oluwakemi, Goparaju, Lakshmi, Gange, Stephen, Kempf, Mirjam-Colette, Turan, Bulent, and Turan, Janet M
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Health Services and Systems ,Public Health ,Health Sciences ,Clinical Research ,HIV/AIDS ,Behavioral and Social Science ,Health Services ,7.1 Individual care needs ,Management of diseases and conditions ,8.1 Organisation and delivery of services ,Health and social care services research ,Infection ,Generic health relevance ,Good Health and Well Being ,Anti-Retroviral Agents ,Communication ,Female ,HIV Infections ,Health Literacy ,Humans ,Trust ,United States ,Health communication ,Health literacy ,HIV ,African American ,Latina ,Public Health and Health Services ,Social Work ,Public health - Abstract
In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.
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- 2022
12. Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women
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Conroy, Amy A, Jain, Jennifer P, Sheira, Lila, Frongillo, Edward A, Neilands, Torsten B, Cohen, Mardge H, Wilson, Tracey E, Chandran, Aruna, Adimora, Adaora A, Kassaye, Seble, Sheth, Anandi N, Fischl, Margaret A, Adedimeji, Adebola, Turan, Janet M, Tien, Phyllis C, and Weiser, Sheri D
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Post-Traumatic Stress Disorder (PTSD) ,Violence Research ,Anxiety Disorders ,Depression ,Social Determinants of Health ,Sexually Transmitted Infections ,Infectious Diseases ,Mental Health ,Behavioral and Social Science ,Mental Illness ,Women's Health ,HIV/AIDS ,Brain Disorders ,Violence Against Women ,Mental health ,Good Health and Well Being ,Gender Equality ,Zero Hunger ,Peace ,Justice and Strong Institutions ,Female ,Food Supply ,Gender-Based Violence ,HIV Infections ,Humans ,Stress Disorders ,Post-Traumatic ,gender-based violence ,mental health ,food insecurity ,antiretroviral adherence ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundGender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps.MethodsWomen completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity.ResultsGBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity.ConclusionsGBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
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- 2022
13. Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa
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Embleton, Lonnie, Logie, Carmen H., Ngure, Kenneth, Nelson, LaRon, Kimbo, Liza, Ayuku, David, Turan, Janet M., and Braitstein, Paula
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- 2023
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14. Examining the Relationships Between Experienced and Anticipated Stigma in Health Care Settings, Patient–Provider Race Concordance, and Trust in Providers Among Women Living with HIV
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Budhwani, Henna, Yigit, Ibrahim, Ofotokun, Igho, Konkle-Parker, Deborah J, Cohen, Mardge H, Wingood, Gina M, Metsch, Lisa R, Adimora, Adaora A, Taylor, Tonya N, Wilson, Tracey E, Weiser, Sheri D, Kempf, Mirjam-Colette, Sosanya, Oluwakemi, Gange, Stephen, Kassaye, Seble, Turan, Bulent, and Turan, Janet M
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Health Services and Systems ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Health Services ,HIV/AIDS ,Clinical Research ,Infection ,Good Health and Well Being ,Anti-Retroviral Agents ,Female ,HIV Infections ,Humans ,Medication Adherence ,Social Stigma ,Trust ,HIV ,health equity ,race ,women living with HIV ,moderation analysis ,WIHS ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
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- 2021
15. Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study
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Sheira, Lila A, Frongillo, Edward A, Hahn, Judith, Palar, Kartika, Riley, Elise D, Wilson, Tracey E, Adedimeji, Adebola, Merenstein, Daniel, Cohen, Mardge, Wentz, Eryka L, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa, Turan, Janet M, Tien, Phyllis C, and Weiser, Sheri D
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- 2021
16. Validation of an adapted instrument to measure female genital fistula-related stigma
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Ayadi, Alison M El, Barageine, Justus K, Neilands, Torsten B, Ryan, Nessa, Nalubwama, Hadija, Korn, Abner, and Turan, Janet M
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Health Services and Systems ,Health Sciences ,Mind and Body ,Mental Health ,Behavioral and Social Science ,Good Health and Well Being ,Female ,Fistula ,Genitalia ,Female ,Humans ,Psychometrics ,Quality of Life ,Reproducibility of Results ,Social Stigma ,Female genital fistula ,obstetric fistula ,stigma ,quality of life ,instrument development ,Uganda ,Public Health and Health Services ,Public Health ,Epidemiology ,Public health ,Policy and administration - Abstract
Female genital fistula results in severe physical, psychological, and social sequelae. Qualitative research confirms stigma pervasiveness; however, no quantitative instrument exists to measure fistula-related stigma. We adapted an existing HIV-related stigma instrument to fistula-related stigma and assessed its reliability and validity. We recruited 60 Ugandan women seeking genital fistula surgery (December 2014-June 2015). We used exploratory factor analysis to explore the scale's latent structure and evaluated internal consistency reliability with Raykov's ρ statistic. We assessed construct validity through linear regression of stigma with quality of life, depressive symptoms and self-esteem. We retained 15 items across factors 'enacted stigma' and 'internalised stigma' (ρ = 0.960 and ρ = 0.748, respectively). Stigma was inversely associated with all quality of life domains; effect sizes were largest for environmental (enacted stigma, 0.69-point reduction) and psychological (internalised stigma, 0.67-point reduction) domains. Both stigma domains were associated positively with depressive symptoms and inversely with self-esteem, with 0.75 and 1.05-point increases in depressive symptoms and 0.45 and 0.77-point decreases in self-esteem for enacted and internalised stigma, respectively. Results suggest the reliability and validity of the adapted fistula stigma instrument. This instrument may help us understand stigma levels, compare stigma across individuals and communities, prioritise stigma-reduction strategies, and assess intervention impact.
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- 2021
17. Disclosure Concerns and Viral Suppression in People Newly Initiating HIV Care: The Role of Internalized HIV Stigma.
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Yigit, Ibrahim, Bayramoglu, Yunus, Weiser, Sheri D, Johnson, Mallory O, Mugavero, Michael J, Turan, Janet M, and Turan, Bulent
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HIV/AIDS ,Pediatric ,Infectious Diseases ,Behavioral and Social Science ,Prevention ,7.1 Individual care needs ,Management of diseases and conditions ,Adult ,Anti-HIV Agents ,Disclosure ,Female ,HIV Infections ,HIV-1 ,Humans ,Male ,Medication Adherence ,Middle Aged ,Social Stigma ,Young Adult ,disclosure concerns ,internalized stigma ,ART adherence ,viral suppression ,new-to-care ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundResearch on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns).Setting/methodsOne hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma.ResultsDisclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect.ConclusionsFindings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.
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- 2021
18. Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study
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Rice, Whitney S, Fletcher, Faith E, Akingbade, Busola, Kan, Mary, Whitfield, Samantha, Ross, Shericia, Gakumo, C Ann, Ofotokun, Igho, Konkle-Parker, Deborah J, Cohen, Mardge H, Wingood, Gina M, Pence, Brian W, Adimora, Adaora A, Taylor, Tonya N, Wilson, Tracey E, Weiser, Sheri D, Kempf, Mirjam-Colette, Turan, Bulent, and Turan, Janet M
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Health Services and Systems ,Public Health ,Health Sciences ,Clinical Research ,Clinical Trials and Supportive Activities ,Behavioral and Social Science ,Health Services ,Health and social care services research ,8.1 Organisation and delivery of services ,Generic health relevance ,Infection ,Good Health and Well Being ,Adult ,Black or African American ,Attitude ,Attitude of Health Personnel ,Consumer Behavior ,Female ,Focus Groups ,HIV Infections ,Health Equity ,Hispanic or Latino ,Humans ,Middle Aged ,Midwestern United States ,New England ,Patient Participation ,Patient Safety ,Qualitative Research ,Quality of Health Care ,Southeastern United States ,Women's Health ,Quality of health care ,Patient satisfaction ,Women living with HIV ,Engagement in care ,HIV ,AIDS ,Qualitative ,African American ,Black ,Hispanic ,HIV/AIDS ,Public Health and Health Services ,Sociology ,Health services and systems ,Public health ,Policy and administration - Abstract
BackgroundEnding the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied.MethodsWe conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.ResultsThemes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).ConclusionsQuality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.
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- 2020
19. Changes in Internalized Stigma and HIV Health Outcomes in Individuals New to HIV Care: The Mediating Roles of Depression and Treatment Self-Efficacy
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Yigit, Ibrahim, Bayramoglu, Yunus, Weiser, Sheri D, Johnson, Mallory O, Mugavero, Michael J, Turan, Janet M, and Turan, Bulent
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Health Services and Systems ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Sexually Transmitted Infections ,Mental Health ,Clinical Trials and Supportive Activities ,Depression ,Infectious Diseases ,Health Disparities ,Behavioral and Social Science ,Mental Illness ,Prevention ,HIV/AIDS ,Clinical Research ,Brain Disorders ,Infection ,Good Health and Well Being ,Adult ,Anti-HIV Agents ,Antiretroviral Therapy ,Highly Active ,Discrimination ,Psychological ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Middle Aged ,Outcome Assessment ,Health Care ,Self Concept ,Self Efficacy ,Social Isolation ,Social Stigma ,Social Support ,Stereotyping ,United States ,internalized stigma ,new-to-care ,ART adherence ,viral suppression ,visit adherence ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.
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- 2020
20. Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV
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Weiser, Sheri D, Sheira, Lila A, Palar, Kartika, Kushel, Margot, Wilson, Tracey E, Adedimeji, Adebola, Merenstein, Dan, Cohen, Mardge, Turan, Janet M, Metsch, Lisa, Adimora, Adaora A, Ofotokun, Ighovwerha, Wentz, Eryka, Tien, Phyllis C, and Frongillo, Edward A
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Mental Illness ,Infectious Diseases ,HIV/AIDS ,Sexually Transmitted Infections ,Depression ,Brain Disorders ,Behavioral and Social Science ,Mental Health ,Infection ,Good Health and Well Being ,Zero Hunger ,Anti-HIV Agents ,Antiretroviral Therapy ,Highly Active ,CD4 Lymphocyte Count ,Child ,Female ,Food Insecurity ,Food Supply ,HIV Infections ,Humans ,Medication Adherence ,Treatment Outcome ,United States ,food insecurity ,HIV ,women ,antiretroviral adherence ,mental health ,nutrition ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p
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- 2020
21. Effects of the Waya Intervention on Marital Satisfaction and HIV Risk Behaviors in Western Kenya: A Pre–Post Study Design
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Kwena, Zachary Arochi, Bukusi, Elizabeth A., Turan, Janet M., Darbes, Lynae, Farquhar, Carey, Makokha, Catherine, and Baeten, Jared M.
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- 2022
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22. Food Insecurity Is Associated With Lower Levels of Antiretroviral Drug Concentrations in Hair Among a Cohort of Women Living With Human Immunodeficiency Virus in the United States
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Leddy, Anna M, Sheira, Lila A, Tamraz, Bani, Sykes, Craig, Kashuba, Angela DM, Wilson, Tracey E, Adedimeji, Adebola, Merenstein, Daniel, Cohen, Mardge H, Wentz, Eryka L, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa R, Turan, Janet M, Bacchetti, Peter, and Weiser, Sheri D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,HIV/AIDS ,Infectious Diseases ,7.1 Individual care needs ,Management of diseases and conditions ,Zero Hunger ,Anti-HIV Agents ,Cohort Studies ,Female ,Food Insecurity ,Food Supply ,HIV ,HIV Infections ,Humans ,Medication Adherence ,Pharmaceutical Preparations ,Prospective Studies ,United States ,food insecurity ,antiretroviral therapy ,adherence ,ART concentrations in hair ,women living with HIV ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundFood insecurity is a well-established determinant of suboptimal, self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. We examined the association of food insecurity with levels of ART concentrations in hair among women living with human immunodeficiency virus (WLHIV) in the United States.MethodsWe analyzed longitudinal data collected semiannually from 2013 through 2015 from the Women's Interagency HIV Study, a multisite, prospective, cohort study of WLHIV and controls not living with HIV. Our sample comprised 1944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair, an objective and validated measure of drug adherence and exposure, were measured using high-performance liquid chromatography with mass spectrometry detection for regimens that included darunavir, atazanavir, raltegravir, or dolutegravir. We conducted multiple 3-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics.ResultsAt baseline, 67% of participants were virally suppressed and 35% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% confidence interval, 0.89 to 0.99). This effect remained unchanged after adjusting for self-reported adherence.ConclusionsFood insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with suboptimal ART adherence and/or drug absorption. Interventions seeking to improve ART adherence among WLHIV should consider and address the role of food insecurity.
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- 2020
23. Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care.
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Yigit, Ibrahim, Modi, Riddhi A, Weiser, Sheri D, Johnson, Mallory O, Mugavero, Michael J, Turan, Janet M, and Turan, Bulent
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Mental Health ,Sexually Transmitted Infections ,Depression ,Women's Health ,Infectious Diseases ,Minority Health ,Clinical Trials and Supportive Activities ,Pediatric ,HIV/AIDS ,Prevention ,Mental Illness ,Brain Disorders ,Behavioral and Social Science ,Clinical Research ,7.1 Individual care needs ,Management of diseases and conditions ,Good Health and Well Being ,Adaptation ,Psychological ,Adolescent ,Adult ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Social Stigma ,Social Support ,Surveys and Questionnaires ,United States ,coping ,depression ,HIV ,intervention ,new-to-care ,stigma ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveConsidering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles.DesignThe iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm.MethodsBaseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined.ResultsThe decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame.ConclusionThe multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.
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- 2020
24. Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis
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Fletcher, Faith E, Sherwood, Nicholas R, Rice, Whitney S, Yigit, Ibrahim, Ross, Shericia N, Wilson, Tracey E, Weiser, Sheri D, Johnson, Mallory O, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wingood, Gina, Turan, Janet M, and Turan, Bulent
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Prevention ,Mental Health ,Depression ,Mental Illness ,Minority Health ,HIV/AIDS ,Behavioral and Social Science ,Women's Health ,Clinical Research ,Infectious Diseases ,Substance Misuse ,Brain Disorders ,Social Determinants of Health ,Health Disparities ,Sexually Transmitted Infections ,Good Health and Well Being ,Adaptation ,Psychological ,Adult ,Anxiety ,Depressive Disorder ,Discrimination ,Psychological ,Female ,HIV Infections ,Humans ,Medication Adherence ,Minority Groups ,Resilience ,Psychological ,Social Stigma ,Substance-Related Disorders ,Treatment Outcome ,United States ,HIV ,resilience ,women living with HIV ,mixed methods ,HIV outcomes ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.
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- 2020
25. Women’s experiences of fistula-related stigma in Uganda: a conceptual framework to inform stigma-reduction interventions
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Ayadi, Alison M El, Barageine, Justus K, Miller, Suellen, Byamugisha, Josaphat, Nalubwama, Hadija, Obore, Susan, Korn, Abner, Sukumar, Smrithi, Kakaire, Othman, Mwanje, Haruna, Lester, Felicia, and Turan, Janet M
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Health Services and Systems ,Health Sciences ,Human Society ,Mental Health ,Clinical Research ,Behavioral and Social Science ,Prevention ,Good Health and Well Being ,Adult ,Female ,Fistula ,Focus Groups ,Humans ,Interviews as Topic ,Qualitative Research ,Shame ,Social Isolation ,Social Stigma ,Uganda ,Stigma ,genital fistula ,obstructed labour ,maternal morbidity ,Public Health and Health Services ,Sociology ,Cultural Studies ,Public Health ,Public health ,Anthropology ,Gender studies - Abstract
Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.
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- 2020
26. Complexities of HIV Disclosure in Patients Newly Entering HIV Care: A Qualitative Analysis.
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Chapman Lambert, Crystal, Tarver, Will L, Musoke, Pamela L, Stringer, Kristi L, Whitfield, Samantha, Turan, Bulent, Modi, Riddhi, Mugavero, Michael J, Fredericksen, Rob J, Weiser, Sheri, Johnson, Mallory O, and Turan, Janet M
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Health Services and Systems ,Nursing ,Health Sciences ,HIV/AIDS ,Pediatric ,Clinical Research ,Sexually Transmitted Infections ,Behavioral and Social Science ,Prevention ,Pediatric AIDS ,Infectious Diseases ,Infection ,Good Health and Well Being ,AIDS Serodiagnosis ,Adult ,Anti-Retroviral Agents ,Antiretroviral Therapy ,Highly Active ,Discrimination ,Psychological ,Fear ,Female ,HIV Infections ,Humans ,Interviews as Topic ,Male ,Prejudice ,Qualitative Research ,Self Disclosure ,Social Discrimination ,Social Stigma ,Social Support ,Treatment Adherence and Compliance ,Truth Disclosure ,United States ,adherence ,engagement in care ,iENGAGE ,new to care ,social support ,stigma ,Public Health - Abstract
The role of HIV disclosure and its influence on engagement in HIV care after initial linkage to care is not well understood. We conducted 28 in-depth interviews with patients newly entering HIV care. Gaining access to social support was a key reason that many patients disclosed their HIV status. For some, HIV disclosure improved support networks related to engagement in care at the time of care entry, in the form of appointment reminders, emotional support, and confidence to disclose more widely. However, some participants cited anticipated stigma as a barrier to disclosure, as they feared rejection or further disclosure without their permission. Early access to social support and skill building related to stigma reduction and coping can be useful resources to help patients manage HIV, as they initiate care. In addition, incorporating support for smart disclosure decisions into interventions may improve access to social support, ultimately improving engagement in care.
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- 2020
27. Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States
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Whittle, Henry J, Leddy, Anna M, Shieh, Jacqueline, Tien, Phyllis C, Ofotokun, Ighovwerha, Adimora, Adaora A, Turan, Janet M, Frongillo, Edward A, Turan, Bulent, and Weiser, Sheri D
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Public Health ,Health Sciences ,Human Society ,Health Disparities ,Clinical Research ,Behavioral and Social Science ,Basic Behavioral and Social Science ,Health Services ,Women's Health ,Minority Health ,Social Determinants of Health ,8.1 Organisation and delivery of services ,Generic health relevance ,Good Health and Well Being ,Zero Hunger ,Adult ,Aged ,Cohort Studies ,Cost of Illness ,Female ,Food Insecurity ,Georgia ,HIV Infections ,Humans ,Middle Aged ,North Carolina ,Poverty ,Prospective Studies ,Qualitative Research ,San Francisco ,Social Stigma ,Socioeconomic Factors ,United States ,Women ,Precarity ,Insecurity ,Food ,Housing ,Healthcare ,Health insurance ,Disability ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Health sciences ,Human society - Abstract
Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017-July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants' disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity-a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state-we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.
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- 2020
28. Stigma in health facilities: why it matters and how we can change it
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Nyblade, Laura, Stockton, Melissa A, Giger, Kayla, Bond, Virginia, Ekstrand, Maria L, Lean, Roger Mc, Mitchell, Ellen MH, Nelson, La Ron E, Sapag, Jaime C, Siraprapasiri, Taweesap, Turan, Janet, and Wouters, Edwin
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Health Services and Systems ,Nursing ,Public Health ,Health Sciences ,Prevention ,Clinical Research ,Behavioral and Social Science ,Health Services ,Good Health and Well Being ,Health Facilities ,Health Personnel ,Humans ,Social Stigma ,Stigma ,Discrimination ,Reduction ,Intervention ,Programs ,Health facilities ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
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- 2019
29. Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya
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Borgstede, Seth J., Elly, Assurah, Helova, Anna, Kwena, Zachary, Darbes, Lynae A., Hatcher, Abigail, Thirumurthy, Harsha, Owino, George, Pisu, Maria, Owuor, Kevin, Braun, Thomas, Turan, Janet M., Bukusi, Elizabeth A., and Nghiem, Van T.
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- 2023
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30. Couple Efficacy and Communal Coping for HIV Prevention Among Kenyan Pregnant Couples
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Musoke, Pamela, Darbes, Lynae, Hatcher, Abigail M., Helova, Anna, Kwena, Zachary, Owino, George, Bukusi, Elizabeth A., and Turan, Janet M.
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- 2022
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31. Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research
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Budhwani, Henna, Paulino-Ramírez, Robert, Waters, John, Bond, Christyenne L., Ruiz, Ingrid, Long, Dustin M., Varas-Díaz, Nelson, Naar, Sylvie, Nyblade, Laura, and Turan, Janet M.
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- 2022
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32. Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States
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Whittle, Henry J, Sheira, Lila A, Wolfe, William R, Frongillo, Edward A, Palar, Kartika, Merenstein, Daniel, Wilson, Tracey E, Adedimeji, Adebola, Weber, Kathleen M, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa, Turan, Janet M, Wentz, Eryka L, Tien, Phyllis C, and Weiser, Sheri D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Behavioral and Social Science ,Prevention ,Anxiety Disorders ,Post-Traumatic Stress Disorder (PTSD) ,Brain Disorders ,Mental Health ,Clinical Research ,Aetiology ,2.3 Psychological ,social and economic factors ,Zero Hunger ,Good Health and Well Being ,Anxiety ,Cohort Studies ,Cross-Sectional Studies ,Depression ,Female ,Food Supply ,HIV Infections ,Humans ,Longitudinal Studies ,Middle Aged ,Risk Factors ,Stress Disorders ,Post-Traumatic ,United States ,food insecurity ,anxiety ,stress ,PTSD ,HIV ,Animal Production ,Food Sciences ,Nutrition and Dietetics ,Nutrition & Dietetics ,Animal production ,Food sciences ,Nutrition and dietetics - Abstract
BackgroundFood insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes.ObjectiveThe aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States.MethodsParticipants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013-March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes.ResultsAfter adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P
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- 2019
33. Poverty stigma is associated with suboptimal HIV care and treatment outcomes among women living with HIV in the U.S.
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Leddy, Anna M, Turan, Janet M, Johnson, Mallory O, Neilands, Torsten B, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wingood, Gina, Tien, Phyllis C, Wilson, Tracey E, Logie, Carmen H, Weiser, Sheri D, and Turan, Bulent
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Infectious Diseases ,Behavioral and Social Science ,Health Disparities ,Sexually Transmitted Infections ,HIV/AIDS ,Clinical Research ,Prevention ,Infection ,Adult ,Anti-Retroviral Agents ,CD4 Lymphocyte Count ,Cross-Sectional Studies ,Drug Utilization ,Female ,HIV Infections ,Humans ,Middle Aged ,Poverty ,Prospective Studies ,Social Stigma ,Sustained Virologic Response ,Treatment Outcome ,United States ,Viral Load ,HIV care and treatment ,poverty stigma ,women living with HIV ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveTo examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes.DesignWe analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study.MethodsExposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count at least 350 cells/μl, and attending all HIV care visits in the past 6 months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking antiretroviral therapy (ART), number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs, or shelter. We also explored whether self-reported at least 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl.ResultsExperienced poverty stigma was associated with lower adjusted odds of viral suppression [adjusted odds ratio (aOR) 0.76; 95% confidence interval (CI) 0.61-0.96], CD4 cell count at least 350 cells/μl (aOR 0.69; 95% CI 0.52-0.91), and attending all HIV care visits (aOR 0.73; 95% CI: 0.54-0.98). Exploratory mediation analysis suggests that at least 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl.ConclusionLongitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.
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- 2019
34. Neighborhood Racial Diversity, Socioeconomic Status, and Perceptions of HIV-Related Discrimination and Internalized HIV Stigma Among Women Living with HIV in the United States
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Crockett, Kaylee B, Edmonds, Andrew, Johnson, Mallory O, Neilands, Torsten B, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wingood, Gina, Tien, Phyllis C, Cohen, Mardge, Wilson, Tracey E, Logie, Carmen H, Sosanya, Oluwakemi, Plankey, Michael, Golub, Elizabeth, Adimora, Adaora A, Parish, Carrigan, Weiser, Sheri D, Turan, Janet M, and Turan, Bulent
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Public Health ,Health Sciences ,Women's Health ,Clinical Research ,Basic Behavioral and Social Science ,Behavioral and Social Science ,Pediatric ,Mental Health ,Infectious Diseases ,Health Disparities ,Prevention ,Social Determinants of Health ,HIV/AIDS ,Sexually Transmitted Infections ,Adult ,Aged ,Anti-HIV Agents ,Cross-Sectional Studies ,Discrimination ,Psychological ,Female ,Geographic Mapping ,HIV Infections ,Humans ,Male ,Middle Aged ,Race Factors ,Residence Characteristics ,Social Class ,Social Isolation ,Social Stigma ,United States ,geocoding ,racial diversity ,HIV ,internalized stigma ,discrimination ,women ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Relationships that traverse sociodemographic categories may improve community attitudes toward marginalized groups and potentially protect members of those groups from stigma and discrimination. The present study evaluated whether internalized HIV stigma and perceived HIV-related discrimination in health care settings differ based on individual- and neighborhood-level characteristics of women living with HIV (WLHIV). We also sought to extend previous conceptual and empirical work to explore whether perceived HIV-related discrimination mediated the association between neighborhood racial diversity and internalized HIV stigma. A total of 1256 WLHIV in the Women's Interagency HIV Study (WIHS) attending 10 sites in metropolitan areas across the United States completed measures of internalized HIV stigma and perceived HIV-related discrimination in health care settings. Participants also provided residential information that was geocoded into Federal Information Processing Standard (FIPS) codes and linked with census-tract level indicators. In cross-sectional analyses, greater neighborhood racial diversity was associated with less internalized HIV stigma and less perceived HIV-related discrimination regardless of individual race. Neighborhood median income was positively associated with internalized HIV stigma and perceived discrimination, while individual income was negatively associated with perceptions of stigma and discrimination. In an exploratory mediation analysis, neighborhood racial diversity had a significant indirect effect on internalized HIV stigma through perceived HIV-related discrimination. An indirect effect between neighborhood income and internalized stigma was not supported. These findings suggest that greater neighborhood racial diversity may lessen HIV stigma processes at the individual level and that HIV stigma-reduction interventions may be most needed in communities that lack racial diversity.
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- 2019
35. A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States
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Rice, Whitney S, Turan, Bulent, Fletcher, Faith E, Nápoles, Tessa M, Walcott, Melonie, Batchelder, Abigail, Kempf, Mirjam-Colette, Konkle-Parker, Deborah J, Wilson, Tracey E, Tien, Phyllis C, Wingood, Gina M, Neilands, Torsten B, Johnson, Mallory O, Weiser, Sheri D, and Turan, Janet M
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Health Services and Systems ,Public Health ,Health Sciences ,Behavioral and Social Science ,Prevention ,Sexually Transmitted Infections ,HIV/AIDS ,Mental Health ,Women's Health ,Infectious Diseases ,Clinical Research ,7.1 Individual care needs ,Management of diseases and conditions ,Infection ,Good Health and Well Being ,Adaptation ,Psychological ,Aged ,Anti-Retroviral Agents ,Depression ,Fear ,Female ,HIV Infections ,Humans ,Interviews as Topic ,Medication Adherence ,Middle Aged ,Patient Compliance ,Qualitative Research ,Social Stigma ,Surveys and Questionnaires ,United States ,Young Adult ,HIV ,AIDS ,antiretroviral therapy ,mixed methods ,adherence ,stigma ,mental health ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Among places where people living with HIV experience and anticipate HIV-related stigma, stigma in health care settings may be particularly harmful. Utilizing an exploratory sequential mixed methods approach, we conducted interviews (n = 76) and questionnaires (N = 460) with older adult women living with HIV enrolled in the Women's Interagency HIV Study in Birmingham, AL; Jackson, MS; Atlanta, GA; and San Francisco, CA. Interviews addressed facilitators and barriers to HIV treatment adherence, including HIV-related stigma. Qualitative data were coded using thematic analysis. Questionnaires assessed self-reported antiretroviral therapy (ART) adherence and experienced and anticipated HIV-related stigma from various sources (i.e., health care personnel, family, partner, and community). Covariate-adjusted logistic regression analyses examined total and mediated effects of stigma on ART adherence. Interviewees described fears and experiences of stigma in health care settings; including privacy violations, disrespect for patient autonomy, and reproductive coercion; and how these influenced their adherence to HIV treatment recommendations. Experienced and anticipated HIV-related stigma in health care settings were associated with suboptimal (or
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- 2019
36. Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV
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Turan, Bulent, Rice, Whitney S, Crockett, Kaylee B, Johnson, Mallory, Neilands, Torsten B, Ross, Shericia N, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wingood, Gina, Tien, Phyllis C, Cohen, Mardge, Wilson, Tracey E, Logie, Carmen H, Sosanya, Oluwakemi, Plankey, Michael, Golub, Elizabeth, Adimora, Adaora A, Parish, Carrigan, Weiser, Sheri D, and Turan, Janet M
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Mental Health ,Pediatric ,HIV/AIDS ,Clinical Research ,Depression ,Behavioral and Social Science ,Adult ,Anti-Retroviral Agents ,Female ,HIV Infections ,Humans ,Longitudinal Studies ,Medication Adherence ,Middle Aged ,Social Stigma ,United States ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveWe investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence.DesignObservational longitudinal study utilizing data from the Women's Interagency HIV Study cohort.MethodsA measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862).ResultsHigher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]).ConclusionThese results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.
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- 2019
37. Buffering Internalization of HIV Stigma
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Turan, Bulent, Crockett, Kaylee B, Buyukcan-Tetik, Asuman, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey E, Tien, Phyllis C, Wingood, Gina, Neilands, Torsten B, Johnson, Mallory O, Weiser, Sheri D, and Turan, Janet M
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Epidemiology ,Public Health ,Health Sciences ,HIV/AIDS ,Brain Disorders ,Prevention ,Behavioral and Social Science ,Social Determinants of Health ,Infectious Diseases ,Mental Illness ,Sexually Transmitted Infections ,Mental Health ,Clinical Research ,Good Health and Well Being ,Adult ,Aged ,Anti-HIV Agents ,Anti-Retroviral Agents ,Depression ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Middle Aged ,Social Stigma ,Virus Internalization ,Young Adult ,negative evaluation ,attachment ,resilience ,HIV ,stigma ,adherence ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
BackgroundOne mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits-fear of negative social evaluation, attachment-related anxiety, and dispositional resilience-in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence.Setting/methodsIn study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling for age, education, race, time on ART, and substance use.ResultsIn both studies, fear of negative evaluation and attachment-related anxiety moderated the effect of perceived HIV stigma in the community on internalized HIV stigma: People higher on those moderating variables had stronger associations between perceived stigma in the community and internalized stigma. In study 2, resilience was assessed and also moderated the effect of perceived HIV stigma in the community on internalized stigma. In moderated mediation models, fear of negative evaluation, attachment-related anxiety, and resilience moderated the indirect effect of perceived HIV stigma in the community on ART adherence and depression through internalized stigma.ConclusionsInterventions to assuage internalization of HIV stigma should focus on bolstering attachment-related security, social competence, and resilience.
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- 2019
38. Persistent Food Insecurity Is Associated with Adverse Mental Health among Women Living with or at Risk of HIV in the United States
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Tuthill, Emily L, Sheira, Lila A, Palar, Kartika, Frongillo, Edward A, Wilson, Tracey E, Adedimeji, Adebola, Merenstein, Daniel, Cohen, Mardge H, Wentz, Eryka L, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa, Kushel, Margot, Turan, Janet M, Konkle-Parker, Deborah, Tien, Phyllis C, and Weiser, Sheri D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Behavioral and Social Science ,Mental Health ,Prevention ,Clinical Research ,Depression ,Brain Disorders ,Serious Mental Illness ,Mental health ,Good Health and Well Being ,Zero Hunger ,Adult ,Female ,Food Supply ,HIV Infections ,Humans ,Middle Aged ,Prospective Studies ,Risk Factors ,Socioeconomic Factors ,United States ,Women's Health ,food insecurity ,HIV ,mental health ,women ,Animal Production ,Food Sciences ,Nutrition and Dietetics ,Nutrition & Dietetics ,Animal production ,Food sciences ,Nutrition and dietetics - Abstract
BackgroundFood insecurity and mental health negatively affect the lives of women in the United States. Participants in the Women's Interagency HIV Study (WIHS) provided the opportunity to understand the association of food insecurity with depression and mental well-being over time.ObjectiveWe investigated the association between current and persistent food insecurity and depression among women at risk of or living with HIV in the United States.MethodsWe used longitudinal data from the WIHS, a prospective cohort study in women at risk of or living with HIV from multiple sites in the United States. Participants completed 6 semiannual assessments from 2013 to 2016 on food security (FS; high, marginal, low, and very low) and mental health (i.e., depressive symptoms and mental well-being). We used multiple regression analysis to estimate the association between these variables.ResultsAmong 2551 participants, 44% were food insecure and 35% reported depressive symptoms indicative of probable depression. Current marginal, low, and very low FS were associated with 2.1-, 3.5-, and 5.5-point (all P
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- 2019
39. Food Insecurity Is Associated With Inflammation Among Women Living With HIV
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Leddy, Anna M, Roque, Annelys, Sheira, Lila A, Frongillo, Edward A, Landay, Alan L, Adedimeji, Adebola A, Wilson, Tracey E, Merenstein, Daniel, Wentz, Eryka, Adimora, Adaora A, Ofotokun, Igho, Metsch, Lisa R, Cohen, Mardge H, Tien, Phyllis C, Turan, Janet M, Turan, Bulent, and Weiser, Sheri D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Public Health ,Health Sciences ,Immunology ,HIV/AIDS ,Infectious Diseases ,Infection ,Zero Hunger ,Adult ,Body Mass Index ,Cross-Sectional Studies ,Female ,Food Supply ,HIV Infections ,Humans ,Inflammation ,Interleukin-6 ,Linear Models ,Middle Aged ,Multivariate Analysis ,Receptors ,Tumor Necrosis Factor ,Type I ,United States ,food insecurity ,chronic inflammation ,HIV ,inflammatory cytokines ,women living with HIV ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Biological sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundChronic inflammation is associated with AIDS-defining and non-AIDS-defining conditions. Limited research has considered how food insecurity influences chronic inflammation among people living with human immunodeficiency virus (HIV). We examined whether food insecurity was associated with higher levels of inflammation among women living with HIV (WWH) in the United States.MethodsWe analyzed cross-sectional data collected in 2015 from 421 participants on antiretroviral therapy from the Women's Interagency HIV Study. The exposure was any food insecurity. The outcome was inflammation, measured by proinflammatory cytokine interleukin-6 (IL-6) and tumor necroses factor receptor 1 (TNFR1) levels. We conducted multivariable linear regressions, adjusting for sociodemographic, clinical, and nutritional factors.ResultsNearly one-third of participants (31%) were food insecure and 79% were virally suppressed (
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- 2019
40. Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study
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Ayadi, Alison M El, Barageine, Justus, Korn, Abner, Kakaire, Othman, Turan, Janet, Obore, Susan, Byamugisha, Josaphat, Lester, Felicia, Nalubwama, Hadija, Mwanje, Haruna, Tripathi, Vandana, and Miller, Suellen
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Health Services and Systems ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Behavioral and Social Science ,Mind and Body ,Clinical Research ,Rehabilitation ,Prevention ,Good Health and Well Being ,Adaptation ,Psychological ,Female ,Humans ,Longitudinal Studies ,Quality of Life ,Rectovaginal Fistula ,Self Concept ,Social Stigma ,Uganda ,Vaginal Fistula ,Vesicovaginal Fistula ,Women's Health ,vesicovaginal fistula ,rectovaginal fistula ,obstetric labour complications ,urinary incontinence ,social stigma ,quality of life ,complications obstétricales du travail ,fistule recto-vaginale ,fistule vésico-vaginale ,incontinence urinaire ,qualité de vie ,stigmatisation sociale ,Public Health and Health Services ,Tropical Medicine ,Clinical sciences ,Epidemiology ,Public health - Abstract
ObjectivesTo explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.MethodsWe recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.ResultsAcross post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).ConclusionsOur longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
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- 2019
41. INTERNALIZED HIV STIGMA PREDICTS PAIN AMONG WOMEN LIVING WITH HIV IN THE UNITED STATES: THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
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Crockett, Kaylee B, Esensoy, Turkan Alinea, Johnson, Mallory, Neilands, Torsten, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wingood, Gina, Tien, Phyllis, Cohen, Mardge, Wilson, Tracey, Logie, Carmen, Sosanya, Oluwakemi, Plankey, Michael, Golub, Elizabeth, Adimora, Adaora, Parish, Carrigan, Weiser, Sheri, Turan, Janet, and Turan, Bulent
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Public Health and Health Services ,Social Work ,Public Health ,Public health - Abstract
Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women’s Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.
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- 2019
42. Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States
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Whittle, Henry J, Sheira, Lila A, Frongillo, Edward A, Palar, Kartika, Cohen, Jennifer, Merenstein, Daniel, Wilson, Tracey E, Adedimeji, Adebola, Cohen, Mardge H, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa, Turan, Janet M, Wentz, Eryka L, Tien, Phyllis C, and Weiser, Sheri D
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Public Health ,Health Sciences ,Behavioral and Social Science ,Drug Abuse (NIDA only) ,Prevention ,Substance Misuse ,HIV/AIDS ,Clinical Research ,Zero Hunger ,Good Health and Well Being ,Adult ,Amphetamine-Related Disorders ,Cocaine-Related Disorders ,Cohort Studies ,Female ,Food Supply ,HIV Infections ,Humans ,Logistic Models ,Longitudinal Studies ,Marijuana Use ,Middle Aged ,Multivariate Analysis ,Opioid-Related Disorders ,Prospective Studies ,Risk Factors ,Substance-Related Disorders ,United States ,Drug use ,food insecurity ,HIV ,mental health ,substance use ,women ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Public health ,Clinical and health psychology - Abstract
Background and aimsFew longitudinal studies have examined the relationship between food insecurity and substance use. We aimed to investigate this relationship using longitudinal data among women with or at risk for HIV in the United States.DesignWomen's Interagency HIV Study (WIHS), a prospective cohort study.SettingNine sites across the United States.ParticipantsA total of 2553 women with or at risk for HIV.MeasurementsSemi-annual structured interviews were conducted during April 2013-March 2016. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. Outcomes were: any illicit substance use except cannabis; licit or illicit cannabis use; stimulant use (crack, cocaine, or methamphetamine); opioid use (heroin or methadone in a non-prescribed way); and prescription drug misuse (prescription narcotics, amphetamines, or tranquilizers in a non-prescribed way) since the last visit. We used multivariable logistic regression with random effects to examine longitudinal associations of current and previous FS with the outcomes simultaneously, adjusting for socio-demographic factors, HIV serostatus, physical health and health insurance.FindingsAverage number of visits was 4.6. At baseline, 71% of participants were HIV-seropositive, 44% reported marginal, low, or very low FS, and 13% were using illicit substances. In adjusted analyses, current low and very low FS were significantly associated with 1.59 [95% confidence interval (CI) = 1.02, 2.46; P = 0.039] and 2.48 (95% CI = 1.52, 4.04; P
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- 2019
43. Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV
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Turan, Bulent, Crockett, Kaylee B, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey E, Tien, Phyllis C, Wingood, Gina, Neilands, Torsten B, Johnson, Mallory O, Weiser, Sheri D, and Turan, Janet M
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Mental Health ,HIV/AIDS ,Infectious Diseases ,Clinical Research ,Sexually Transmitted Infections ,Behavioral and Social Science ,7.1 Individual care needs ,Management of diseases and conditions ,Adult ,Aged ,Aged ,80 and over ,Anti-HIV Agents ,CD4 Lymphocyte Count ,Cross-Sectional Studies ,Female ,HIV Infections ,Humans ,Medication Adherence ,Middle Aged ,Models ,Psychological ,Object Attachment ,Patient Compliance ,Sexual Partners ,Viral Load ,attachment ,HIV ,psychosocial ,insecurity ,avoidance ,anxiety ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundTreatment adherence and viral suppression remain suboptimal in the United States. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others' help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes.MethodsWe examined cross-sectional associations of the 2 attachment-related insecurity dimensions with antiretroviral treatment (ART) adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in 4 US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race.ResultsAttachment-related avoidance was the only unique predictor of suboptimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts.ConclusionsInterventions may need to focus on the vulnerable subpopulation with high attachment insecurity and incorporate existing strategies that address insecure attachment models.
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- 2019
44. Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S.
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Conroy, Amy A, Cohen, Mardge H, Frongillo, Edward A, Tsai, Alexander C, Wilson, Tracey E, Wentz, Eryka L, Adimora, Adaora A, Merenstein, Daniel, Ofotokun, Ighovwerha, Metsch, Lisa, Kempf, Mirjam-Colette, Adedimeji, Adebola, Turan, Janet M, Tien, Phyllis C, and Weiser, Sheri D
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Humans ,HIV Infections ,Multivariate Analysis ,Odds Ratio ,Risk Factors ,Cohort Studies ,Longitudinal Studies ,Prospective Studies ,Violence ,Poverty ,Food Supply ,Adult ,Middle Aged ,United States ,Female ,General Science & Technology - Abstract
BACKGROUND:Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women's Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV. METHODS:Study participants completed six assessments from 2013-16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling for visits (level 1) nested within individuals (level 2), to estimate the association of experiencing violence. RESULTS:Among 2,343 women (8,528 visits), we found that victims of sexual or physical violence (odds ratio = 3.10; 95% confidence interval: 1.88, 5.19) and psychological violence (odds ratio = 3.00; 95% confidence interval: 1.67, 5.50) were more likely to report very low food security. The odds of experiencing violence were higher for women with very low food security at both the current and previous visit as compared to only the current visit. HIV status did not modify these associations. CONCLUSIONS:Food insecurity was strongly associated with violence, and women exposed to persistent food insecurity were even more likely to experience violence. Food programs and policy must consider persistent exposure to food insecurity, and interpersonal harms faced by food insecure women, such as violence.
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- 2019
45. Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study.
- Author
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El Ayadi, Alison M, Barageine, Justus, Korn, Abner, Kakaire, Othman, Turan, Janet, Obore, Susan, Byamugisha, Josaphat, Lester, Felicia, Nalubwama, Hadija, Mwanje, Haruna, Tripathi, Vandana, and Miller, Suellen
- Subjects
Humans ,Rectovaginal Fistula ,Vesicovaginal Fistula ,Vaginal Fistula ,Longitudinal Studies ,Adaptation ,Psychological ,Self Concept ,Quality of Life ,Women's Health ,Uganda ,Female ,Social Stigma ,complications obstétricales du travail ,fistule recto-vaginale ,fistule vésico-vaginale ,incontinence urinaire ,obstetric labour complications ,quality of life ,qualité de vie ,rectovaginal fistula ,social stigma ,stigmatisation sociale ,urinary incontinence ,vesicovaginal fistula ,Rehabilitation ,Behavioral and Social Science ,Clinical Research ,Mind and Body ,Prevention ,Public Health and Health Services ,Tropical Medicine - Abstract
ObjectivesTo explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.MethodsWe recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.ResultsAcross post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).ConclusionsOur longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
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- 2019
46. Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States
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Palar, Kartika, Frongillo, Edward A, Escobar, Jessica, Sheira, Lila A, Wilson, Tracey E, Adedimeji, Adebola, Merenstein, Daniel, Cohen, Mardge H, Wentz, Eryka L, Adimora, Adaora A, Ofotokun, Ighovwerha, Metsch, Lisa, Tien, Phyllis C, Turan, Janet M, and Weiser, Sheri D
- Subjects
Public Health ,Health Sciences ,HIV/AIDS ,Depression ,Mental Health ,Brain Disorders ,Behavioral and Social Science ,Clinical Research ,Zero Hunger ,Adult ,Cross-Sectional Studies ,Female ,Food Supply ,HIV Infections ,Humans ,Middle Aged ,Social Stigma ,Social Support ,Socioeconomic Factors ,United States ,Food insecurity ,Internalized stigma ,Women ,HIV ,Public Health and Health Services ,Social Work ,Public health - Abstract
Food insecurity, internalized HIV stigma, and depressive symptoms are independently associated with poor HIV outcomes. Food insecurity, stigma, and depression may be interrelated among women living with HIV (WLHIV). We hypothesized that food insecurity would be independently associated with internalized stigma and depressive symptoms among WLHIV in the United States (US), and would partially account for associations between stigma and depressive symptoms. We tested hypotheses using regression models and partial correlation analysis with cross-sectional data among 1317 WLHIV from the Women's Interagency HIV Study. In adjusted models, greater food insecurity was associated with internalized HIV stigma and depressive symptoms (all p
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- 2018
47. A Systematic Review of Behavioral Couples-Based Interventions Targeting Prevention of Mother-to-Child Transmission in Low- and Middle-Income Countries
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Hampanda, Karen, Pelowich, Krysta, Chi, Benjamin H., Darbes, Lynae A., Turan, Janet M., Mutale, Wilbroad, and Abuogi, Lisa
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- 2022
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48. Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study
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Crockett, Kaylee B., Turan, Bulent, Whitfield, Samantha, Kay, Emma Sophia, Budhwani, Henna, Fifolt, Matthew, Hauenstein, Kris, Ladner, Murray D., Sewell, Joshua, Payne-Foster, Pamela, Nyblade, Laura, Batey, D. Scott, and Turan, Janet M.
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- 2022
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49. Structural barriers to maternity care in Cameroon: a qualitative study.
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Harsono, Alfonsus Adrian Hadikusumo, Bond, Christyenne Lily, Enah, Comfort, Ngong, Mary Glory, Kyeng, Rahel Mbah, Wallace, Eric, Turan, Janet M., Szychowski, Jeffery M., Carlo, Waldemar A., Ambe, Lionel Neba, Halle-Ekane, Gregory, Muffih, Pius Tih, Tita, Alan Thevenet N., and Budhwani, Henna
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HEALTH services accessibility ,MEDICAL care use ,MATERNAL health services ,EXECUTIVES ,QUALITATIVE research ,OCCUPATIONAL adaptation ,MEDICAL quality control ,RESEARCH funding ,INTERVIEWING ,HEALTH policy ,MATERNAL-child health services ,PSYCHOLOGICAL adaptation ,PREGNANT women ,JUDGMENT sampling ,DESCRIPTIVE statistics ,TELEMEDICINE ,THEMATIC analysis ,EMERGENCY medical services communication systems ,RIOTS ,LABOR demand ,STAKEHOLDER analysis ,COMPARATIVE studies ,DATA analysis software ,GROUNDED theory ,HEALTH equity ,RESOURCE-limited settings ,TRANSPORTATION of patients - Abstract
Background: The maternal mortality and perinatal mortality rate in Cameroon are among the highest worldwide. To improve these outcomes, we conducted a formative qualitative assessment to inform the adaptation of a mobile provider-to-provider intervention in Cameroon. We explored the complex interplay of structural barriers on maternity care in this low-resourced nation. The study aimed to identify structural barriers to maternal care during the early adaptation of the mobile Medical Information Service via Telephone (mMIST) program in Cameroon. Methods: We conducted in-depth interviews and focus groups with 56 key stakeholders including previously and currently pregnant women, primary healthcare providers, administrators, and representatives of the Ministry of Health, recruited by purposive sampling. Thematic coding and analysis via modified grounded theory approach were conducted using NVivo12 software. Results: Three main structural barriers emerged: (1) civil unrest (conflict between Ambazonian militant groups and the Cameroonian government in the Northwest), (2) limitations of the healthcare system, (3) inadequate physical infrastructure. Civil unrest impacted personal security, transportation safety, and disrupted medical transport system. Limitations of healthcare system involved critical shortages of skilled personnel and medical equipment, low commitment to evidence-based care, poor reputation, ineffective health system communication, incentives affecting care, and inadequate data collection. Inadequate physical infrastructure included frequent power outages and geographic distribution of healthcare facilities leading to logistical challenges. Conclusion: Dynamic inter-relations among structural level factors create barriers to maternity care in Cameroon. Implementation of policies and intervention programs addressing structural barriers are necessary to facilitate timely access and utilization of high-quality maternity care. [ABSTRACT FROM AUTHOR]
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- 2024
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50. A Randomized Pilot Trial of a Novel Behavioral Intervention for Chronic Pain Tailored to Individuals with HIV
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Merlin, Jessica S, Westfall, Andrew O, Long, Dustin, Davies, Susan, Saag, Michael, Demonte, William, Young, Sarah, Kerns, Robert D, Bair, Matthew J, Kertesz, Stefan, Turan, Janet M, Kilgore, Meredith, Clay, Olivio J, Starrels, Joanna, Pekmezi, Dorothy, and Johnson, Mallory O
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Public Health ,Health Sciences ,Pain Research ,Prevention ,HIV/AIDS ,Chronic Pain ,Clinical Research ,Clinical Trials and Supportive Activities ,Behavioral and Social Science ,7.1 Individual care needs ,Evaluation of treatments and therapeutic interventions ,6.6 Psychological and behavioural ,Management of diseases and conditions ,Good Health and Well Being ,Cognitive Behavioral Therapy ,Comorbidity ,Feasibility Studies ,Female ,HIV Infections ,Humans ,Male ,Middle Aged ,Pain Management ,Patient Acceptance of Health Care ,Pilot Projects ,Self-Management ,Surveys and Questionnaires ,Treatment Outcome ,HIV ,Pain ,Social cognitive theory ,Self-management ,Public Health and Health Services ,Social Work ,Public health - Abstract
Chronic pain is an important and understudied comorbidity in people living with HIV (PLWH). We conducted a pilot trial of Skills TO Manage Pain (STOMP), an innovative social cognitive theory-based pain self-management intervention tailored to PLWH, to assess feasibility, acceptability, and preliminary efficacy. Eligibility criteria included being HIV+, ≥ moderate pain for ≥ 3 months and a score of ≥ 4 on the three-item PEG pain severity and interference scale. Participants were randomized in a 1:1 fashion to STOMP or a usual care comparison. Among 22 participants randomized to STOMP, median session attendance was 9/12 (75%). Of 19 STOMP participants surveyed, 13 reported being "much better" overall since beginning treatment. Brief pain inventory-total scores decreased by 2 points in the intervention group and 0.9 in the control group (p = 0.11). STOMP is feasible, acceptable, and shows preliminary evidence of efficacy and promise for a full-scale trial.
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- 2018
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