Julia Seay

Experiences with HIV Testing, Entry, and Engagement in Care by HIV-Infected Women of Color, and the Need for Autonomy, Competency, and Relatedness

Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV.

Self-reported sleep disturbance is associated with lower CD4 count and 24-h urinary dopamine levels in ethnic minority women living with HIV

BACKGROUND Sleep disturbance is associated with dopamine dysregulation, which can negatively impact immune status. Individuals living with HIV experience more sleep difficulties, and poor sleep may compound immune decrements associated with HIV infection. Little research has examined associations between sleep, dopamine, and immune status (CD4 count) in individuals with HIV. As ethnic minority women living with HIV (WLWH) are at heightened risk for HIV disease progression, we related sleep reports to both CD4 count and dopamine levels in a cohort of ethnic minority WLWH. METHODS Participants were 139 low-income WLWH (ages 20-62; 78.3% African-American or Caribbean) who reported both overall sleep quality and sleep disturbance on the Pittsburgh sleep quality index (PSQI). CD4 count and HIV viral load were measured via morning peripheral venous blood samples, and concentrations of dopamine were measured via 24-h urine collection. Covariates included HIV viral load, length of time since HIV diagnosis, HAART adherence, perceived stress and depression. RESULTS After controlling for all covariates, greater sleep disturbance was associated with significantly lower CD4 count (β=-.20, p=.03) and lower levels of dopamine (β=-.25, p=.04). Poorer overall sleep quality was marginally associated with lower CD4 count (β=-.16, p=.08), and was not associated with dopamine. CONCLUSION Our analyses suggest that sleep disturbance is independently related with immune status and dopamine levels in WLWH. Lower levels of dopamine may indicate neuroendocrine dysregulation and may impact immune and health status. Results highlight sleep disturbance rather than overall sleep quality as potentially salient to neuroendocrine and immune status in ethnic minority WLWH.

Oxytocin, Social Support, and Sleep Quality in Low-Income Minority Women Living With HIV

Sleep disturbances are highly prevalent in women with HIV, and few studies examine potential protective factors that may reduce risk for sleep disturbances in this high-risk population. This study predicted that HIV-specific social support from various sources (i.e., friends, family members, and spouses), as well as oxytocin (OT), would explain sleep quality in 71 low-income minority women living with HIV. Social support from family members was associated with better sleep quality in women. For women with high OT, support from friends was associated with better sleep quality, whereas for women with low OT, support from friends was associated with poorer sleep quality. Women with low OT may not effectively interpret and utilize available support resources, which may be associated with sleep disturbances.

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

BACKGROUND Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. METHODS At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. RESULTS The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = -.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = -.010, p = .115). CONCLUSIONS Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.

Cancer Screening Utilization Among Immigrant Women in Miami, Florida

Background: Routine cancer screening for cervical, breast, and colorectal cancers reduces disease-associated morbidity and mortality through early detection and treatment. Lack of access to health care is a major barrier to screening in immigrant populations.Objectives: We aimed to characterize compliance with national cancer screening guidelines and to assess predictors of screening compliance among women residing in each of two distinct immigrant communities in Miami-Dade County—Little Haiti (Haitian) and Hialeah (Cuban).Methods: Through a collaborative community-based participatory research (CBPR) initiative, researchers, key community stakeholders, and community members developed the study design. Data were collected from a total of 234 women via a rapid assessment survey administered by community health workers (CHWs).Results: Compliance with national screening guidelines for breast, cervical, and colorectal screening was low in both community samples relative to national averages, and for cervical cancer screening was significantly lower in Little Haiti than Hialeah (p < .01). In addition, knowledge of cervical cancer etiology was significantly greater in Hialeah than in Little Haiti (p < .01). Health insurance and having a usual source of health care were significant correlates of cancer screening.Conclusion: Given the disparities in cancer screening between our samples and the larger sociodemographic groups in which they are often included, targeted approaches that address structural barriers (lack of health insurance or usual source of care) may improve access to cancer screening among recent immigrants. Community partnerships may be essential in facilitating the interventions needed to overcome cancer-related disparities in these groups.

Cognitive vulnerability for depression in HIV

UNLABELLED Biased inhibitory processing, frequency and valence of automatic thoughts, and inability to use positive schemas to regulate negative mood are cognitive factors linked to depression. These processes may underlie the established link between adaptive cognitive coping strategies (acceptance and positive reframing) and depression in persons with HIV. How individual differences in HIV-related neurocognitive deficits moderate such effects is unknown. In a secondary analysis, we tested the direct effects of coping on depressed affect as mediated by the frequency and valence of automatic thoughts and how this model was moderated by neurocognitive function in a cohort of HIV+ men and women. METHODS HIV+ adults (mage=39.8, SD=9.5) provided data for the baseline assessment of a randomized trial that investigated the effects of a cognitive-behavioral stress management intervention. Measures included coping, depressive symptoms, positive (PAT) and negative automatic thoughts (NAT), and HIV-dementia. RESULTS After controlling for covariates, cognitive coping was related to depressed mood as mediated via NAT (β=-.92) and PATs (β=.61), (R(2)=.42, F(7, 325)=33.50, p<.0001). The indirect effect of coping on depressive symptoms via NAT and PAT was moderated by neurocognitive function. LIMITATION Cross-sectional design does not allow for the inference of causation among the variables. CONCLUSION Results support a cognitive vulnerability model for depression whereby HIV-related neurocognitive deficits interfere with the ability to use acceptance and positive reframing strategies to increase the frequency of PAT and decrease NAT in adults living with symptoms of depression.

Intravaginal practices are associated with greater odds of high-risk HPV infection in Haitian women

ABSTRACT Objective: Haitian women have the highest incidence of cervical cancer within the Western hemisphere. Intravaginal hygiene practices have been linked with human papilloma virus (HPV) infection and cervical dysplasia. These practices, known as ‘twalet deba’ in Haitian Creole, are common among Haitian women and are performed with various natural and synthetic agents. As part of a community-based participatory research initiative aimed at reducing cervical cancer disparities in rural Haiti, we explored the use of intravaginal agents and their associations with high-risk HPV infection. Design: Community Health Workers recruited 416 women for cervical self-sampling from two neighborhoods within Thomonde, Haiti. Participants were interviewed regarding intravaginal hygiene practices and completed a cervical self-sampling procedure. Cervical samples were analyzed for the presence of high-risk HPV infection. Associations between each intravaginal agent and high-risk HPV infection were examined via univariate logistic regression analyses, as well as via multivariate analyses controlling for sociodemographic factors and concurrent agent use. Results: Nearly all women (97.1%) performed twalet deba, using a variety of herbal and commercially produced intravaginal agents. Approximately 11% of the participants tested positive for high-risk HPV. Pigeon pea and lime juice were the only agents found to be associated with high-risk HPV in the univariate analyses, with women who used these agents being approximately twice as likely to have high-risk HPV as those who did not. Only pigeon pea remained significantly associated with high-risk HPV after controlling for sociodemographic factors and concurrent agent use. Conclusion: Two agents, pigeon pea and lime juice, may contribute to risk for HPV infection in this population. Results suggest that in addition to cervical cancer screening interventions, future preventive initiatives should focus on minimizing risk by advocating for the use of less-toxic twalet deba alternatives.

Vaginal Infections in Haitian Immigrant Women Living in Miami, Florida.

Objective. To characterize vulvovaginal candidiasis (VC), trichomonas vaginalis (TV), and bacterial vaginosis (BV) among Haitian women living in Miami to identify contributing factors to cervical cancer disparity in this population. Methods. Using a CBPR framework, 246 Haitian women (ages 21–65) were recruited. Self-collected cervical cytology specimens were analyzed for VC, TV, and BV. Results. The proportion of participants with VC, TV, and BV, were 7.3%, 9.3%, and 19.9%, respectively. Conclusion. Haitian women may have a higher prevalence of TV than the general U.S. population, which may increase susceptibility to HPV, the primary cause of cervical cancer.

Feasibility of Fecal Immunochemical Testing Among Hispanic and Haitian Immigrants Living in South Florida

those without funding from the life sciences industry. The CDC did not prompt or require organizations to disclose their financial associations as part of their comments. Disclosure, however, is one means of managing conflicts of interest, and organizations were not precluded from disclosing their revenue sources. In the future, the CDC should request or require such information, just as the US Food and Drug Administration suggests that such information be provided as part of public comments to the agency. US Senate committees5 and investigative journalists6 have scrutinized the financial associations of opioid manufacturers and patient advocacy and professional organizations. A major concern is that opposition to regulatory, payment, or clinical policies to reduce opioid use may originate from groups that stand to lose financially if sales of opioids decline. Our findings demonstrate that greater transparency is required about the financial relationships between opioid manufacturers and patient and professional groups.

Get Vaccinated! and Get Tested! Developing Primary and Secondary Cervical Cancer Prevention Videos for a Haitian Kreyòl-Speaking Audience

Although routine screening reduces cervical cancer rates between 60% and 90%, thousands of women worldwide are diagnosed with the disease on an annual basis because of inadequate screening. Haitian women in South Florida experience a disproportionate burden of cervical cancer, with disease rates 4 times higher than the average for women in Miami. An ongoing community-based participatory research initiative to assess and reduce this burden has revealed that a complex interplay of factors contributes to a lack of access to screening in this community, including socioeconomics, language barriers, and traditional understandings of health and disease. In an effort to address some of these barriers and encourage uptake of primary and secondary cervical cancer prevention strategies, 2 videos on cervical cancer prevention were created using a community-based participatory research framework. The video screenplays were created by a Haitian screenwriter using evidence-based medical information provided by academic researchers. The films feature Haitian actors speaking a Haitian Kreyòl dialogue with a storyline portraying friends and family discussing human papillomavirus disease and vaccination, Papanicolaou testing, and cervical cancer. Focus groups held with Haitian women in South Florida suggested that the films are engaging; feature relatable characters; and impact knowledge about human papillomavirus, cervical cancer development, and current prevention recommendations.