Pathways between intimate partner violence and HIV care and treatment during pregnancy and postpartum: A qualitative study in southwestern Kenya.

Intimate partner violence (IPV) is associated with suboptimal HIV treatment behaviors and health outcomes among perinatal women. Less is known about the postpartum phase or how distinct types of perinatal IPV exposure may inhibit HIV-related care. We conducted a qualitative study nested within an ongoing trial among perinatal women in rural Kenya to explore the influence of IPV on adherence to HIV treatment during pregnancy and postpartum.

How Does Poverty Stigma Affect Depression Symptoms for Women Living with HIV? Longitudinal Mediating and Moderating Mechanisms.

Purpose: In a sample of women living with HIV, we examined whether individual traits fear of negative evaluation and resilience moderate the internalization of poverty stigma that these women experience from others. We also examined the downstream effects of these processes on depression symptoms using moderated serial mediation analyses.

Methods: Data were collected annually for 4 years (2016-2020; T1, T2, T3, and T4) from 369 women living with HIV at 4 US cities using validated measures.

Development and Validation of a Novel Risk Calculator to Predict Sub-optimal HIV Outcomes Among Pregnant and Postpartum Women with HIV in Kenya.

No tool currently exists to predict the cumulative risk of suboptimal clinical outcomes among pregnant and postpartum women with HIV (PPWH). This study sought to develop and validate a parsimonious risk calculator capable of predicting disengagement from care and HIV treatment failure among PPWH. We created the risk calculator using data from 1,331 PPWH from Southwestern Kenya (Homabay, Migori, and Kisumu Counties) in the Mother Infant Visit Adherence and Treatment Engagement Trial.

Development and Implementation of Informational Toolkits to Address Inequities in COVID-19 Testing.

Background: The COVID-19 pandemic disproportionately affected African American communities. Informational toolkits have emerged as a strategy to address such inequities. Community-driven approaches to toolkit design may enhance their relevance and impact in underserved communities.

Intimate partner violence related to disclosure of sickle cell disease during pregnancy: evidence from the sickle cell belt of central India.

Background: Intimate partner violence (IPV) negatively impacts pregnant women and their unborn children. Globally, an estimated 19%, 9%, and 6% of women experience psychological, physical, and sexual IPV, respectively, during pregnancy. These rates are higher among pregnant women living with a stigmatizing disease.

Stigma related to weight and body size among women living with and living without HIV: A qualitative study.

Body changes including weight gain and visceral adiposity are prevalent among women living with HIV and may pose risks for weight stigma-negative attitudes, beliefs, and judgments about a person related to their body size. We undertook a qualitative investigation to describe experiences of weight stigma and to compare and contrast those experiences among women living with and living without HIV. Participants were recruited from Women's Interagency HIV Study sites in Jackson, MS; Birmingham, AL; and Atlanta GA and invited to participate in an individual phone interview.

Results of a workshop intervention trial to reduce HIV and intersectional stigma among sexual and gender minorities and healthcare workers in the Dominican Republic.

Eliminating stigmas that harm sexual and gender minorities (SGM) with HIV is necessary to end the epidemic; however, few validated stigma-reducing interventions for healthcare settings exist, and even fewer have been evaluated in Spanish-speaking contexts. Finding Respect and Ending Stigma around HIV (FRESH) is a healthcare setting stigma-reduction intervention that was adapted and tested to address HIV and intersectional stigmas that harm SGM with HIV in the Dominican Republic. Herein, we detail the intervention adaptation process and present feasibility, acceptability, and pre-post preliminary effectiveness results ascertained via paired t-tests.

Overcoming Research Mistrust in African American Communities by Engaging Community Members as Research Team Members: Challenges and Opportunities.

Objectives: We aimed to understand factors surrounding COVID-19 testing in vulnerable urban and rural African American communities in Alabama, which are characterized by mistrust in medical research.

Methods: To address widespread mistrust, we trained lay community members as research coordinators (Community Engagement Coordinators-CECs) and employed them for study recruitment and data collection. We then explored their experiences through group discussions and individual interviews.

Associations Between Internalized HIV Stigma and Cognitive Function Among Older Women With HIV.

Objectives: Internalized HIV stigma refers to the negative beliefs, feelings, and attitudes that people with HIV (PWH) adopt about themselves due to societal HIV stigma. Internalized HIV stigma negatively affects mental health but less is known about this factor on cognitive function in PWH. This study examines associations between internalized HIV stigma and cognition among women aged 50+ with HIV.

Health insurance, race, and receipt of a postpartum visit among patients giving birth in a referral hospital in the US South.

Background: The United States faces a maternal mortality crisis with stark and unacceptable disparities. Postpartum care (PPC) is crucial for identifying and managing complications after childbirth. However, access to PPC is inconsistent, especially for marginalized individuals such as Black birthing people and Medicaid beneficiaries.

The Intersectional Influence of Experienced Stigma on Clinically Significant Depressive Symptoms Among Gay, Bisexual, and Other Men Who Have Sex with Men.

We sought to determine how intersectional stigma, operationalized by interactions of perceived stigma experiences in adulthood attributed to various social identities/characteristics (age, gender, race, ethnicity/nationality, religion, height/weight, other aspect of appearance [unrelated to the identities/characteristics listed-e.g. height/weight/race/gender], physical disability, sexual orientation, and HIV status), associates with clinically significant depressive symptoms (DS).

Evaluation of risk stratification and problem management plus (PM+) for pregnant women with HIV in Kenya (Tatua study): Protocol paper.

Background: While many pregnant and postpartum women with HIV (PPWH) in the African Region successfully engage in HIV care, a substantial number still face significant barriers, including poor mental health and HIV stigma. These psychosocial barriers contribute to poor medication and clinic visit adherence, poor health outcomes, including unsuppressed viral load, and increased risk of perinatal transmission of HIV. To efficiently improve health outcomes within a resource-constrained health system, responsive and effective interventions are urgently needed to support women who are at the highest risk of sub-optimal outcomes.

Association of experienced stigma in healthcare settings with health outcomes among Black women living with HIV: Mediating roles of internalized stigma, anticipated stigma, and trust in HIV care.

Background: Black women living with HIV (WLHIV) often have suboptimal ART adherence due to a multitude of social and structural barriers, including HIV-related stigma. Trust in healthcare providers plays a significant role in adhering to ART and is likely lower among Black WLHIV compared to their White counterparts. This study examined the relationship between experienced stigma in healthcare settings and ART adherence and viral suppression through anticipated stigma in healthcare settings, internalized stigma, and medical mistrust.

"You're in an Image of a Man but Not a Man": A Qualitative Analysis of Intersectional Stigma Among Men with HIV Experiencing Subfertility in Rural Southwestern Uganda.

Many men with HIV (MWH) want to have children and may encounter HIV- and infertility-related stigma experiences. Integration of reproductive health and HIV care for men is rare. When available, safer conception care focuses on HIV prevention but lacks fertility support.

Brief Report: Internalized Poverty-Related Stigma and Interpersonal Violence Among Women Living With HIV in the United States.

Background: Interpersonal violence (IPV) affects half of women living with HIV (WLHIV) in the United States and has important consequences for mental health and HIV outcomes. Although different types of stigmas (eg, HIV- or sexual identity-related) are associated with increased risk of IPV, the relationship between poverty-related stigma and IPV is unclear, even though poverty frequently co-occurs with IPV.

Methods: Data from up to 4 annual visits (2016-2020) were collected from 374 WLHIV enrolled in a substudy of the Women's Interagency HIV Study (now known as Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study) at 4 sites across the United States.

Challenges and Opportunities in Examining and Addressing Intersectional Stigma and Health.

Background: 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research.

Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis.

Background: In the US, Women, especially Black and Latina women living in disadvantaged environments, are disproportionally affected by HIV. Women living with HIV (WLHIV) have higher rates of suboptimal antiretroviral therapy (ART) adherence, and detectable viral load (VL). Experiences of intersectional poverty, HIV, gender, and racial stigmas may increase the rates of detectable VL through suboptimal ART adherence.

Mental health and quality of life following breast cancer diagnosis in patients seen at a tertiary care hospital in Nairobi, Kenya: A qualitative study.

Mental health challenges are common following cancer diagnosis, negatively impacting treatment and quality of life for breast cancer (BC) patients. This pilot study provides an understanding of the impacts of BC diagnosis and care experiences on the mental health of patients seen at the Aga Khan University Hospital in Nairobi, Kenya. We conducted 40 in-depth interviews, including 10 women with newly diagnosed BC, 10 women with metastatic BC, 10 family members and 10 healthcare professionals.

A Tool to Help Nurses Provide Health Education on Adverse Pregnancy Outcomes and Cardiovascular Health.

Adverse pregnancy outcomes are associated with poor short- and long-term cardiovascular health. However, patients and their health care providers may not have knowledge of this risk or of the healthful practices that can reduce this risk. Childbirth care can be a pivotal time in the patient-clinician relationship to build awareness and spur prevention planning.

The Relationship Between Provider and Patient Racial Concordance and Receipt of Postpartum Care.

Access to postpartum care (PPC) varies in the US and little data exists about whether patient factors may influence receipt of care. Our study aimed to assess the effect of provider-patient racial concordance on Black patients' receipt of PPC. We conducted a cross-sectional study analyzing over 24,000 electronic health records of childbirth hospitalizations at a large academic medical center  in Alabama from January 2014 to March 2020.

When HIPAA hurts: legal barriers to texting may reinforce healthcare disparities and disenfranchise vulnerable patients.

Effective health communication between healthcare providers and patients is a cornerstone of quality healthcare. It underpins trust, comprehension, and patient-informed care. Robust research shows that effective communication, including the use of text messaging for communication can improve maternal/fetal and neonatal outcomes and patient satisfaction, particularly among vulnerable patients.

Exploring the role of motherhood in healthcare engagement for women living with HIV in the USA.

Mothers living with HIV are faced with managing their own complex healthcare and wellness needs while caring for their children. Understanding the lived experiences of mothers living with HIV, including grandmothers and mothers with older children - who are less explicitly represented in existing literature, may guide the development of interventions that best support them and their families. This study sought to explore the role of motherhood and related social/structural factors on engagement with HIV care, treatment-seeking behaviour, and overall HIV management among mothers living with HIV in the USA to inform such efforts.