The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study

Lambert, Crystal Chapman; Fazeli, Pariya L; Yiğit, İbrahim; Elopre, Latesha; King, Kiko; Kempf, Mirjam-Colette; Guthrie, Barbara; Mugavero, Michael J.

doi:10.1097/jnc.0000000000000312

Cited by 5 publications

(2 citation statements)

References 45 publications

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“…The first study among 84 Black women living with HIV showed that social support and resilience mediated the relationship between various dimensions of stigma, and better self-management of health. 50 The second study showed that Black participants reported greater access to psychosocial resources (mastery, self-esteem, and social support) than White participants. 51,52 The third study compared African Americans with lesbian, gay, and bisexual participants and described how people with conspicuous stigmas such as race are better able to seek out social support from visible peers than people with concealed stigmas such as sexuality.…”

Section: Discussionmentioning

confidence: 96%

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Malama,

Logie,

Sokolovic

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. Setting: Ontario, British Columbia, and Quebec, Canada. Methods: We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. Results: There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. Conclusion: Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.

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Section: Discussionmentioning

confidence: 96%

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Malama,

Logie,

Sokolovic

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…The results of this study are also related to previous research on Black women living with HIV (WLWH), where experiencing recent stress and lifetime traumatic events has many negative outcomes, such as missing HIV care appointments (Chapman Lambert, Wright, et al., 2022). Positive factors (i.e., social support and resilience) have been found to mediate the association between different dimensions of stigma (e.g., enacted stigma in the community) and patient activation (the patient's overall ability to manage a chronic condition) in Black WLWH, where these positive factors appear to buffer against the negative effects of stigma (Chapman Lambert, Fazeli, et al., 2022). Given that HIV‐seropositive individuals experience stressors unique to their HIV‐status (Chapman Lambert, Wright, et al., 2022; López‐Matos et al., 2021), the difference in the stressor exposure and functional impairment association at low levels of grit between HIV status groups in our study may be related to the stigma the HIV‐seropositive group experiences.…”

Section: Discussionmentioning

confidence: 99%

Psychological grit moderates the relation between lifetime stressor exposure and functional outcomes among HIV‐seropositive and HIV‐seronegative adults

et al. 2023

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The ability to maintain functional independence throughout the lifespan may be diminished among medically compromised and chronically stressed populations. People living with HIV are more likely to demonstrate functional impairment and report greater exposure to lifetime and chronic stressors than their seronegative counterparts. It is well‐known that exposure to stressors and adversity is associated with functional impairment outcomes. However, to our knowledge, no studies have examined how protective factors such as psychological grit mitigate the negative effects of lifetime and chronic stressor exposure on functional impairment, and how this association differs by HIV‐status. To address this issue, we studied associations between lifetime and chronic stressor exposure, grit, and functional impairment in 176 African American and non‐Hispanic White HIV‐seropositive (n = 100) and HIV‐seronegative (n = 76) adults, aged 24–85 (M = 57.28, SD = 9.02). As hypothesised, HIV‐seropositive status and lower grit, but not lifetime stressor exposure, were independently associated with more functional impairment. Moreover, there was a significant three‐way interaction between HIV‐status, grit, and lifetime stressor exposure, b = 0.07, p = 0.025, 95% CI [0.009, 0.135]. Specifically, lifetime stressor exposure was related to more functional impairment for HIV‐seronegative—but not HIV‐seropositive—adults who reported low levels of grit. These findings suggest that the protective effects of grit may differ across populations at risk for functional impairment.

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Factors affecting patient activation among patients with systemic lupus erythematosus

Wang,

Song,

et al. 2024

Sci Rep

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There are limited published studies on patient activation among patients with systemic lupus erythematosus (SLE) in China. Disease activity can significantly influence a patient's perception of their condition, subsequently impacting patient activation. However, the mechanisms through which disease activity influences patient activation remain poorly understood. This study aimed to investigate patient activation among patients with SLE in China and explore the influencing factors. We conducted a cross-sectional study from June to December 2021 at a rheumatology and immunology department of a tertiary hospital in Chengdu, China. Data were collected by questionnaire, including general information, disease activity, quality of chronic illness care, health literacy, self-efficacy, motivation, social support, and patient activation. A patient activation model was constructed based on the conceptual framework derived from the individual and family self-management theory. To evaluate the moderating effect of disease activity on patient activation model, participants were divided into two subgroups (low disease activity group and high disease activity group). 426 SLE patients were included. The mean score of patient activation among SLE patients was 63.28 ± 11.82, indicating that most SLE patients lacked skills and confidence to stick with health-promoting behaviors. Health literacy, social support, and self-efficacy had the greatest effect on patient activation. In the multi-group analysis, social support and health literacy contributed more to patient activation in SLE patients with high and low disease activity, respectively. Patient activation among SLE patients in China was at the third level. Healthcare professionals should help them adhere to health-promoting behaviors. Health literacy, social support, and self-efficacy are vital factors for patient activation. These factors should be prioritized based on disease activity when developing individually tailored interventions for patient activation.

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The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study

Cited by 5 publications

References 45 publications

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Psychological grit moderates the relation between lifetime stressor exposure and functional outcomes among HIV‐seropositive and HIV‐seronegative adults

Factors affecting patient activation among patients with systemic lupus erythematosus

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