Appreciating Reasons for Nonadherence in Women

Okonsky, Jennifer; Webel, Allison R.; Rose, Carol Dawson; Johnson, Mallory O.; Asher, Alice; Cuca, Yvette; Kaihura, Alphoncina; Hanson, Jan E.; Portillo, Carmen J.

doi:10.1080/07399332.2014.903952

Cited by 9 publications

(12 citation statements)

References 42 publications

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“…47,48 Other potential barriers to HIV care visit attendance were not measured such as reliable transportation and distance from home to clinic. Future investigations should collect these data to test this model while controlling for other barriers to attending care.…”

Section: Discussionmentioning

confidence: 99%

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Rice

Crockett

Mugavero

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes is unclear. Methods Among 196 HIV clinic patients in Birmingham, Alabama, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales, and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariate-adjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence, and the mediating role of visit adherence in the association between internalized stigma and ART adherence. Results Higher internalized stigma was associated with lower visit adherence (B=−0.04, p=0.04). Black (versus white) race and depressive symptoms were significant predictors within this model. Mediation analysis yielded no effect by depression in the association between internalized stigma and visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the indirect effect of internalized stigma on sub-optimal ART adherence was mediated by lower visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]). Conclusion Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.

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Section: Discussionmentioning

confidence: 99%

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Rice

Crockett

Mugavero

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Provider perspectives on how people understand information has focused on ensuring that patients receive disease and treatment information at the correct reading level and in the correct language (Shiffman, Gerlach, Sembower, & Rohay, 2011); on the importance of taking HIV medication (Millard, Elliott, & Girdler, 2013); and on how to address symptoms and manage side effects (Okonsky et al, 2014). It does not always, however, prioritize building and maintaining long-term relationships between patients and providers, as our data suggest is so important.…”

Section: Discussionmentioning

confidence: 99%

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care

Dawson–Rose¹,

Cuca²,

Webel³

et al. 2016

Journal of the Association of Nurses in AIDS Care

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Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient–provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient’s trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient–provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

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“…The data and analyses presented here were part of a larger longitudinal study to validate a self-management instrument for WLWH (Okonsky et al, 2015; Webel, Asher, et al, 2012). For the analysis presented here, data were collected using convenience sampling in the San Francisco Bay Area in California, USA, from October 2010 to February 2011.…”

Section: Methodsmentioning

confidence: 99%

HIV Stigma and Social Capital in Women Living With HIV

Cuca¹,

Asher²,

Okonsky³

et al. 2017

Journal of the Association of Nurses in AIDS Care

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Women living with HIV (WLWH) continue to experience HIV-related stigma. Social capital is one resource that could mitigate HIV stigma. Our cross-sectional study examined associations between social capital and HIV-related stigma in 135 WLWH in the San Francisco Bay Area. The mean age of study participants was 48 years; 60% were African American; 29% had less than a high school education; and 19% were employed. Age was significantly associated with perceived HIV stigma (p = .001), but total social capital was not. Women with lower Value of Life social capital scores had significantly higher total stigma scores (p = .010) and higher Negative Self-image stigma scores (p = .001). Women who felt less valued in their social worlds may have been more likely to perceive HIV stigma, which could have negative health consequences. This work begins to elucidate the possible relationships between social capital and perceived HIV stigma.

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Appreciating Reasons for Nonadherence in Women

Cited by 9 publications

References 42 publications

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care

HIV Stigma and Social Capital in Women Living With HIV

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