Black older women living with HIV (BOWLH) in the United States are disproportionately affected by HIV infection and poor treatment engagement rates, often caused by multiple social determinants of health. In this descriptive qualitative study, we interviewed 17 BOWLH to investigate the facilitators and barriers to HIV treatment engagement. Data were analyzed using the socioecological framework. Findings demonstrate the positive influences of supportive social networks, perceived benefits, HIV-related knowledge, raising HIV awareness in communities, and impact of HIV state laws. The highlighted barriers were mainly low income, substance use, HIV-related stigma, influence of stereotypes and assumptions about older women living with HIV, and health insurance. Religion, managing comorbidities, attitude toward, HIV disclosure, and caregiving roles had both positive and negative influences on engagement. These findings illuminate factors of HIV treatment engagement that might be culturally founded; disseminating these factors to health care professionals is a critical intervention to support this population.

Objective Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD. Design A cross‐sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model. Results Women currently breastfeeding (AOR = 0.87 CI: 0.79–0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates. Conclusions Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Background and Purpose:HIV infection is a health disparity among transgender women. Despite limited HIV-prevention interventions and services, many transgender women do not access these interventions and services. The purpose of this study was to identify the process by which barriers may prevent transgender women from receiving HIV-prevention interventions and services and to have participants propose ideas on how to overcome these barriers.Methods:Utilizing a grounded theory approach, 25 in-depth, semistructured interviews were conducted with transgender women aged 20–69 years. After providing written informed consent, participants completed an in-depth individual interview. Interviews were audio-recorded and transcribed verbatim. Categories and subcategories were identified from the data using open, axial, and selective coding.Results:A theory grounded in the data namedLiving in Stealthemerged that described this central phenomenon that underpinned the other main categories ofEncountering Social BarriersandEncountering Structural Barriers.Generating Ideas for Restructuring HIV-Prevention for Transgender Womenwas the final category in which participants provided ideas to overcome HIV-prevention barriers.Implications:Clinicians and researchers providing HIV-prevention services and interventions for transgender women need awareness of the complex nature of HIV prevention for this subpopulation of women. More research is needed to incorporate findings from this study into HIV-prevention interventions for transgender women.

AimGuided by Mcleroy's socio‐ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post‐partum women living with HIV.MethodQuantitative, research methodology.DesignWe conducted a retrospective, secondary data analysis of 143 Black post‐partum women living with HIV who received peripartum care in South‐Florida, United States, from 2009 to 2017. We examined odds of immediate post‐partum engagement at 3 months post‐partum, and ongoing primary care engagement at 12 months post‐partum.ResultsThe independent group analyses showed low levels of immediate post‐partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post‐partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post‐partum engagement. Also, immediate post‐partum disengagement was a significant predictor for ongoing primary care disengagement.ConclusionThis study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities.ImpactThe study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at‐risk women and intervene accordingly to ensure that their care is not marginalized.Patient/Public ContributionThis study includes direct patient data from Black post‐partum women living with HIV who were seen at prenatal and post‐partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service‐users, who further corroborated our findings, and provided insights and future recommendations.

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