African American Women: The Face of HIV/AIDS in Washington, DC

In 2007, the estimated HIV and AIDS case rates among adult and adolescent African-American females in the United States was 60.6 per 100,000, as compared to 3.3 per 100,000 for adult and adolescent white American females. Women living with HIV or AIDS often face complex social problems that may inhibit them from accessing resources and healthcare services to assist them in coping with the disease. In-depth interviews and direct observations utilizing open-ended note taking were conducted at an HIV service provider’s office to determine the unique needs that develop because of these complex social issues, specifically among HIV positive women of color in Washington, DC. Ethnographic methods were used to address the study’s research questions among 10 women of different ages and backgrounds in group settings at a non-profit organization in Washington, DC. The qualitative results of the study indicate that the women dealt with a myriad of social and mental issues related to their diagnosis, such as fear of disclosure to family and friends. The study also revealed that the women were in dire need of mental health services to address their unresolved issues regarding their diagnosis. The implications of this research add to the growing body of literature on the mental and social health needs of women of color who are HIV positive

Project THANKS: A Socio-Ecological Framework For An Intervention Involving HIV Positive African American Women With Comorbidities

HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them

The Impact of Psychosocial Stress on Maternal Health Outcomes: A Multi-State PRAMS 8 (2016-2018) Analysis

Introduction: Significant racial disparities persist in maternal morbidity rates, disproportionately affecting Black women. Experiencing high levels of stress during pregnancy is associated with increased risk for preterm birth, infant mortality, and preeclampsia. This study investigates the impact of psychosocial life stressors on maternal morbidity and racial disparities utilizing the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset. Methods: Participants (N=24,209) included were from Phase 8 (2016-2018) of the PRAMS survey across five states. Stressors were grouped into traumatic, partner-related, financial, or emotional. Maternal outcomes included gestational diabetes, hypertensive disorders of pregnancy, prenatal depression, and postpartum depression. The association between life stressors and maternal morbidity was evaluated using modified Poisson regression models with robust error variance to estimate adjusted prevalence ratios. Results: Black women were more likely to report all stressors, and Hispanic women had an increased prevalence of partner-related and financial stressors. Experiencing any maternal morbidity was associated with partner (38.0% versus 22.0%; p\u3c0.001), trauma (20.9% versus 10.9%; p\u3c0.001), financial (40.5% versus 25.7%; p\u3c0.001), and emotional stress (36.4% versus 28.3%; p\u3c0.001). Compared to mothers who reported no stressors, mothers who reported 1-3 stressors, 4-6 stressors, and ≥ 7 stressors had a 1.14, 1.38, and 1.45 higher adjusted prevalence ratio of maternal morbidity, respectively. Conclusions/Implications: Psychosocial stress has a substantial impact on maternal outcomes. Pregnant women should be screened and connected with resources to alleviate the burden of their respective stressful life events

A Scoping Review: Overview of Current Respectful Maternity Care Research by Research Approach and Study Location

Introduction: Disrespectful care during childbirth contributes to poor health outcomes, perpetuates disparities, and encourages childbirth outside of healthcare facilities. To measure disrespectful care, investigators use many research approaches. Most research has focused on low/low-middle income countries. This scoping review aims to 1) summarize current research and research approaches to analyze whether these approaches identify the same types of mistreatment and 2) identify gaps in current research analyzing disrespectful care during childbirth. Methods: Following PRISMA guidelines, this review utilized search terms to filter articles from the Pubmed database. Using specific criteria, articles were then excluded by title and abstract, then full article review. Included articles were organized by research approach and analyzed for study location and the presence of 9 types of mistreatment. Results: 102 included articles were organized by research approach, including direct labor observation, survey, interview, and focus groups, yielding 144 total studies to account for articles with more than one research approach. Each research approach identified all 9 types of mistreatment, with neglect/abandonment, verbal mistreatment, and physical mistreatment reported the most. Low-income countries represented 134/144 studies, with most research centered in East Africa and India. High-income countries represented only 7% of research. Discussion: This review is the first to organize current respectful maternity care research by research approach and study location. Analysis of study location shows gaps in research, particularly among high-income countries. Further research, particularly in high-income countries, is necessary to better this global health concern

The Healthcare Experiences of African Americans with a Dual Diagnosis of HIV/AIDS and a Nutrition-Related Chronic Disease: A Pilot Study

For HIV-positive African Americans, the mistrust of medical providers due to anticipation of unequal treatment care, prejudice, and bias can become a major deterrent to medication and treatment adherence. Although programs and services incorporate strategies to improve patient–provider relationships, a deeper understanding of their healthcare experiences, especially among those with a dual diagnosis of HIV/AIDS and a nutrition-related chronic disease, is lacking. This qualitative study aimed to address this gap by conducting focus groups with participants who identified themselves as being African American, and having a dual diagnosis of HIV/AIDS, and a chronic disease. Content analysis generated several major themes, highlighting the impact of a negative healthcare experience on their ability to self-manage their health. Factors such as lack of consistency in care team, negative interactions with doctors, feelings of stigma due to prejudice and bias from healthcare staff, loss of privacy, and the need for comprehensive services that targeted their physical, emotional, and nutritional health emerged as recurring sub-themes. These findings provide the foundation for the design of a comprehensive intervention model that helps participants to communicate their medical needs more effectively, thus optimizing their overall health outcomes and quality of life

The role of prenatal food insecurity on breastfeeding behaviors: Findings from the United States pregnancy risk assessment monitoring system

Background In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity and breastfeeding has been explored previously, with varying results. The purpose of this study was to determine the relationship between prenatal food insecurity and breastfeeding initiation and early cessation (\u3c 10 weeks) among U.S. mothers. Methods Data were pooled from 2012 to 2013 (Phase 7) of the Pregnancy Risk Assessment Monitoring System, a population-based cross-sectional survey of postpartum women administered 2–4 months after delivery. The analytic sample was drawn from Colorado, Maine, New Mexico, Oregon, Pennsylvania, and Vermont, and limited to mothers aged 20 years and older whose infants were alive and living with them at the time of the survey (n = 10,159). We used binomial and multinomial logistic models to assess the predictive association between food insecurity and breastfeeding initiation and early cessation, respectively, while controlling for confounders. Results Most women reported prenatal food security (90.5%) and breastfeeding initiation (91.0%). Of those who initiated breastfeeding, 72.7% breastfed for \u3e 10 weeks. A larger proportion of food secure women compared to food insecure women, initiated breastfeeding (91.4% vs. 87.6%, P \u3c 0.01), and patterns of early breastfeeding cessation differed significantly between the two groups (P \u3c 0.01). In the final models, prenatal food insecurity was not associated with breastfeeding initiation or early cessation, with one exception. Compared to food secure mothers, mothers reporting food insecurity had a lower risk of breastfeeding for 4–6 weeks than for \u3e 10 weeks, independent of covariates (relative risk ratio 0.65; 95% CI 0.50, 0.85; P \u3c 0.01). Women who were married, had a college degree, and did not smoke were more likely to initiate breastfeeding and breastfeed for a longer time, regardless of food security status (P \u3c 0.01). Conclusions Socioeconomic, psychosocial, and physiological factors explain the association between prenatal food insecurity and breastfeeding outcomes among this U.S. sample. More targeted and effective interventions and policies are needed to encourage the initiation and duration of breastfeeding, regardless of food security status

Project Thanks: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective

Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants\u27 ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs

Race-Based Sexual Stereotypes, Gendered Racism, and Sexual Decision Making Among Young Black Cisgender Women

Background. Due to their intersecting racial identity and gender identity, Black women are characterized by stigmatizing race-based sexual stereotypes (RBSS) that may contribute to persistent, disproportionately high rates of adverse sexual and reproductive health outcomes. RBSS are sociocognitive structures that shape Black women\u27s social behavior including their sexual scripts. Objective. The purpose of this study was to explore the influence of RBSS on the sexual decision making of young Black women (YBW). Methods. We conducted four focus groups with 26 YBW between the ages of 18 and 25, living in a New York City neighborhood with a high HIV prevalence. Qualitative analysis was used to identify emergent themes within the domains of sexual decision making as it relates to safer sex practices and partner selection. Results. Thematic analyses revealed that RBSS may cause women to adopt more traditional gender stereotypes and less likely to feel empowered in the sexual decision making. Participants reported that RBSS may lead Black women to being resistant to learning new information about safer sex practices, feeling less empowered within intimate relationships, and jeopardizing their sexual well-being to affirm themselves in other social areas encouraging unprotected sex and relationships with men who have multiple sex partners. Discussion and Conclusion. Future research should focus on understanding the social and cultural factors that influence Black women\u27s power in maintaining and improving their sexual health, including the aforementioned stereotypes that have influenced how others may view them as well as how they view themselves