Wei Ti Chen

Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China

Stigma towards people living with HIV is pervasive in China and related to poor service utilization, psychosocial distress and diminished quality of life (QOL). In an effort to identify mechanisms to reduce HIV stigma and its negative consequences, we examined whether social support mediates the relation between enacted stigma and both depressive symptoms and QOL among 120 HIV outpatients in Beijing, China. Generally, perceived social support was associated with less stigma, less depressive symptomatology and better QOL. Using multivariable regression models, we found that social support was a full mediator of the impact of stigma on both depressive symptomatology and QOL. The findings suggest social support may be an important target of interventions to reduce the impact of stigma on poor psychosocial health outcomes.

Chinese HIV-positive patients and their healthcare providers: contrasting Confucian versus Western notions of secrecy and support.

In this qualitative study, 29 HIV-positive, Chinese patients reported highly favorable impressions of their healthcare providers, who were seen as providing important medical-related, financial, and emotional support. Generally, the patient-provider relationship positively impacted the participants and their ability to maintain their health and was especially critical when patients were isolated from familial sources of support due to intense AIDS stigma. Often family members were informed of an HIV diagnosis before the patient, revealing tensions between Confucian principles of collectivism and familial authority and increasingly prevalent Western ideals of individual autonomy and the privileged status of personal health information.

Focus on Increasing Treatment Self-Efficacy to Improve Human Immunodeficiency Virus Treatment Adherence

PURPOSE Human immunodeficiency virus (HIV) treatment self-efficacy is the confidence held by an individual in her or his ability to follow treatment recommendations, including specific HIV care such as initiating and adhering to antiretroviral therapy (ART). The purpose of this study was to explore the potential mediating role of treatment adherence self-efficacy in the relationships between Social Cognitive Theory constructs and self- reported ART adherence. DESIGN Cross-sectional and descriptive. The study was conducted between 2009 and 2011 and included 1,414 participants who lived in the United States or Puerto Rico and were taking antiretroviral medications. METHODS Social cognitive constructs were tested specifically: behaviors (three adherence measures each consisting of one item about adherence at 3-day and 30-day along with the adherence rating scale), cognitive or personal factors (the Center for Epidemiology Studies Depression Scale to assess for depressive symptoms, the 12-Item Short Form Health Survey (SF-12) to assess physical functioning, one item about physical condition, one item about comorbidity), environmental influences (the Social Capital Scale, one item about social support), and treatment self-efficacy (HIV Adherence Self-Efficacy Scale). Analysis included descriptive statistics and regression. RESULTS The average participant was 47 years old, male, and a racial or ethnic minority, had an education of high school or less, had barely adequate or totally inadequate income, did not work, had health insurance, and was living with HIV/acquired immunodeficiency syndrome for 15 years. The model provided support for adherence self-efficacy as a robust predictor of ART adherence behavior, serving a partial mediating role between environmental influences and cognitive or personal factors. CONCLUSIONS Although other factors such as depressive symptoms and lack of social capital impact adherence to ART, nurses can focus on increasing treatment self-efficacy through diverse interactional strategies using principles of adult learning and strategies to improve health literacy. CLINICAL RELEVANCE Adherence to ART reduces the viral load thereby decreasing morbidity and mortality and risk of transmission to uninfected persons. Nurses need to use a variety of strategies to increase treatment self-efficacy.

Conceptualizing antiretroviral adherence in Beijing, China

Abstract International health experts agree that China is on the verge of an AIDS crisis. In response, the Chinese government initiated the “Four Frees and One Care” policy in 2003 to decrease economic barriers and increase access to antiretroviral therapies for people with HIV. However, long-term treatment success requires not only access, but high rates of medication adherence. This qualitative interview study with 29 persons receiving HIV care at Beijings Ditan Hospital identified barriers to and facilitators of medication adherence. The interviews were guided by an a priori conceptual model of adherence with four components: access, knowledge about medications, motivation, and proximal cues to action. Barriers to adherence were related to stigma and fear of discrimination; the medications themselves (including side-effects and complicated dosing regimens); and other economic issues (i.e. costs of transportation, lab tests and hospitalizations). Facilitators included participants’ strong will to live, use of electronic reminders and family support. These results support the conceptual model and suggest that successful interventions must minimize stigma as it negatively affects all components of the model for adherence.

Depressive Symptoms, Self-Esteem, HIV Symptom Management Self-Efficacy and Self-Compassion in People Living with HIV

The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Becks cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = −0.154), education (r = −0.106), work status (r = −0.132), income adequacy (r = −0.204, self-esteem (r = −0.617), HIV symptom self-efficacy (r = − 0.408), and self-kindness (r = − 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Becks theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

Predictors of breast examination practices of Chinese immigrants.

Breast cancer is a significant threat to Chinese women living in the United States. The purposes of this study are, first, to examine the relationships among breast cancer risk knowledge, general cancer beliefs, and breast examination practices and, second, to determine the predictors of breast examination practices among Chinese women in New York. The study offers a descriptive approach that makes use of a correlation cross-sectional survey (N = 135). Five significant predictors are related to breast examination practices as a result of the study findings: age, acculturation, private insurance status, legal status, and length of stay in New York. Findings show that women who have regular breast examinations most likely belong to older generations, as compared with their younger peers. Study findings suggest that healthcare providers must become more culturally sensitive to the practices and needs of Chinese immigrants. Evidently, providing information regarding cancer prevention targeted for female Chinese immigrants can help increase use of cancer screening tests.

A cross-sectional description of social capital in an international sample of persons living with HIV/AIDS (PLWH)

BackgroundSocial capital refers to the resources linked to having a strong social network. This concept plays into health outcomes among People Living with HIV/AIDS because, globally, this is a highly marginalized population. Case studies show that modifying social capital can lead to improvements in HIV transmission and management; however, there remains a lack of description or definition of social capital in international settings. The purpose of our paper was to describe the degree of social capital in an international sample of adults living with HIV/AIDS.MethodsWe recruited PLWH at 16 sites from five countries including Canada, China, Namibia, Thailand, and the United States. Participants (n = 1,963) completed a cross-sectional survey and data were collected between August, 2009 and December, 2010. Data analyses included descriptive statistics, factor analysis, and correlational analysis.ResultsParticipants mean age was 45.2 years, most (69%) identified as male, African American/Black (39.9%), and unemployed (69.5%). Total mean social capital was 2.68 points, a higher than average total social capital score. Moderate correlations were observed between self-reported physical (r = 0.25) and psychological condition (r = 0.36), social support (r = 0.31), and total social capital. No relationships between mental health factors, including substance use, and social capital were detected.ConclusionsThis is the first report to describe levels of total social capital in an international sample of PLWH and to describe its relationship to self-reported health in this population.

Attitudes Toward Antiretroviral Therapy and Complementary and Alternative Medicine in Chinese Patients Infected With HIV

&NA; HIV is an emerging health issue in China, and effective antiretroviral therapy (ART) is now available throughout the country. Complementary and alternative medicine (CAM) includes traditional Chinese medicine (TCM) and has been used in Chinese society for more than 5,000 years. In the West, CAM use is widespread among HIV‐infected individuals; however, rates of CAM use among HIV‐infected individuals in China are unknown. This qualitative study explores issues related to attitudes toward ART and CAM in HIV‐infected individuals in Beijing, China. Semistructured, in‐depth interviews were used to explore attitudes, experiences, and perceptions about ART and CAM among people living with HIV (PLWH). Results indicate that Chinese PLWH have both positive and negative attitudes toward ART and CAM, which led many to report taking CAM not only for daily discomforts but to counteract the side effects of ART. This study shows that social, cultural, and governmental factors coalesced to shape Chinese PLWH attitudes toward ART and CAM.

In sickness and in health: a qualitative study of how Chinese women with HIV navigate stigma and negotiate disclosure within their marriages/partnerships

Abstract In China, there are currently an estimated 180,000 women between 16 and 45 years of age living with HIV. However, we know very little about their lived experiences. Given the spread of the AIDS epidemic in China and the burden it exerts on quality of life, there is an urgent need to understand how HIV affects Chinese women, particularly in the context of their marriages. How do they negotiate the extreme stigma of their illness in making decisions about disclosure and social support, especially in the context of their family life? We recruited 26 Chinese women with HIV in Beijing and Shanghai for in-depth interviews employing a phenomenological approach. We examined the process and outcomes of disclosure within the course of the womens search for social support. Women in HIV-discordant relationships often experienced a termination of their marriage after disclosure, yet others exhibited remarkable resilience, finding new strength through the challenge of their illness. Findings underscore the need for accessible and culturally acceptable interventions for Chinese women with HIV who face considerable stigma in their search for support.

Cognitive control in opioid dependence and methadone maintenance treatment

Background Substance misuse is associated with cognitive dysfunction. We used a stop signal task to examine deficits in cognitive control in individuals with opioid dependence (OD). We examined how response inhibition and post-error slowing are compromised and whether methadone maintenance treatment (MMT), abstinence duration, and psychiatric comorbidity are related to these measures in individuals with OD. Methods Two-hundred-and-sixty-four men with OD who were incarcerated at a detention center and abstinent for up to 2 months (n = 108) or at a correctional facility and abstinent for approximately 6 months (n = 156), 65 OD men under MMT at a psychiatric clinic, and 64 age and education matched healthy control (HC) participants were assessed. We computed the stop signal reaction time (SSRT) to index the capacity of response inhibition and post-error slowing (PES) to represent error-related behavioral adjustment, as in our previous work. We examined group effects with analyses of variance and covariance analyses, followed by planned comparisons. Specifically, we compared OD and HC participants to examine the effects of opioid dependence and MMT and compared OD sub-groups to examine the effects of abstinence duration and psychiatric comorbidity. Results The SSRT was significantly prolonged in OD but not MMT individuals, as compared to HC. The extent of post-error slowing diminished in OD and MMT, as compared to HC (trend; p = 0.061), and there was no difference between the OD and MMT groups. Individuals in longer abstinence were no less impaired in these measures. Furthermore, these results remained when psychiatric comorbidities including misuse of other substances were accounted for. Conclusions Methadone treatment appears to be associated with relatively intact cognitive control in opioid dependent individuals. MMT may facilitate public health by augmenting cognitive control and thereby mitigating risky behaviors in heroin addicts.