A Cross Cultural Perspective of Adherence for Racial/Ethnic Minority Women with HIV, Living in the United States

HIV persists as a global public health tragedy, as more than 36 million lives have been lost to HIV/AIDS. A diagnosis of HIV can be treated as a chronic disease, for those who adhere to their medication regimens and other health recommendations. However, for racial/ethnic minorities living in the United States, many of whom face a multitude of barriers, adherence to medications and medical appointments can be a challenge. For racial/ethnic minority women, specifically, gender roles, HIV stigma, racism, inconsistent access to healthcare, financial and food insecurity are just a few of the barriers they experience, which may interfere with their ability to adhere to medical treatment. For immigrant women, low language literacy, which is linked to health literacy, may further exacerbate these lives where staff and services provide culturally and linguistically competent services. This paper reports parts of a larger mixed-methods inquiry. The goal is part of larger study to develop an intervention for racial/ethnic minority women with HIV, living in the Southeastern region of the United States

A Novel Heart-Centered, Gratitude-Meditation Intervention to Increase Well-Being among Adolescents

Population studies paint a dismal picture of the mental health status of adolescents, in the US and worldwide. Positive psychology, which takes a preventative approach to keeping individuals in higher states of well-being, is being implemented increasingly among youth, with the goal of avoiding future mental health and psychological problems. In this study, a novel intervention, which fused the practice of meditation with gratitude visualizations, was tested among adolescents. The purpose of this quasi-experimental study was to determine the extent to which the intervention affected life satisfaction, school satisfaction, and measured gratitude, among a culturally diverse cohort of adolescents. Instrumentation consisted of three positive psychology measures—the Student Life Satisfaction Scale, the School Satisfaction Subscale, and the Gratitude Questionnaire-Six-Item Form. Participants were randomly assigned either to the delayed-intervention, no-treatment control group or to the experimental group. The four-week intervention was manualized primarily from the heart-centered gratitude visualizations outlined in a happiness and positive emotions handbook, The Jewels of Happiness: Inspiration and Wisdom to Guide Your Life-Journey. The intervention significantly affected life satisfaction, school satisfaction, and gratitude of the experimental group, when compared to the control group. Medium to large effect sizes were detected using the ANCOVA statistical test

Impact of extreme weather on healthcare utilization by people with hiv in metropolitan miami

Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990–2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017–2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients’ ‘no-show’ status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of ‘no-show’ was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population’s utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings

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

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

Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing

Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout

Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice

Mobile health technologies (mHealth) are efficacious along the continuum of HIV/AIDS-from prevention of HIV transmission to those at the highest risk of acquiring infection, to adherence to HIV medical care, for those living with the disease-decreasing the public health burden of the disease. HIV/AIDS is a complex condition, as certain population subgroups are disproportionately affected. Furthermore, barriers experienced at the individual level (e.g., HIV stigma) and at the systems level (i.e., access to care) contribute to these disparities. Low cost, high penetration rates and ease of use mean mHealth SMS/texting solutions hold the biggest promise for curbing the global HIV/AIDS epidemic; yet these technologies have their own challenges. Our primary objective was to assess interventions that promote adherence, which are delivered via SMS/texting, and important design and ethical considerations of these technologies. Specifically, we evaluated the underlying frameworks underpinning intervention design, strategies to safeguard privacy and confidentiality, and measures taken to ensure equity and equitable access across different subgroups of persons living with HIV (PLWH). We also synthesized study outcomes, barriers/facilitators to adherence, and barriers/facilitators of technology to support HIV adherence. A scoping review methodology was utilized, searching the Medline database for recently published articles (January 2017 to June 2019). Two reviewers independently screened titles and abstracts for relevancy using the following eligibility criteria: (a) original research or protocol; (b) inclusion of persons living with HIV; (c) intervention delivery via SMS/text messaging; and, (d) intervention included HIV care adherence. Seven (7) of the 134 articles met full criteria. The great majority (n = 6) did not report whether the interventions were developed under established behavioral change models or frameworks. Strategies to address privacy, confidentiality and equity/equitable access were taken in four ( = 4) studies. Our mixed methods review determined that privacy and confidentiality remain a concern for PLWH. Provisions to accommodate literacy, infrastructure, technology and other challenges (e.g., access to smartphones and Wifi) are important ethical considerations that guarantee equity and equitable access. Further investigation will determine the contexts within which theoretical models and frameworks remain relevant in the rapidly evolving field of digitized interventions that support adherence

A Novel Heart-Centered, Gratitude-Meditation Intervention to Increase Well-Being among Adolescents

Population studies paint a dismal picture of the mental health status of adolescents, in the US and worldwide. Positive psychology, which takes a preventative approach to keeping individuals in higher states of well-being, is being implemented increasingly among youth, with the goal of avoiding future mental health and psychological problems. In this study, a novel intervention, which fused the practice of meditation with gratitude visualizations, was tested among adolescents. The purpose of this quasi-experimental study was to determine the extent to which the intervention affected life satisfaction, school satisfaction, and measured gratitude, among a culturally diverse cohort of adolescents. Instrumentation consisted of three positive psychology measures—the Student Life Satisfaction Scale, the School Satisfaction Subscale, and the Gratitude Questionnaire-Six-Item Form. Participants were randomly assigned either to the delayed-intervention, no-treatment control group or to the experimental group. The four-week intervention was manualized primarily from the heart-centered gratitude visualizations outlined in a happiness and positive emotions handbook, The Jewels of Happiness: Inspiration and Wisdom to Guide Your Life-Journey. The intervention significantly affected life satisfaction, school satisfaction, and gratitude of the experimental group, when compared to the control group. Medium to large effect sizes were detected using the ANCOVA statistical test

Stress, Support, and Length of Diagnosis Among Women Living with HIV/AIDS in the Southern USA, During the COVID-19 Pandemic

Health-related challenges caused and worsened by the global COVID-19 pandemic have proven broad and multifaceted, particularly for racial/ethnic minority women living with HIV (WLWH). The 2020 pandemic has affected the wellbeing and access to care for WLWH in Southeastern Florida, a region that experienced simultaneous high rates of COVID-19 and HIV. WLWH, over a short- or long-term period, likely utilize different coping mechanisms as they face these challenges. This analysis compared pandemic-related stress and support endorsed by participants attending an urban clinic in South Florida, from January through May 2021. Participants completed an adapted version of the Pandemic Stress Index (PSI). The items in the PSI assessed emotional distress, stigma, and support, and were dichotomized, as either "stress" or "support". Mann-Whitney -test assessed differences in distributions of PSI scores (stress and support) comparing long-term survivors (≥10 years with an HIV diagnosis) to those more recently diagnosed (<10 years). The cohort consisted of 63 WLWH, aged 21-71 (Mean = 42 years±12.95). The group of WLWH were almost evenly split, with 50.8% having been diagnosed in the last 10 years (short-term survivors). The high-stress group endorsed lower levels of support, compared to the low-stress group. There was a non-significant trend of higher stress scores for short-term survivors, compared to long-term survivors; and, higher support scores for long-term survivors, compared to short-term survivors. Results suggest a trend in long-term survivor WLWH endorsing lower stress and higher support; the contrary was found for their short-term survivor counterparts. Patterns in COVID-19 related stressors and maladaptive behaviors need further exploration to establish suitable interventions that address disparities within groups of WLWH