Resilience, stress hormones, and health outcomes in women with HIV

Abuse is associated with higher depressive symptoms (DS) and coronary heart disease risk (CHD), lower health-related quality of life (HRQOL), and dysregulated levels of cortisol and norepinephrine (NE). In HIV+ women, abuse relates to higher viral load (VL), lower CD4 count, and nonadherence to highly active antiretroviral therapy (HAART). Resilience (adaptive functioning following trauma) and positive self-esteem (PSE) were hypothesized to buffer the impact of abuse and predict better health outcomes. Three studies tested these hypotheses using self-report measures (for abuse, resilience, DS, HRQOL, and HAART use and adherence), autobiographical narratives (for PSE), Framingham Risk Score (for CHD risk), and blood and urinary specimens for cortisol, NE, and HIV disease markers (VL and CD4 count). Study 1 included 138 HIV+ and 64 HIV- women (87% African-American), and investigated the relationships between childhood sexual abuse (CSA), DS, and HRQOL and whether resilience moderated the relationships between CSA and outcomes. Consistent with the hypothesis, multiple regressions indicated that higher resilience related to lower DS and higher HRQOL across both HIV+ and HIV-women, and CSA related to higher DS only for women scoring low in resilience. Study 2 examined how resilience moderated the relationships between abuse history and HAART adherence, VL, and CD4 count in 138 HIV+ women. As predicted, multiple regressions revealed that resilience related to having undetectable VL. Sexual and multiple abuse histories related to lower HAART adherence only for women scoring low in resilience. Study 3 with 53 HIV+ women investigated the relationships among resilience, PSE, abuse histories, NE, cortisol and CHD risk. In partial support of hypotheses, partial correlations showed that higher resilience related to lower cortisol; higher PSE related to lower NE; higher NE/cortisol ratio related to higher CHD risk; histories of abuse related to higher CHD risk, and lower cortisol related to higher CHD risk. The findings suggest that resilience and PSE relate to better health outcomes for HIV+ and HIV- women, and levels of stress hormones in HIV+ women are related in complex ways to abuse, resilience, PSE, and CHD risk. Promoting resilience and PSE may help HIV+ and HIV- women achieve better health outcomes

Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men

Men who have sex with men (MSM) are the group most at risk for HIV and represent the majority of new infections in the United States. Rates of childhood sexual abuse (CSA) among MSM have been estimated as high as 46 %. CSA is associated with increased risk of HIV and greater likelihood of HIV sexual risk behavior. The purpose of this study was to identify the relationships between CSA complexity indicators and mental health, substance use, sexually transmitted infections, and HIV sexual risk among MSM. MSM with CSA histories (n = 162) who were screened for an HIV prevention efficacy trial completed comprehensive psychosocial assessments. Five indicators of complex CSA experiences were created: CSA by family member, CSA with penetration, CSA with physical injury, CSA with intense fear, and first CSA in adolescence. Adjusted regression models were used to identify relationships between CSA complexity and outcomes. Participants reporting CSA by family member were at 2.6 odds of current alcohol use disorder (OR 2.64: CI 1.24–5.63), two times higher odds of substance use disorder (OR 2.1: CI 1.02–2.36), and 2.7 times higher odds of reporting an STI in the past year (OR 2.7: CI 1.04–7.1). CSA with penetration was associated with increased likelihood of current PTSD (OR 3.17: CI 1.56–6.43), recent HIV sexual risk behavior (OR 2.7: CI 1.16–6.36), and a greater number of casual sexual partners (p = 0.02). Both CSA with Physical Injury (OR 4.05: CI 1.9–8.7) and CSA with Intense Fear (OR 5.16: CI 2.5–10.7) were related to increased odds for current PTSD. First CSA in adolescence was related to increased odds of major depressive disorder. These findings suggest that CSA, with one or more complexities, creates patterns of vulnerabilities for MSM, including post-traumatic stress disorder, substance use, and sexual risk taking, and suggests the need for detailed assessment of CSA and the development of integrated HIV prevention programs that address mental health and substance use comorbidities.This study was supported by a Grant from the NIMH (R01 MH095624) PI: O'Cleirigh; Author time (Safren) was supported, in part, by Grant 5K24MH094214. (R01 MH095624 - NIMH; 5K24MH094214)Accepted manuscrip

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

Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP

Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP

MENTAL HEALTH, SELF-CARE, AND ENGAGEMENT IN CARE AMONG BLACK WOMEN LIVING WITH HIV

Objectives: Due to sociostructural factors, Black women living with human immunodeficiency virus (HIV) in the United States represent the highest percentage of women with HIV and experience mental health struggles that impact health behaviors. This study examines associations between mental health, self -care, medication adherence, engagement with healthcare, HIV -related healthcare visits, and hospitalization. Methods: One hundred and nineteen Black women living with HIV in the Southeastern United States completed measures on scheduled visits (general and HIV -related healthcare), visits attended/missed/rescheduled, mental healthcare engagement (therapy and support groups), hospital visits (emergency room and overnight stays), medication adherence, and a clinician -administered interview assessing mental health. Results: Higher self -care was associated with fewer emergency room visits (beta =-0.31, P<.001) and hospitalizations (beta =-0.22, P<.05). Higher post -traumatic stress disorder symptoms were associated with hospitalization (beta =0.23, P<.05) and missed HIV -related visits (beta =0.20, P<.05) but higher outpatient mental healthcare visits for group psychotherapy (beta =0.20, P< .05). Higher suicidality was associated with lower HIV -related healthcare visits scheduled (beta =-0.26, P<.01). Higher HIV load was associated with higher HIV -related healthcare visits scheduled (beta =0.45, P<.001) and hospitalization (beta =0.41, P<.001). Higher Wisepill medication adherence (beta =-0.28, P<.01) and self -reported adherence (beta =-0.33, P<.001) were associated with fewer HIV missed visits. Higher self -reported adherence was associated with fewer emergency room visits (beta =-0.38, P<.001) and hospitalizations (beta =-0.27, P<.001). Conclusions: Our findings highlight the need for treating mental health symptoms and enhancing self -care among Black women living with HIV to improve engagement in care and health behaviors and decrease emergency room visits and hospitalization

Black Women Living with HIV: A Latent Profile Analysis of Intersectional Adversities, Resilience, and Mental Health

Black women living with HIV (BWLWH) face adversities, including discrimination (race, HIV, and gender related) and trauma. This study examines which latent profiles of resilience (R) and adversity (A) are most prevalent and their relationships to mental health among 119 BWLWH [age = 44.1 (standard deviation = 10.9)]. Questionnaires measured resilience (post-traumatic growth, trait/coping resilience, religious coping, social support), adversity (discrimination, trauma, microaggressions), and mental health [post-traumatic stress disorder (PTSD) symptoms, post-traumatic cognitions (PTC), and depressive symptoms]. Four salient profiles emerged through latent profile analysis and mental health differences were evaluated. Profile 1 (19.8%) reported lowest scores on 4 resilience measures, lowest traumas, and second lowest on discrimination (low resilience/low adversity-LR/LA). Profile 2 (13.8%) had second lowest on 3 resilience measures but second highest social support, highest/second highest on traumas and discrimination and microaggressions (low resilience/high adversity-LR/HA). Profile 3 (59.5%) exhibited higher scores on resilience and lowest scores on 3 of 4 adversity measures (high resilience/low adversity-HR/LA). Profile 4 (6.9%) reported high on 3 resilience measures, but third lowest on social support, and second highest/highest traumas, discrimination, and microaggressions (high resilience/high adversity-HR/HA). For PTC, the HR/LA group had significantly lower scores compared with the LR/LA and LR/HA groups; and LR/HA had higher PTC scores than the HR/HA group. PTSD scores were significantly lower for HR/LA than all profiles. Depression scores were significantly higher for LR/LA and LR/HA groups than HR/LA. Findings indicate that lower adversity alongside higher resilience leads to better mental health. Policies must address intersectional discrimination and prevent trauma impacting BWLWH; interventions are needed to improve social support and healing.Clinical Trial Registration number NCT02764853

Gendered Racial Microaggressions and Self-Silencing Associated with Suicidality Among Black Women Living with HIV

Black women represent the majority of women living with HIV in the USA and their risk for suicide may be linked to the impact of psychosocial stressors experienced at the intersection of race and gender such as gendered racial microaggressions (GRMS) and silencing the self (to maintain harmony). However, little research has been done on the relationship between microaggressions, self-silencing, and suicidality among BWLWH. As part of an intervention development study, 119 BWLWH in the Southeastern USA completed a baseline assessment consisting of a clinical interview (e.g., Mini-International Neuropsychiatric Interview) to assess suicidality, the gendered-racial microaggressions scale (GRMS), and the Silencing the Self-Scale. Multivariate linear regression analyses controlling for age and education indicated that higher microaggression appraisal scores on the GRMS scale (β = 2.80, p < .01) was associated with current suicidality and higher self-silencing was associated with current suicidality (β = 1.05, p < .01) and lifetime suicidality (β = 1.03, p < .01). Additional analyses that included major depression indicated that self-silencing uniquely contributed to suicidality above and beyond depression. Our findings support the importance of understanding how gender and race specific factors may relate to suicidality. Future research is needed to examine potential moderating factors (e.g., coping strategies) that may be enhanced through interventions and structural changes are needed to decrease acts of microaggressions