Taking It One Day at a Time: African American Women Aging with HIV and Co-Morbidities

As black women over age 50 represent a growing share of women living with HIV, understanding what helps them persist and engage in ongoing HIV care will become increasingly important. Delineating the specific roles of social support and stigma on HIV care experiences among this population remains unclear. We qualitatively examined how experiences with stigma and social support either facilitated or inhibited engagement in HIV care, from the perspective of older black women. Semi-structured interviews were conducted with 20 older black women currently receiving HIV care at primary care clinics in the Metropolitan Boston area. Women expressed that experiences with stigma and seeking support played an important role in evaluating the risks and benefits of engaging in care. Social support facilitated their ability to engage in care, while stigma interfered with their ability to engage in care throughout the course of their illness. Providers in particular, can facilitate engagement by understanding the changes in these women's lives as they struggle with stigma and disclosure while engaging in HIV care. The patient's experiences with social support and stigma and their perceptions about engagement are important considerations for medical teams to tailor efforts to engage older black women in regular HIV care.

Section: Discussionmentioning

confidence: 99%

How Older Black Women Perceive the Effects of Stigma and Social Support on Engagement in HIV Care

McDoom

Bokhour

Sullivan

et al. 2015

“…29 However, diabetes is increasingly recognized as a significant comorbidity, 30 and aging HIV + women reported co-morbidities such as diabetes as significant health burdens. 31 Co-morbidities are playing an increasingly important role in the healthrelated quality of life and health burdens of HIV-infected individuals.…”

Section: Discussionmentioning

confidence: 99%

Health Status of HIV-Infected Women Entering Care: Baseline Medical Findings from the Women of Color Initiative

Quinlivan

Fletcher

Eastwood

et al. 2015

The WOC Initiative is a prospective study of 921 women of color (WOC) entering HIV care at nine (three rural, six urban) sites across the US. A baseline interview was performed that included self-reported limitation(s) in activity, health conditions, and the CDC's health-related quality of life measures (Healthy Days). One-third of the WOC reported limiting an activity because of illness or a health condition and those with an activity limitation reported 13 physically and 14 mentally unhealthy days/month, compared with 5 physically and 9 mentally unhealthy days/month in the absence of an activity limitation. Age was associated with a three- to fourfold increased risk of an activity limitation but only for WOC in the urban sites. Diabetes was associated with a threefold increased risk of a limitation among women at rural sites. Cardiac disease was associated with a six- to sevenfold increased risk of an activity limitation for both urban and rural WOC. HIV+ WOC reported more physically and mentally unhealthy days than the general US female population even without an activity limitation. Prevention and treatment of diabetes and cardiovascular disease will need to be a standard part of HIV care to promote the long-term health and HRQOL for HIV-infected WOC.

“…Additionally, our dataset did not include co-morbidities, such as diabetes and hypertension, which can impact HIV self-management, especially in the older population. 42 Given that co-morbidities can complicate HIV/AIDs regimens, the presence of added conditions in older PLWHA might account for differences in VL and CD4 cell counts between age groups. This is a topic worth further Baseline CD4 and VL counts were defined as the first available value after January 1, 2005, or at the time of diagnosis for newly identified HIV-infected individuals.…”

Section: Disparities In Hiv Viral Load and Cd4 Count Trendsmentioning

confidence: 99%

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

Chakraborty

Iyer

Duffus

et al. 2015

On a population level, trends in viral load (VL) and CD4 cell counts can provide a marker of infectivity and an indirect measure of retention in care. Thus, observing the trend of CD4/VL over time can provide useful information on disparities in populations across the HIV care continuum when stratified by demography. South Carolina (SC) maintains electronic records of all CD4 cell counts and HIV VL measurements reported to the state health department. We examined temporal trends in individual HIV VLs reported in SC between January 1, 2005 and December 31, 2012 by using mixed effects models adjusting for gender, race/ethnicity, age, baseline CD4 count, HIV risk category, and residence. Overall VL levels gradually decreased over the observation period. There were significant differences in the VL decline by gender, age groups, rural/urban residence, and HIV risk exposure group. There were significant differences in CD4 increases by race/ethnicity, age groups, and HIV risk exposure group. However, the population VL declines were slower among individuals aged 13-19 years compared to older age groups ( p < 0.0001), among men compared to women ( p = 0.002), and among people living with HIV/AIDS (PLWHA) with CD4 count £ 200 cell/mm 3 compared to those with higher CD4 counts ( p < 0.0001). Significant disparities were observed in VL decline by gender, age, and CD4 counts among PLWHA in SC. Population based data such as these can help streamline and better target local resources to facilitate retention in care and adherence to medications among PLWHA.