Comfort Enah

Religion, spirituality, and older adults with HIV: critical personal and social resources for an aging epidemic

By 2015, approximately half of adults with HIV in the United States will be 50 and older. The demographic changes in this population due to successful treatment represent a unique challenge, not only in assisting these individuals to cope with their illness, but also in helping them to age successfully with this disease. Religious involvement and spirituality have been observed to promote successful aging in the general population and help those with HIV cope with their disease, yet little is known about how these resources may affect aging with HIV. Also, inherent barriers such as HIV stigma and ageism may prevent people from benefitting from religious and spiritual sources of solace as they age with HIV. In this paper, we present a model of barriers to successful aging with HIV, along with a discussion of how spirituality and religiousness may help people overcome these barriers. From this synthesis, implications for practice and research to improve the quality of life of this aging population are provided.

The moderating effect of sexual pressure on young urban women's condom use.

The purpose of this study was to examine whether womens experiences of sexual pressure moderated the relationship between sexual empowerment determinants and condom use in a sample of 100 high-risk women, ages 19-25. Five sexual empowerment determinants of condom use were identified from the literature: HIV knowledge, self-esteem, condom self-efficacy, positive attitudes toward condom use, and condom negotiation skills. Linear and logistic regression analyses revealed that positive attitudes toward condom use and condom negotiation skills were significant predictors of condom use. These relationships, however, were moderated by sexual pressure. Findings indicate that womens experiences with sexual pressure have the potential to decrease the likelihood of condom use, even though other sexually protective behaviors may be exhibited.

Digital Gaming for HIV Prevention With Young Adolescents

&NA; The search for intervention strategies appropriate for young adolescents has recently led to the use of digital games. Digital gaming interventions are promising because they may be developmentally appropriate for adolescent populations. The gaming approach also capitalizes on an inherent interest to adolescents and circumvents traditional barriers to access to prevention interventions faced in some geographical areas. Notwithstanding, research on gaming in HIV prevention is quite limited. In this review article, we examine the need for contextually relevant HIV prevention interventions among young adolescents. From this, we provide a theoretical framework for exploring contextually relevant HIV risk factors and a foundation for gathering and using input from the target population to adapt an existing game or to create a developmentally appropriate and contextually relevant HIV prevention game.

“Keep it simple”: older African Americans’ preferences for a health literacy intervention in HIV management

Purpose Health literacy is lower in minorities and older adults, and has been associated with nonadherence to medications, treatment, and care in people living with human immunodeficiency virus (HIV). Likewise, African Americans with HIV are more likely to be nonadherent to their HIV medications, less likely to keep their clinic appointments related to HIV treatment and care, and more likely to die during hospitalizations than their ethnic counterparts. The present study explored the preferences of older African Americans with HIV for a health literacy intervention to promote HIV management. Patients and methods In this qualitative study, 20 older adult African Americans living with HIV were recruited from an HIV/acquired immunodeficiency syndrome outpatient clinic in the southeastern region of the US. Using patient-centered participatory design methods, semi-structured individual interviews were conducted to determine patient preferences for intervention development and design. Health literacy was also measured using the Rapid Estimate of Adult Literacy in Medicine – Revised (REALM-R). Results Four major themes emerged related to intervention development and design: keep health information simple; use a team-based approach for health education; tailor teaching strategies to patients’ individual needs; and account for patients’ low experience, but high interest, in technology. Forty-five percent of the study population had low health literacy based on the revised Rapid Estimate of Adult Literacy in Medicine. Conclusion Future interventions that target minorities and older adults living with HIV should consider patients’ learning needs, sex-specific and mental health needs, and delivery approaches, in order to increase uptake and improve disease management and health outcomes.

Qualitative evaluation of the relevance and acceptability of a web-based HIV prevention game for rural adolescents.

African Americans in the rural Southern United States continue to experience disproportionate increases in new HIV/AIDS infections. Electronic gaming interventions hold promise but the use of HIV prevention games is limited. The purpose of this study was to assess the acceptability and relevance of a web-based HIV prevention game for African American rural adolescents. Findings from focus groups conducted with 42 participants suggested that the game was educational and somewhat entertaining but lacking in real-life scenarios and player-control. Findings are congruent with self-efficacy literature and constructivist approaches to learning. Findings have implications for gaming intervention development and further research.

Piloting an HIV Prevention Intervention for Cameroonian Girls

&NA; In this report, the authors describe the pilot test of a school‐based culturally tailored HIV prevention intervention for 10‐ to 12‐year‐old Cameroonian females. The aims of this research were to determine the feasibility of recruiting and enrolling Cameroonian girls in HIV prevention research studies, estimate the efficacy of the intervention, and assess cultural sensitivity of the intervention and study protocols. Sixty participants completed the study. A pre‐/posttest design was used to evaluate the intervention. Findings include 100% participation of all eligible participants with a majority (78%) of participants reporting positive perceptions of the intervention. The intervention was estimated to be potentially effective with significant increases in immediate postintervention sexual‐abstinence behavior skills (t = 4.51; p < .05) and intentions to postpone sexual activity (t = 3.40; p < .05). Findings can inform more rigorously designed studies of the intervention. This line of research can contribute to decreasing new infections among adolescents.

A psychometric examination of an instrument to measure the dimensions of Champion's Health Belief Model Scales for cervical cancer screening in women living with HIV

PURPOSE The purpose of this paper was to examine the psychometric properties of Champions Health Belief Model Scales for cervical cancer and screening among women living with HIV. METHODS A secondary data analysis was conducted using data from an exploratory cross-sectional study with a convenience sample of 300 women living with HIV receiving care at two HIV ambulatory care clinics in Florida. A 39-item adaptation of the Champions Health Belief Model Scales was administered via paper and pencil. RESULTS The authors used internal consistency measures, confirmatory factor analysis, and ordinal item response theory (IRT) techniques to examine the psychometric properties of the instrument. The 39-item instrument had adequate internal consistency and factor structure. However, the IRT analyses suggested that the instrument could be reduced to 24-items (61.5%), without loss of relevant information. CONCLUSION A shortened 24-item instrument demonstrated good internal consistency among women living with HIV. Future work should include validating the properties of the reduced instrument in diverse samples of patients and conditions.

Perceptions of Brain Health and Cognition in Older African Americans and Caucasians With HIV: A Focus Group Study

&NA; As people age with HIV, cognitive problems may become more prevalent and severe, but lifestyle behaviors (i.e., physical activity) have been shown to protect brain health and cognition. We examined the perceptions that older adults living with HIV have about protecting and improving brain health and cognition through lifestyle behaviors. Qualitative data were analyzed from four focus groups (N = 30) of African Americans and Caucasians living with HIV and at least 50 years of age. An open‐coding scheme using conventional content analysis was employed. Two results were found. First, many older adults with HIV in our study expressed a variety of cognitive complaints that interfered with daily function. Second, these participants reported few specific ideas about how such health behaviors were important to their own brain health and cognition. Education interventions may help older adults with HIV learn to improve and protect brain health and cognition as they age.

Make It Like the Real World: Adolescents’ Recommendations for the Design of a Digital HIV Prevention Game

Digital games have shown promise in studies focusing on disease prevention and disease self-management in children and young adolescents. The purpose of this study was to gather formative data for the design of an HIV prevention game for adolescents. Qualitative research methods that included focus group sessions with four groups of adolescents were used (N = 38). Content analysis strategies were used to analyze verbatim transcripts and observational notes. Themes emerging from the data included: players’ control, virtual reward systems, immersive action, and the need for tailoring. Findings are being used in the design of a digital game that is responsive to recommendations to “make it like the real world.” HIV prevention strategies could benefit from incorporating emerging technologies that are inherently attractive to many adolescents. Adolescent participants support the use of digital games in HIV prevention and wanted such games to reflect their lives.

The state of adherence to HIV care in Black women

&NA; The purpose of this systematic review was to assess the state of adherence to HIV care such as HIV medication and appointment adherence among Black women in the United States. After a systematic search of CINAHL, PubMed, EMBASE, and clinicialtrials.gov, 26 studies and two ongoing trials met inclusion criteria. Psychosocial factors such as intersectional stigmas and depression were among the salient factors associated with adherence‐to‐care behaviors in women living with HIV (WLWH). In addition, interpersonal factors such as social support and the patient–provider relationship were frequently associated with adherence‐to‐care behaviors. No culturally relevant interventions for Black WLWH were found in the literature, but one ongoing trial that was developed specifically for Black WLWH seemed promising. Considering the dearth of tailored interventions, more gender‐specific and culturally relevant interventions are urgently needed to improve adherence‐to‐care behaviors and optimize health outcomes for Black WLWH.