The impact of trauma on South African women with HIV: The role of anxiety and physical symptomology

Robbertz, Abigail S; Ishiekwene, Martha; Hucks, Olivia L; Armistead, Lisa

doi:10.2989/16085906.2021.1914692

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…Importantly, HIV symptom burden is an important trigger of HRPD (Moens et al, 2015). Research has demonstrated that HRPD can increase the likelihood of opportunistic infections by reducing adherence to ART among PLWHA, thereby increasing patient symptom burden (Robbertz et al, 2021). Therefore, clinical medical staff should recognize the symptom burden contributed by HRPD (Sabranski et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

New Insight into HIV-Related Psychological Distress: A Concept Analysis

Zhai

et al. 2022

Clin Nurs Res

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Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant’s method. The findings include HRPD’s (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman’s theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.

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Section: Resultsmentioning

confidence: 99%

New Insight into HIV-Related Psychological Distress: A Concept Analysis

Zhai

et al. 2022

Clin Nurs Res

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“…The literature among women living with HIV shows that stressors including traumatic life experiences, intimate partner violence, resource insecurity, and social isolation are associated with poor mental health. [58][59][60] Examining the impact of the abovementioned stressors was, however, beyond the scope of our study, which sought to assess HIV-related stigma, racial discrimination, and gender discrimination as exposures. We recommend future research to explore the impact of the aforementioned psychosocial stressors on HIV treatment outcomes through pathways mediated by mental health conditions.…”

Section: Discussionmentioning

confidence: 99%

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

Malama,

Logie,

Sokolovic

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. Setting: Ontario, British Columbia, and Quebec, Canada. Methods: We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. Results: There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. Conclusion: Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.

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“…Traumatic stress is often comorbid with other mental health disorders, such as depression, anxiety disorders, and substance use [25][26][27], which are also linked to poor care engagement [28,29]. The high burden of sexual trauma among WLH in South Africa [19,30,31] may therefore be a significant contributing factor for the low rates of viral suppression seen among WLH [32]. care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial

Sikkema

Rabie

King

et al. 2022

Trials

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Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.

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The impact of trauma on South African women with HIV: The role of anxiety and physical symptomology

Cited by 4 publications

References 32 publications

New Insight into HIV-Related Psychological Distress: A Concept Analysis

New Insight into HIV-Related Psychological Distress: A Concept Analysis

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial

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