African American Older Adults Living with HIV: Exploring Stress, Stigma, and Engagement in HIV Care

Abstract

Limited information is available about factors that aff ect care engagement among African American older people living with HIV (OPLWH), despite the fact that this is the racial/ ethnic group most disproportionally living with HIV/ AIDS in the United States. Th e present mixed methods study examined the experiences of stress, HIV-related stigma, and engagement in care in a sample of 35 African American OPLWH. Quantitative methods measured global stress, HIV-stigma, and engagement in care, while in-depth qualitative interviews captured the lived experiences of HIV care engagement. Engagement in care was moderately correlated with overall stigma (r = -0.33, p = .05) and perceived stress (r = -0.42, p = .01). Qualitative interviews revealed that stigma was not the most signifi cant stressor in the elders' lives, but instead a present and underlying force that was overshadowed by everyday life stressors that aff ected care engagement. Recommendations include that a retention specialist work alongside health care providers to increase engagement.

Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review

“…The included studies recruited a total of 68,933 participants, with individual sample sizes ranging from 14 in Rwanda [ 98 ] to 2987 in China [ 187 ]. The recruited participants included diverse samples of PLWH, including adolescents and young adults living with HIV in 12 studies [ 22 , 23 , 38 , 62 , 72 , 80 , 83 , 125 , 126 , 129 , 163 , 178 ], adolescent girls and young women living with HIV in four studies [ 33 , 54 , 68 , 117 ], pregnant women living with HIV in one study [ 31 ], older women living with HIV in one study [ 151 ], older adults living with HIV in seven studies [ 44 , 61 , 63 , 77 , 81 , 139 , 161 ], women living with HIV in 19 studies [ 25 , 42 , 50 , 57 , 58 , 59 , 89 , 90 , 110 , 123 , 135 , 136 , 138 , 141 , 157 , 158 , 168 , 169 , 179 ], men living with HIV in six studies [ 46 , 75 ,…”

Patient-Identified Markers of Quality Care: Improving HIV Service Delivery for Older African Americans

“…Linkage to and engagement in care are further complicated by housing and food insecurity [9]. Environmental barriers to care are wide-ranging and may intersect with mental health challenges, as well as stress, stigma, substance use problems, and health comorbidities [10,11].…”

“…Given the depth of the challenges preventing African American people living with HIV from accessing, engaging, and remaining in care, it is important to offer an inclusive medical care model that centers the patient's voice in treatment [16,[21][22][23][24][25][26][27][28]. The hierarchical structure of healthcare settings often creates additional forms of stigma and discrimination that are overtly or unconsciously reinforced by healthcare providers [9,10,27,28]. Recently, scholars have paid increased attention to the patient's role in facilitating engagement in care [9,10,16,[21][22][23][24][25][26][27][28].…”

“…The hierarchical structure of healthcare settings often creates additional forms of stigma and discrimination that are overtly or unconsciously reinforced by healthcare providers [9,10,27,28]. Recently, scholars have paid increased attention to the patient's role in facilitating engagement in care [9,10,16,[21][22][23][24][25][26][27][28]. Outside of healthcare settings, many individuals receive support from loved ones and deploy coping and resiliency strategies to help manage their HIV care in a unique and strategic manner [27][28][29].…”

“…Outside of healthcare settings, many individuals receive support from loved ones and deploy coping and resiliency strategies to help manage their HIV care in a unique and strategic manner [27][28][29]. With populations who have experienced historical marginalization, it is imperative that healthcare providers understand the patient's experiences and knowledge in ways that encourage improved health outcomes [9,10].…”