Psychosocial Risk Factors of Quality of Life Outcomes Among Older Adults Living With HIV

Antiretroviral therapy, higher education, and HIV disclosure have been linked to improved quality of life (QoL) among people living with HIV. However, research examining psychosocial risk factors of QoL among older adults living with HIV (OALH) is lacking. Therefore, the main aim of this study was to examine the psychosocial risk factors of QoL among OALH. Data were obtained from 156 adults aged 50 and older living with HIV in South Carolina. Multivariable regression models adjusting for sociodemographic characteristics were used to determine the association between psychosocial risk factors and QoL domains among OALH. Stigma was associated with the physical (β=0.058, p=0.023), social (β=-0.149, p=0.006), and spiritual (β=0.124, p=<0.001) domains. Resilience was associated with the psychological (β=0.206, p=<0.001), independence (β=0.100, p=0.010), social (β=0.166, p=0.004), and environmental (β=0.312 p=<0.001) domains. Depression and experiencing trauma were also associated with varying QoL domains. Findings may inform interventions geared towards improving QoL among OALH.

Mediating Role of Loneliness on Stigma and Depressive Symptoms Among Older Persons Living With HIV

Studies have shown associations among stigma, loneliness, and depressive symptoms in older persons living with HIV (OPLWH) but research assessing the mediating pathway among these variables is lacking. As such, the aims of this study were to assess the association between stigma and depressive symptoms and to test the mediating effects of loneliness. A sample of 146 OPLWH (50 years of age and older) recruited from an outpatient HIV clinic in Atlanta, GA, completed a cross-sectional survey. Mediation analysis, guided by Baron and Kenny’s (1986) criteria, was conducted using Stata v14.2 to assess the direct and indirect effects of loneliness on the association between stigma and depressive symptoms while controlling for covariates (self-rated health [0=poor to fair, 1=good to excellent]; past unstable housing [0=No, 1=Yes]; and HIV disclosure status [0=to none; 1=to someone]). Loneliness mediated the association between stigma and depressive symptoms (β=0.79, SE=0.23, p < .001). The model reflected a very good fit (χ2=0.09, p=.765; CFI=1.00, TLI=1.09, RMSEA < 0.001) and explained 27% of the variance in loneliness and 33% of the variance in depressive symptoms. Stigma predicted higher loneliness, which in turn predicted more depressive symptoms. Findings suggest that addressing depressive symptoms in OPLWH may require multifaceted interventions targeting psychosocial and interpersonal factors including stigma and loneliness.

Considerations for Developing and Implementing an Online Community-Based Exercise Intervention for Adults Living with HIV: a qualitative study

Objectives: To describe the need for and utility of online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV. Design: Qualitative descriptive study using web-based semi-structured interviews. Participants: We recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: 1) adults living with HIV, 2) rehabilitation professionals, 3) fitness personnel, 4) educators with eLearning experience, and 5) representatives from HIV community-based organizations (CBOs). Data Collection: We asked participants to describe their experiences with online CBE, need and utility for online CBE, and factors in developing and implementing online CBE interventions. We analyzed data using group-based content analytical techniques. Results: Among the 11 participants, most had experience working with adults living with HIV (73%) or with tele-health/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: 1)person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), 2)accessibility of program (physical space to exercise, reliable internet, access to devices, digital literacy), 3)program delivery and technology (live versus pre-recorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), 4)attributes of program personnel (working with CBOs, relatable instructors, diverse staff), 5)program content and design (tailored exercise classes, educational sessions) and 6)building community (shared experiences, peer support, social opportunities). Conclusions: There is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.

HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Given the recent evidence on “Undetectable = Untransmittable” (U=U) and pre-exposure prophylaxis (PrEP), the present study aimed to investigate HIV disclosure behaviors and their associations with sexual risk behaviors and U=U and PrEP awareness among men who have sex with men (MSM) in China. A cross-sectional survey was conducted among 689 MSM recruited through a gay-friendly non-governmental organization located in Chengdu, China in 2018–2019. Information was collected by a structured self-administrated questionnaire. The enrolled sample included 554 (80.4%) participants who were HIV-negative and 135 (19.6%) participants with an unknown HIV status. In terms of disclosure, 41.4% of participants informed all partners about their HIV status all the time (informing behavior), while 30.4% asked all partners about their HIV status all the time (asking behavior). Only one-fifth knew about U=U, but this was not statistically associated with either informing or asking behavior. Half (50.5%) had heard of PrEP but this was not statistically associated with either informing or asking behavior. Common barriers to informing and asking behaviors were lower risk perception of HIV infection, a history of sexually transmitted infections, engagement in receptive sex, and a history of sex with casual partners. We found that both U=U and PrEP awareness and HIV serostatus disclosure were infrequent and not associated in this study of Chinese MSM. These data indicate huge information gaps among MSM in China.

Guiding caregivers through disclosure: a qualitative investigation into caregivers responses to a disclosure intervention for HIV-infected children in Soweto, South Africa

Awareness of HIV status improves health outcomes in HIV infected children, yet disclosure is often delayed by hesitant caregivers. This qualitative investigation explored how 30 caregivers responded to a HIV Disclosure study conducted between 2017 and 2020 at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Caregivers were assisted in disclosing to their children, aged 7-13 years. Following that, a sub-sample of caregivers were interviewed to elaborate on findings.1) Barriers to disclosure included caregivers being ill-equipped, fear of negative consequences and children considered lacking emotional or cognitive readiness. 2) Deflecting diagnosis and the need for medication motivated caregivers to disclosure. 3) Apprehension was evident during disclosure, however, overall disclosure was a positive experience with the assurance and support of the healthcare providers. These results highlight the significant role healthcare providers play in supporting caregivers through the disclosure process and how, in turn, this has a positive impact on the community as a whole.

Using an HIV Disclosure Model to Slow the Spread of COVID-19

Black/African American populations in the United States are disproportionately affected by the COVID-19 pandemic, and there is evidence suggesting that vaccine hesitancy is a concern among this group. As an alternative to the primary prevention method of vaccination, the tertiary method of disclosing one’s COVID-19 status after contracting the virus is of utmost importance in reducing the spread of the virus. Recommendations to inform disclosure decisions based on an HIV disclosure model can be applied to COVID-19-positive Black populations in clinical and community settings to reduce the spread of the virus among this population.