Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis

Fletcher, Faith E.; Sherwood, Nicholas; Rice, Whitney S.; Yiğit, İbrahim; Ross, Shericia; Wilson, Tracey E.; Weiser, Sheri D.; Johnson, Mallory O.; Kempf, Mirjam-Colette; Konkle‐Parker, Deborah; Wingood, Gina M.; Turan, Janet M.; Turan, Bülent

doi:10.1089/apc.2019.0309

Cited by 40 publications

(43 citation statements)

References 46 publications

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“…The most salient themes that emerged were that caregiver-related stressors, structural issues and personal choice were the barriers participants identified, and that routinization, religion/spirituality and caregiver role promoted adherence to care. Our findings concurred with Fletcher et al ( 28 ); study participants (59%) were US-based, Black non-Hispanic women, who reported on “hardiness,” spirituality/religion and family as strengths that helped them cope with their diagnoses. Similarly, Dale et al (2018) ( 29 ) described that Black women with a history of trauma relied on resiliency and social support to overcome HIV-related stigma, which in turn promoted HIV adherence.…”

Section: Discussionsupporting

confidence: 92%

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Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

Duthely

Sanchez‐Covarrubias

Brown

et al. 2021

Front. Public Health

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Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH).Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence.Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups.Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = −0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)—a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04).Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.

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Section: Discussionsupporting

confidence: 92%

“…It was beyond the scope of this study to conduct such analyses. It is worth noting, however, that a recent US-based study of predominantly low-income women, demonstrated in higher order analyses significant moderating effects of these relationships (i.e., depression, HIV-related stigma, ARV adherence) ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

Duthely

Sanchez‐Covarrubias

Brown

et al. 2021

Front. Public Health

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“…In other words, it is a positive adaptation to adverse events, and may act as a buffer against adverse mental health outcomes. In PLWH, high resilience has been associated with lower depression and anxiety ( McGowan et al, 2017 , Thurston et al, 2018 ), improved health behaviors leading to higher ART adherence and viral suppression ( Brewer et al, 2020 , Dulin et al, 2019 , Fletcher et al, 2020 ), safer sexual practices ( McNair et al, 2017 ), and higher health-related quality of life ( Fang et al, 2015 ). In the Miami Adult Studies on HIV (MASH) cohort, PLWH exhibited higher resilience than their HIV-uninfected peers during the early months of the pandemic ( Diaz-Martinez et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

HIV, psychological resilience, and substance misuse during the COVID-19 pandemic: A multi-cohort study

Baum

Tamargo

Diaz-Martinez

et al. 2022

Drug and Alcohol Dependence

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“…Fletcher et al analyzed in-depth interview data exploring resilience strategies that women living with HIV leveraged to cope with stressors [17]. Qualitative findings included resilience themes such as 'hardiness' (a sense of having control over your life; committing yourself to get through the hard times; and seeing difficult situations as challenges to overcome) and 'supercoping' (women who modeled an ability to overcome many challenges, come out looking and feeling good, and are able to deflect derogatory statements and mistreatment).…”

Section: Contributions To the Hiv Care Continuum: Social Determinants...mentioning

confidence: 99%

The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua

Arnold

Campbell²,

Koester³

2022

Current Opinion in HIV and AIDS

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Purpose of reviewDespite enormous advances in prevention and care modalities, HIV continues to burden populations around the globe and is largely driven by social and behavioral processes. Mixed methods and qualitative research endeavors are best suited to uncovering and making sense of these dynamics, producing unique and actionable findings to alleviate the burden of HIV. We reviewed the global literature published on PubMed from 2020 to 2021 to identify studies that produced new insights into the social and behavioral dynamics that drive the HIV epidemic, focusing on mixed methods or purely qualitative study designs. Recent findingsMixed methods and qualitative studies have revealed important nuances in the social and behavioral dynamics associated with the HIV prevention and care continua, from preexposure prophylaxis uptake and adherence to engagement in HIV care and treatment, and have important implications for attaining goals for controlling the epidemic. SummaryArticles reviewed contribute to advancing our understanding of complex social dynamics, structural level factors such as healthcare systems and policy, as well as the research endeavor itself and the need to diversify and sustain research to truly represent the perspectives of those most impacted by HIV. Numerous studies represent the unique ability of qualitative and mixed methods research to expand our understanding of and empathy for individuals living with and affected by HIV, offering new insights to help alleviate the burden of HIV.

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Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis

Cited by 40 publications

References 46 publications

Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

HIV, psychological resilience, and substance misuse during the COVID-19 pandemic: A multi-cohort study

The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua

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