Psychosocial complications of HIV/AIDS-metabolic disorder comorbidities among patients in a rural area of southeastern United States

Hernandez, Dominica; Kalichman, Seth C.; Hp, Katner; Burnham, Kaylee E.; Kalichman, Moira O.; Hill, Marnie

doi:10.1007/s10865-018-9912-0

Cited by 12 publications

(10 citation statements)

References 46 publications

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“…Applying an intersectional lens, this separation fails to acknowledge clients' complex health experiences and the interaction between HIV and other medical conditions that disproportionately impact those who are most marginalized in a particular socio-political context [12,48,49]. The burden of seeking separated care may be especially harmful consid-ering that those with less access to HIV prevention services and HIV education, such as those in rural communities and burdened by class oppression, are disproportionately likely to have comorbid healthcare needs and more adverse HIV outcomes [50][51][52].…”

Section: Discussionmentioning

confidence: 99%

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action

Golub

Fikslin

2022

J Int AIDS Soc.

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Introduction There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra‐personal processes (i.e. knowledge or internalization of community‐level stigma that might limit clients’ engagement in care) or inter‐personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity. Discussion We apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV‐specific and intersectional stigma. Conclusions This commentary is a theory‐informed call to action for the assessment of existing HIV service implementation, for the development of new stigma‐reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system‐level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.

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Section: Discussionmentioning

confidence: 99%

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action

Golub

Fikslin

2022

J Int AIDS Soc.

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“…Other observations showed that after various interventions of AIDS patients, their HIV-1 RNA expression level and viral load were drastically altered [42], and HIV-1 RNA and viral load can be used to evaluate the prognosis effect of AIDS patients. Another study found that HIV infection can lead to significant reduction of CD4 + /CD8 + ratio [43]. The reduction of CD4 + /CD8 + ratio indicated that the immune function was markedly decreased, which promotes the further increase of HIV-1 RNA expression, indicating an interplay between HIV-1 RNA and CD4 + /CD8 + .…”

Section: Disease Markersmentioning

confidence: 97%

Treatment with Antiviral Drugs Will Significantly Inhibit the HIV-1 RNA POL Gene Expression and Viral Load in AIDS Patients

Shi

Wang

et al. 2023

Disease Markers

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Objective. This study is to investigate the difference in HIV-1 RNA pol gene expression in AIDS patients before and after antiviral treatment and its effect on the expression level of CD4+/CD8+ T cells in peripheral blood. Methods. The participants included 200 AIDS patients who had undergone antiviral medication, and the quantity of HIV-1 RNA pol gene was determined using nested polymerase chain reaction (nPCR). The levels of CD3+, CD4+, and CD8+ T lymphocytes in peripheral blood were measured by flow cytometry before and after therapy. The receiver operating characteristics (ROC) curve was used to assess the impact of HIV-1 RNA pol gene expression and the CD4+/CD8+ ratio on the prognosis of AIDS patients. Results. After three months of therapy, the levels of HIV-1 RNA and viral load in the patients showed a drastic decline, while the levels of CD4+/CD8+ were markedly elevated ( P < 0.05 ). Logistic analysis revealed that patients’ viral loads were positively correlated with HIV-1 RNA and negatively correlated with CD4+/CD8+ ( P < 0.05 ). The alanine aminotransferase (ALT), white blood cell (WBC) count, Serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), and platelet (PLT) levels significantly increased following a 24-month therapy, while no significant changes were observed in the level of aspartate aminotransferase (AST), red blood cell (RBC), and neutrophil (NEU) (%). ( P > 0.05 ). Conclusion. Antiviral drugs significantly inhibit the HIV-1 RNA POL gene expression and viral load in AIDS patients but upregulate the expression level of CD4+/CD8+ T cells in peripheral blood.

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“…The positive correlations between depression and posttraumatic symptoms, internalizing stigma and number of traumatic experiences, are not surprising. Several studies have demonstrated the comorbidity of stigma, depression, and posttraumatic stress symptoms in primary care settings [51-53].…”

Section: Discussionmentioning

confidence: 99%

Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial

Nakimuli-Mpungu¹,

Musisi²,

Wamala³

et al. 2019

JMIR Res Protoc

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Background Psychosocial characteristics, including self-esteem, perceived social support, coping skills, stigma, discrimination, and poverty, are strongly correlated with depression symptoms. However, data on the extent of these correlations among persons living with HIV and the associations between psychosocial characteristics and HIV treatment outcomes are limited in sub-Saharan Africa. Objective This paper aims to describe the recruitment process and baseline characteristics associated with depression in a sample of HIV-positive people in a cluster randomized trial of group support psychotherapy (GSP) for depression delivered by trained lay health workers (LHWs). Methods Thirty eligible primary care health centers across three districts in Uganda were randomly allocated to have their LHWs trained to deliver GSP (intervention arm) or group HIV education and treatment as usual (control arm) to persons living with HIV comorbid with depression. Baseline demographic, socioeconomic, and psychosocial characteristics were collected via interviewer-administered questionnaires. Among eligible participants, differences between those enrolled versus those who refused enrollment were assessed using chi square for categorical variables and t tests for continuous variables. Spearman rank order correlation analyses were conducted to determine associations between baseline depression symptoms and adherence to antiretroviral therapy (ART), viral load suppression, and other psychosocial variables. Results The study screened 1473 people and 1140 were found to be eligible and enrolled over 14 weeks. Participants recruited comprised 95% of the target sample size of 1200. The sample’s mean age was 38.5 (SD 10.9) years and both genders were well represented (males: 46.32%, 528/1140). Most participants met the diagnostic criteria for major depressive disorder (96.92%, 1105/1140), had significant posttraumatic stress symptoms (72.46%, 826/1140), reported moderate suicide risk (52.54%, 599/1140), had primary or no formal education (86.22%, 983/1140), and reported no income-generating activity (72.63%, 828/1140) and no food insecurity (81.67%, 931/1140). Among eligible participants, 48 of 1140 (4.21%) refused to participate in the interventions; these participants were more likely to be males (χ 2 1 =4.0, P =.045) and have significantly lower depression symptoms scores (t 2 =2.36, P =.01) than those who participated in the interventions. There was a significant positive correlation between viral load and number of traumatic experiences (ρ=.12, P =.05). Adherence to ART was positively correlated with perceived social support (ρ=.15, P <.001), but negatively correlated with depression symptoms (ρ=–.11, P =.05) and stigma (ρ=–.14, ...

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Psychosocial complications of HIV/AIDS-metabolic disorder comorbidities among patients in a rural area of southeastern United States

Cited by 12 publications

References 46 publications

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action

Recognizing and disrupting stigma in implementation of HIV prevention and care: a call to research and action

Treatment with Antiviral Drugs Will Significantly Inhibit the HIV-1 RNA POL Gene Expression and Viral Load in AIDS Patients

Recruitment and Baseline Characteristics of Participants in the Social, Emotional, and Economic Empowerment Through Knowledge of Group Support Psychotherapy Study (SEEK-GSP): Cluster Randomized Controlled Trial

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