Richard L. Sowell

Spiritual activities as a resistance resource for women with human immunodeficiency virus.

BACKGROUND Few studies have investigated the role that spiritual activities play in the adaptational outcomes of women with human immunodeficiency virus (HIV) disease. OBJECTIVE To examine the role of spiritual activities as a resource that may reduce the negative effects of disease-related stressors on the adaptational outcomes in HIV-infected women. METHODS A theoretically based causal model was tested to examine the role of spiritual activities as a moderator of the impact of HIV-related stressors (functional impairment, work impairment, and HIV-related symptoms) on two stress-related adaptational outcomes (emotional distress and quality of life), using a clinic-based sample of 184 HIV-positive women. RESULTS Findings indicated that as spiritual activities increased, emotional distress decreased even when adjustments were made for HIV-related stressors. A positive relationship between spiritual activities and quality of life was found, which approached significance. Findings showed that HIV-related stressors have a significant negative effect on both emotional distress and quality of life. CONCLUSIONS The findings support the hypothesis that spiritual activities are an important psychological resource accounting for individual variability in adjustment to the stressors associated with HIV disease.

Quality of life in HIV-infected women in the south-eastern United States

The purpose of this study was to evaluate the relative importance of social (social support, material resources, disclosure, and family functioning) and psychological factors (stigma, emotional distress, intrusion, avoidance, and fatalism) as predictors of the quality of life of women infected with HIV. The cross-sectional data were drawn from interviews of a sample of 264 women recruited from 8 HIV/AIDS treatment sites in a south-eastern state. Variance in quality of life variables, included limited daily functioning, general anxiety, and HIV symptoms was analyzed using ANOVA, correlations, and hierarchical multiple regression analysis. Limited daily functioning was predicted by stigma, fatalism, employment status, and stage of disease (R2 = 0.179). General anxiety was predicted by emotional distress, intrusion, and marital status (R2 = 0.503). Reported HIV symptoms were predicted by material resources, disclosure, intrusion, age, employment status, and race (R2 = 0.294). The results of this study support that social and, particularly, psychological factors are important in their influence on quality of life in women with HIV infection and suggest the need for interventions which address such factors.

Experiences of disclosure in women infected with HIV

In this qualitative focus group study, we explored issues of disclosure for women infected with HIV. The sample included 19 women who participated in one of four focus group sessions. Participants talked about and described their experiences sharing information about their HIV infection with others. Content analysis was used to code the data and identify major issues. Participants uniformly expressed concern about disclosing their HIV status because they expected and feared negative responses from others. Descriptions of disclosure revealed an evaluative process involving an analysis of potential risks and benefits. Three themes that represent concerns about disclosure were identified: discrimination, confidentiality, and the context of disclosure. Based on the findings, we concluded that these concerns are important factors influencing disclosure decisions and the use of supportive services and resources. The findings have implications for designing interventions to assist women in coping with the diagnosis of HIV and to promote their quality of life.

Domestic Violence in Hispanics in the Southeastern United States: A Survey and Needs Analysis

Violence is a significant health issue for Latinas in the United States (US), with 54.9% reporting violent victimization. However, little is known about battering among Hispanic women in the southeast. The southeastern corridor, a rural area in search of cheap labor, is a magnet for undocumented agricultural workers. The purpose of this study was to describe domestic violence in Hispanic/Latino women in the southeastern US, including type and frequency of violence experienced, barriers to obtaining treatment, and services needed by women who have been abused. Hispanic women completed questionnaires developed from information from focus groups. Results indicate that domestic violence is a major health problem for women in the southeast, and document previous findings as well as offer new insights about Hispanic women who have experienced domestic violence. Implications are discussed in terms of the need for community partnerships and interventions, as well as routine screening and crisis intervention.

A model of HIV disclosure: Disclosure and types of social relationships

Purpose: The purpose of this study was to assess perceptions of HIV positive (+) persons regarding disclosure of their serostatus to others with the goal of developing a model of HIV disclosure that could be used by healthcare providers (HCPs) in HIV prevention. Data sources: Data were collected through 13 focus groups from 104 HIV+ participants. The groups were formed based on three HIV risk exposure categories—men who have sex with men, high‐risk heterosexuals, and substance users. Conclusions: Data analysis revealed three themes: disclosure of one’s HIV+ serostatus depends on type of social relationships, fear, and stigma, with social relationships being the major theme. A model of HIV disclosure emerged from the data analysis of social relationships. In the model, social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure—depending on the social relationship with the person to whom one did or did not disclose. Results indicated that HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. Implications for practice: Results of this study provide a “Model of HIV Disclosure” that can be utilized by nurse practitioners and other HCPs in clinical practice when providing treatment, counseling, and prevention education for HIV+ clients and for prevention education for HIV negative clients—especially for family, friends, sexual partners, and employers of HIV+ clients.

The effectiveness of coping strategies used by HIV-seropositive women

The effectiveness of active and passive coping strategies was examined in a sample of 264 women infected with HIV. Coping was measured concurrent with, and 3 months prior to, measurement of physical symptoms and emotional distress. Two causal models were tested: one for active coping and one for passive coping. Active coping strategies examined included seeking social support, managing the illness, and spiritual activities. Avoidance was used as an indicator of passive coping. In both models, physical symptoms and emotional distress were positively and significantly related. The findings indicated that, whereas current avoidance coping was not related to emotional distress, current active coping was positively related to physical symptoms and negatively related to emotional distress. The immediate effects of active coping appeared to serve a protective function in that emotional distress decreased with greater use of active coping, even as physical symptoms increased. Avoidance coping had no such protective effect for emotional distress. In addition, the use of avoidance coping decreased and active coping increased as physical symptoms increased, suggesting that active coping is more likely to be used with increasing levels of physical symptoms. The findings suggest that interventions that support attempts to use active coping strategies as physical symptoms increase may be effective in promoting positive adaptation to HIV disease.

Decisions to Have a Baby by HIV-Infected Women

As the epidemiologic picture of HIV changes to include increased numbers of women of childbearing age, particularly those of African American heritage and thosefrom rural southern cultures, those who provide services to these women need to understand the processes used by HIV-infected women to make reproductive decisions. Focus-group data with subsequent content analysis were used to discover themes surrounding pregnancy decisions among 22 women in two predominantly rural southeastern states. The results both validated and amplified previous findings and added new perspectives. The analyses revealed six overarching themes: spiritual and religious beliefs, knowledge and beliefs about HIV: previous experience with childbearing attitudes offamilies and sex partners, personal health, and intrapersonal motivation to have a baby.

Physiological and Psychological Correlates of Fatigue in HIV Disease

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.

Factors influencing intent to get pregnant in HIV-infected women living in the southern USA

This descriptive study sought to identify factors that influence HIV-infected womens intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent ( n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.

HIV-Infected Women's Decisions to Take Antiretrovirals

Despite the potential benefits of antiretrovirals, HIV-infected women may not be accepting or adhering to recommended drug therapies. To help women make informed decisions surrounding antiretroviral therapy, health care professionals need insight into how HIV-infected women decide to take or not to take antiretroviral drugs. The purpose of this study was to describe the influences affecting decisions made by women in the southern United States to accept and adhere to antiretroviral therapy. Focus group data with subsequent dimensional analysis were used to discover themes surrounding antiretroviral decisions among 22 women in two predominantly rural, southeastern states. The focus groups included some women who were currently taking antiretrovirals, some who had taken them in the past, and some who had never taken them. The analyses revealedfour overarching themes that influenced womens decisions regarding antiretrovirals: health professionals, beliefs about antiretrovirals, side effects, and attitudes of peers and family.