Lori Chambers

Association of returning to work with better health in working-aged adults: a systematic review.

OBJECTIVES We systematically reviewed the literature on the impact of returning to work on health among working-aged adults. METHODS We searched 6 electronic databases in 2005. We selected longitudinal studies that documented a transition from unemployment to employment and included a comparison group. Two reviewers independently appraised the retrieved literature for potential relevance and methodological quality. RESULTS Eighteen studies met our inclusion criteria, including 1 randomized controlled trial. Fifteen studies revealed a beneficial effect of returning to work on health, either demonstrating a significant improvement in health after reemployment or a significant decline in health attributed to continued unemployment. We also found evidence for health selection, suggesting that poor health interferes with peoples ability to go back to work. Some evidence suggested that earlier reemployment may be associated with better health. CONCLUSIONS Beneficial health effects of returning to work have been documented in a variety of populations, times, and settings. Return-to-work programs may improve not only financial situations but also health.

Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses

Objective To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. Data sources A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. Study eligibility criteria Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. Outcome measures Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. Results 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. Conclusions This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.

Stigma, HIV and health: a qualitative synthesis

BackgroundHIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV.MethodsA thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health.ResultsThe metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy.ConclusionThis review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV.

Systematic review of stigma reducing interventions for African/Black diasporic women

Literature indicates that racism, sexism, homophobia and HIV‐related stigma have adverse impacts on health, well‐being, and quality of life among HIV‐positive women of African descent (African/Black diaspora). However, limited evidence exists on the effectiveness of interventions aimed at reducing stigma tailored for these women. This study systematically reviewed randomized controlled trials (RCTs), non‐randomized observational and quasi‐experimental studies evaluating the effectiveness of interventions aimed at reducing stigma experienced by this population.

A House is not a Home: The Housing Experiences of African and Caribbean Mothers Living with HIV

HIV-positive mothers living in Toronto, ON, face myriad economic and social challenges that put them at risk for housing instability and homelessness. These challenges are exacerbated for mothers from African and Caribbean communities as they navigate a web of shelter, housing, health care and social care systems that do not adequately address their social positioning as HIV-positive and racialized mothers. To date, there is a dearth of research that has taken a cultural, ethnoracial and gendered lens to explore these issues, and consequently, little is known about their experiences of housing instability as it intersects with issues related to motherhood, poverty, sexism, racism, immigration status and HIV-related stigma and discrimination. This paper presents findings from the HIV, Housing and Families community-based research study and highlights the unique and complex housing issues African and Caribbean mothers facing by living with HIV in Toronto. Implications for policy and practice are also discussed.

Not Just “A Roof over Your Head”: The Meaning of Healthy Housing for People Living with HIV

Abstract The literature has identified housing as a fundamental unmet need for people living with HIV; yet there has been little qualitative evidence exploring housing and HIV, particularly from a Canadian context. This paper focuses on our qualitative analyses of the housing experiences of 48 HIV-positive people living in Ontario. Findings from our interviews illustrate healthy housing as a dynamic interconnection between health, housing and other social factors that are influential to the health and well-being of people with HIV. Four salient themes have emerged from our qualitative findings: the interplay between healthy housing and economic security; the relationship between HIV, health and housing precariousness; the interconnection between housing, HIV, safety, stigma, social isolation and social exclusion; and the meaning of healthy housing for people living with HIV. These findings re-emphasize the importance of housing policies that consider housing as more than just a roof over one’s head, but also as something that supports the physical, mental, emotional and social well-being of people living with HIV.

From Serodiscordant to Magnetic: The Feasibility and Acceptability of a Pilot Psychoeducational Group Intervention Designed to Improve Relationship Quality

ABSTRACT Serodiscordant or magnetic couples experience HIV-related issues that can compound daily stressors. Psychoeducational couples group interventions can build coping skills and increase relationship satisfaction. Throughout Summer 2014, 6 gay male magnetic couples (n = 12) collaboratively designed and participated in an 8-session psychoeducational support group. The intervention was feasible (i.e., recruitment was <2 weeks, it was easy to coordinate) and acceptable (i.e., each session was consistently rated very good or outstanding). Relationship quality improved significantly in all couples regardless of whether couples agreed on how to manage HIV within their relationship. Implementation of this model is encouraged to fully evaluate this promising intervention.

Decolonizing Scoping Review Methodologies for Literature With, for, and by Indigenous Peoples and the African Diaspora: Dialoguing With the Tensions

This article summarizes our deepened understanding of decolonizing research with, for, and by Indigenous peoples and peoples of African descent that emerged from conducting a scoping review of the methodological literature and reflecting on our review process. Although our review identified decolonizing methodologies as a promising approach, we questioned if our scoping review process engaged in decolonizing knowing. To unpack the epistemological tensions between decolonizing knowing and Western ways of doing scoping reviews, we engaged in individual and collective reflective processes—dialoguing with the tensions—moving from individual immersion in the literature to transformative dialogues among the team. In reflecting upon our tensions with the scoping review process, themes that emerged included (a) ontological/epistemological disjunctures, (b) tensions with concepts and language, and (c) relationships with the literature and beyond. This reflexive process provides valuable insight into ways in which review methods might be made a decolonizing research experience.

High rates of posttraumatic stress symptoms in women living with HIV in Canada

Purpose Women living with HIV experience high levels of trauma exposure before and after diagnosis. One of the most challenging outcomes following trauma exposure is posttraumatic stress disorder. Despite high exposure to traumatic events, the presence and contributors to posttraumatic stress disorder symptoms have not been examined in women living with HIV in Canada. Methods The current study examines the presence of, contributors to, and geographical regions associated with self-reported posttraumatic stress symptoms (PTSS) among 1405 women enrolled in the Canadian HIV Women’s Sexual & Reproductive Health Cohort Study (CHIWOS). Results Separate linear regression models were run for the three provinces in the cohort: British Columbia, Ontario and Québec. Scores consistent with posttraumatic stress disorder were reported by 55.9%, 39.1% and 54.1% of the participants in each province, respectively (F(2, 1402) = 13.53, p < .001). Conclusions The results demonstrate that women living with HIV have high rates of PTSS, and that rates and variables associated with these symptoms vary by province. These results suggest the need for trauma-informed practices and care for women living with HIV in Canada, which may need to be tailored for the community and identities of the women.