Articles tagged as "Resilience"

MSM resilience to HIV

Identifying resilience resources for HIV prevention among sexual minority men: a systematic review.

Woodward EN, Banks RJ, Marks AK, Pantalone DW. AIDS Behav. 2016 Dec 15. [Epub ahead of print]

Most HIV prevention for sexual minority men and men who have sex with men targets risk behaviors (e.g., condom use) and helps <50% of participants. Bolstering resilience might increase HIV prevention's effectiveness. This systematic review identified resilience resources (protective factors) in high-risk, HIV-negative, sexual minority men. We reviewed PsycINFO, PsycARTICLES, MEDLINE, references, and Listservs for studies including sexual minority men with 1+ HIV risk factor (syndemics): childhood sexual abuse, partner abuse, substance abuse, or mental health symptoms. From 1356 articles screened, 20 articles met inclusion criteria. Across the articles, we identified and codified 31 resilience resources: socioeconomic (e.g., employment), behavioral coping strategies (e.g., mental health treatment), cognitions/emotions (e.g., acceptance), and relationships. Resilience resources were generally associated with lower HIV risk; there were 18 low-risk associations, 4 high-risk associations, 8 non-significant associations. We generated a set of empirically based resilience variables and a hypothesis to be evaluated further to improve HIV prevention.

Abstract access  

Editor’s notes: This systematic review sought to identify why gay men and other men who have sex with men, at high-risk of HIV, remain HIV negative. HIV-negative, gay men and other men who have sex with men, with a key risk factor for HIV were identified. These risk factors were childhood sexual abuse, partner abuse, substance abuse or mental health symptoms. The authors sought to identify why such men remain HIV negative. Why they are resilient to infection. Some 20 studies met the inclusion criteria. Four broad categories of resilience were identified; socioeconomic (e.g. degree, full-time job); behavioural coping strategies (e.g. accessing mental health services), cognitions/ emotions (e.g. acceptance of a situation); and relationships (e.g. perceived sufficient social support). Of the 31 sub-categories of resilience resources identified, four were identified as protective for HIV infection: main sex partner is HIV negative, willingness to use PrEP, PrEP acceptance and condom use. Resilience resource research for HIV prevention is a sparse area of study. This study generated a set of resilience variables upon which further research can be built.

  • share

An innovative method to evaluate community support for children: Using existing datasets

How effective is help on the doorstep? A longitudinal evaluation of community-based organisation support. 

Sherr L, Yakubovich AR, Skeen S, Cluver LD, Hensels IS, Macedo A, Tomlinson M. PLoS One. 2016 Mar 11;11(3):e0151305. doi: 10.1371/journal.pone.0151305. eCollection 2016.

Community-based responses have a lengthy history. The ravages of HIV on family functioning has included a widespread community response. Although much funding has been invested in front line community-based organisations (CBO), there was no equal investment in evaluations. This study was set up to compare children aged 9-13 years old, randomly sampled from two South African provinces, who had not received CBO support over time (YC) with a group of similarly aged children who were CBO attenders (CCC). YC baseline refusal rate was 2.5% and retention rate was 97%. CCC baseline refusal rate was 0.7% and retention rate was 86.5%. 1848 children were included—446 CBO attenders compared to 1402 9-13 year olds drawn from a random sample of high-HIV prevalence areas. Data were gathered at baseline and 12-15 months follow-up. Standardised measures recorded demographics, violence and abuse, mental health, social and educational factors. Multivariate regression analyses revealed that children attending CBOs had lower odds of experiencing weekly domestic conflict between adults in their home (OR 0.17; 95% CI 0.09, 0.32), domestic violence (OR 0.22; 95% CI 0.08, 0.62), or abuse (OR 0.11; 95% CI 0.05, 0.25) at follow-up compared to participants without CBO contact. CBO attenders had lower odds of suicidal ideation (OR 0.41; 95% CI 0.18, 0.91), fewer depressive symptoms (B = -0.40; 95% CI -0.62, -0.17), less perceived stigma (B = -0.37; 95% CI -0.57, -0.18), fewer peer problems (B = -1.08; 95% CI -1.29, -0.86) and fewer conduct problems (B = -0.77; 95% CI -0.95, -0.60) at follow-up. In addition, CBO contact was associated with more prosocial behaviours at follow-up (B = 1.40; 95% CI 1.13, 1.67). No associations were observed between CBO contact and parental praise or post-traumatic symptoms. These results suggest that CBO exposure is associated with behavioural and mental health benefits for children over time. More severe psychopathology was not affected by attendance and may need more specialised input.

Abstract  Full-text [free] access 

Editor’s notes: This study is novel in both its research question and its methodology. The study aims to assess whether receipt of support from community-based organisations (CBOs) impacts the mental and social well-being of children in high HIV prevalence areas. The CBOs studied include many different organisations with diverse services, giving the study the benefit of assessing the overall impact of a combination of small, motivated groups. This helps lend credibility to CBOs and to convince policymakers and funders to support small-scale CBOs.

In terms of methodology, the study utilises two longitudinal datasets from southern Africa to explore the study aims. One survey is from a study of children affected by HIV served by CBOs, while the other is from a study of children affect by HIV without CBO support. There are some limitations to using two different studies, most especially unclear comparability and, in this case, lack of control data to adjust for possible differences, for example on socio-economic status or how HIV specifically affected the child. Despite these, this paper has striking results, and is an innovative effort to improve our understanding of the impact of CBOs on children’s well-being and should spur further creativity in impact evaluation methods.

South Africa
  • share

Facing uncertainty – ageing with HIV

Aging with HIV: a model of disability.

Solomon P, O'Brien K, Wilkins S, Gervais N. J Int Assoc Provid AIDS Care. 2014 Aug 22. pii: 2325957414547431. [Epub ahead of print]

The purpose of this qualitative study was to develop a theoretical model describing the disability experienced by older adults living with HIV. Forty nine HIV positive men and women over the age of 50 years participated in in-depth qualitative interviews. Transcribed interviews were analyzed using grounded theory techniques. Uncertainty or worrying about the future was at the core of the model. Components of disability including symptoms and impairments, difficulties with day to day activities and challenges to social participation were experienced in the context of extrinsic or environmental factors (social support, stigma) and intrinsic contextual factors (positive living strategies, age). Time was an overarching component of the model. The model suggests areas for interventions to prevent or reduce disability related to the consequences of aging with HIV and improve overall quality of life.

 Abstract access 

Editor’s notes: This paper is a very welcome addition to the growing body of research on HIV and ageing. Time is highlighted in the findings. Time has been regained (because treatment has kept people alive to grow old) and time is moving too fast (as individuals fear accelerated ageing because of HIV). The authors also highlight the centrality of uncertainty in the lives of the 49 people interviewed. Uncertainty is central to ageing. No-one of us knows quite how well we may remain as we age. However, the interaction between HIV and the ageing process is an added layer of uncertainty. The average age of people in this study was only 56, so they were relatively young, older people. We can expect worries over adequate social support and managing increasing ill-health and disability, will increase as people age. The authors urge us to look at the impact of HIV on older people’s quality of life as a whole, in the design of programmes. This paper is a timely reminder of the social, mental and physical burden HIV continues to impose on people’s lives.

Northern America
  • share