Researcher: Turan, Janet Molzan
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Turan, Janet Molzan
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Publication Metadata only HIV and intersectional stigma among people living with HIV and healthcare workers and antiretroviral therapy adherence in the Dominican Republic(SAGE, 2024) Kerr, Jelani; Yigit, Ibrahim; Long, Dustin M.; Paulino-Ramirez, Robert; Waters, John; Hao, Jiaying; Nyblade, Laura; Varas-Diaz, Nelson; Naar, Sylvie; Bond, Christyenne L.; Budhwani, Henna; Turan, Janet Molzan; School of MedicineBackground HIV-related stigma, discrimination, and social marginalization undermines optimal HIV care outcomes. More research examining the impact of HIV-related stigma, discrimination, other interlocking forms of oppression, and antiretroviral therapy (ART) adherence is needed to optimize HIV treatment programming. This study uses data from two clinics in the Dominican Republic to examine client and healthcare worker (HCW) perceptions of HIV and intersectional stigmas among people living with HIV.Methods Surveys exploring demographics, HIV-related stigma, various dimensions of discrimination (race/ethnicity, HIV status, sexual orientation), healthcare engagement, and medication adherence were collected from 148 clients and 131 HCWs. Analysis of variance was conducted to examine differences in stigma by clinic and logistic regressions were used to determine predictors of optimal client medication adherence.Results Perceived discrimination in healthcare facilities due to clients' sexual orientation retained significance in crude and multivariable logistic regression models and was negatively associated with ART adherence (aOR:0.79; 95% CI:0.66, 0.95).Discussion Findings highlight the importance of implementing strategies to address stigma, discrimination, and social marginalization, particularly within healthcare facilities.Publication Metadata only How does poverty stigma affect depression symptoms for women living with HIV? longitudinal mediating and moderating mechanisms(Springer, 2023) Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Wilson, Tracey E.; Tien, Phyllis C.; Wingood, Gina; Neilands, Torsten B.; Johnson, Mallory O.; Logie, Carmen H.; Weiser, Sheri D.; Department of Psychology; Department of Psychology; Turan, Bülent; Turan, Janet Molzan; College of Social Sciences and Humanities; School of MedicineIn a sample of women living with HIV, we examined whether individual traits fear of negative evaluation and resilience moderate the internalization of poverty stigma that these women experience from others. We also examined the downstream effects of these processes on depression symptoms using moderated serial mediation analyses. Data were collected annually for 4 years (2016-2020; T1, T2, T3, and T4) from 369 women living with HIV at 4 US cities using validated measures. Moderation effects were evaluated examining simple slopes at one standard deviation above and below the mean of the moderator. In all mediation analyses utilizing bootstrapping, we used the independent variable measured at T1, the mediators measured at subsequent visits (T2 and T3), and the outcome at the last visit (T4) to preserve the temporal sequence among the independent variable, mediators, and outcome variable. We also adjusted for T1 values of all mediators and outcome variables in analyses. Women with stronger fears of negative evaluation by others or lower dispositional resilience had stronger associations between experienced poverty stigma and internalized poverty stigma. Internalized poverty stigma (T2) mediated the association between experienced poverty stigma (T1) and depression symptoms (T4); this mediated association was moderated by fear of negative evaluation and resilience (T1). Finally, internalized poverty stigma (T2) and avoidance coping (T3) were serial mediators in the association between experienced poverty stigma (T1) and depression symptoms (T4), moderated by fear of negative evaluation and resilience. Understanding factors that minimize internalization of stigma and buffer its negative effects on mental health can inform interventions to improve health outcomes of individuals with stigmatized conditions.Publication Metadata only Acceptability, feasibility and potential of an intervention using secret Facebook groups to complement existing HIV prevention strategies among female sex workers in Cameroon, a randomized pilot study(Routledge Journals, Taylor & Francis Ltd, 2023) Vazquez Guillamet, Laia J.; Babey, Mary Mah; Njah, Mercy; Blake, Hassanatu; Jasani, Amy; Kyeng, Rahel; Hao, Jiaying; Long, Dustin; Tih, Pius; Turan, Janet M.; Khan, Eveline Mboh; Dionne, Jodie; Turan, Janet Molzan; School of MedicineThis randomized pilot project evaluated an intervention promoting health care literacy around HIV, pre-exposure prophylaxis (PrEP), and stigma reduction using private social media groups that complemented existing HIV prevention services among female sex workers (FSWs) in Cameroon. The intervention was 12 HIV and sexual health videos tailored to FSWs that were released over 8 weeks through a secret Facebook group platform. In-person surveys were administered before, after the intervention, and three months later. No HIV seroconversions were detected; all participants completed follow-up and agreed to recommend the intervention to a coworker. Although the intervention was assessed to be acceptable and feasible to implement, poor internet connectivity was a key barrier. In time-series analysis, the intervention group participants reported improved PrEP interest, PrEP knowledge, and condom use along with reduced PrEP and HIV-related stigma, but no impact on sex-work related stigma or social cohesion. Similar results occurred in the control group. Cross-contamination and small pilot study size might have hindered the ability to detect the differential impact of this intervention. As communications technology increases in Cameroon, it is essential to learn more about FSWs preferences on the use of social media platforms for HIV prevention strategies.Publication Metadata only Longitudinal associations of experienced and perceived community stigma with antiretroviral therapy adherence and viral suppression in new-to-care people with HIV: mediating roles of internalized stigma and depression symptoms(Lippincott Williams and Wilkins, 2024) Yigit, Ibrahim; Kurt, Guelsah; Weiser, Sheri D.; Johnson, Mallory O.; Mugavero, Michael J.; Department of Psychology; Department of Psychology; Turan, Bülent; Turan, Janet Molzan; College of Social Sciences and Humanities; School of MedicineBackground:Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States.Setting/Methods:Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit.Results:Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms.Conclusions:These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.Publication Metadata only Community recommendations for promoting HIV testing to black young men who have sex with men in the southern United States(Sage, 2024) Budhwani, Henna; Outlaw, Angulique Y.; Oster, Robert A.; Mugavero, Michael J.; Johnson, Mallory O.; Hightow-Weidman, Lisa B.; Naar, Sylvie; Nash, Princess; Turan, Janet Molzan; School of MedicineBackground Considering the need to increase HIV testing among racial minority youth in the southern United States, we conducted an exploratory study in Alabama to elucidate recommendations on improving testing rates among Black young men who have sex with men (BYMSM).Methods We conducted in-depth interviews and focus groups with BYMSM and prevention and outreach workers. Data collection occurred online and in person between 2020-2022.Results Our sample included data from n = 56 BYMSM and n = 12 prevention and outreach workers. BYMSMs' mean age = 24 years. Among prevention and outreach workers, 58% identified as male with mean age = 39 years; 83% identified as Black. Transcripts were coded thematically; five concurrent themes emerged from both BYMSM and prevention and outreach workers: promoting testing at younger ages, need for visibility and outreach, connecting through shared experiences, value of nonjudgmental approaches, and need to increase HIV knowledge in BYMSM.Conclusions Findings suggest that cultivating trust is salient to promoting HIV testing in BYMSM. To end the epidemic in the southern United States, a region that is heavily rural with high rates of HIV, it may be necessary to begin prevention conversations at younger ages and equip prevention and outreach workers with communication skills that leverage de-stigmatizing approaches.Publication Metadata only Intersectional stigma, fear of negative evaluation, depression, and ART adherence among women living with HIV who engage in substance use: a latent class serial mediation analysis(Springer/Plenum Publishers, 2024) Stringer, Kristi Lynn; Pala, Andrea Norcini; Cook, Robert L.; Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Wilson, Tracey E.; Tien, Phyllis C.; Wingood, Gina; Neilands, Torsten B.; Johnson, Mallory O.; Logie, Carmen H.; Weiser, Sheri D.; Department of Psychology; Department of Psychology; Turan, Janet Molzan; Turan, Bülent; School of Medicine; College of Social Sciences and HumanitiesWomen Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma;(C2) moderate SU stigma;(C3) higher HIV and lower SU stigma;(C4) moderate HIV and high SU stigma;and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNE and depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV.Publication Metadata only Antiretroviral therapy adherence among peripartum women with HIV in Kenya: an explanatory mixed methods study using dry blood spot measures and narrative interviews(Taylor & Francis, Routledge, 2024) Hampanda, K.; Grubbs, H.; Castillo-Mancilla, J.; Anderson, P. L.; Thorne, J.; Helova, A.; Onono, M.; Abuogi, L. L.; Turan, Janet Molzan; School of MedicineAdherence to antiretroviral therapy (ART) remains sub-optimal among pregnant and postpartum women with HIV (PPWH) in high HIV prevalence low resource settings with few effective behavioral interventions. A large body of qualitative literature has established general barriers and facilitators to ART adherence in PPWH at various levels (individual, interpersonal, structural). However, research exploring the underlying behavioral mechanisms of ART adherence in PPWH with objectively verified adherence biomarkers is extremely limited. We conducted 24 in-depth interviews with postpartum women in western Kenya who had linked ART drug concentrations obtained from three dried blood spot samples across the peripartum period. Among PPWH with a low drug concentration (n = 13) compared to those with continuously high drug concentrations (n = 11), distinct themes emerged related to HIV status disclosure, social support, interactions with the health system, and health beliefs. By combining ART biomarkers with patient reported challenges, there is the potential for real-time interventions to support sustained ART adherence among PPWH and improve maternal and infant health outcomes.Publication Metadata only A moderated mediation analysis of HIV and intersectional stigmas and antiretroviral adherence in people living with HIV in the Dominican Republic(Springer/Plenum Publishers, 2024) Yigit, Ibrahim; Paulino-Ramirez, Robert; Waters, John; Long, Dustin M.; Budhwani, Henna; Turan, Janet Molzan; School of MedicineExperiencing HIV and intersectional stigmas in healthcare settings may affect antiretroviral treatment (ART) adherence among people with HIV (PWH), given their need for frequent interactions with clinical settings and healthcare providers. Considering the importance of reducing stigmas to promote well-being and the need to elucidate how stigma influences health across various settings, we examined how experienced HIV stigma in Dominican Republic healthcare settings impacts ART adherence through internalized HIV stigma and whether race or sexual orientation stigma moderates this relationship. Participants were 471 PWH (aged 17-71) who were recruited from two HIV clinics in the Dominican Republic in 2021-2022. Results revealed a significant mediation effect (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) after adjusting for effect of age and time since HIV diagnosis, suggesting that experienced HIV stigma in healthcare settings was associated with more internalized HIV stigma (B = 0.39, SE = 0.11, p = .001), subsequently linked to lower ART adherence (B=-0.26, SE = 0.11, p = .016). The indirect effect was significant at low levels of race stigma (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) but not at high levels of race stigma (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). This indirect effect was also significant at low levels of sexual orientation stigma (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) but not at high levels of sexual orientation stigma (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). These findings suggest that addressing experienced HIV stigma in Dominican Republic healthcare settings, along with various dimensions of HIV-related stigma (e.g., internalized stigma) and intersecting stigmas (e.g., race, sexual orientation), is vital for improving health outcomes, such as optimal ART adherence. Experimentar estigmas relacionados con el VIH e interseccionales en entornos de atenci & oacute;n m & eacute;dica puede afectar la adherencia al tratamiento antirretroviral (TAR) entre las personas que viven con VIH (PVVIH), dado que necesitan interacciones frecuentes con entornos cl & iacute;nicos y proveedores de atenci & oacute;n m & eacute;dica. Considerando la importancia de reducir los estigmas para promover el bienestar y la necesidad de esclarecer c & oacute;mo el estigma influye en la salud en diversos contextos, examinamos c & oacute;mo el estigma del VIH experimentado en entornos de atenci & oacute;n m & eacute;dica en la Rep & uacute;blica Dominicana impacta la adherencia al TAR a trav & eacute;s del estigma internalizado del VIH y si el estigma racial o de orientaci & oacute;n sexual modera esta relaci & oacute;n. Los participantes fueron 471 PVVIH (de 17 a 71 a & ntilde;os) que fueron reclutados de dos cl & iacute;nicas de VIH en la Rep & uacute;blica Dominicana en 2021-2022. Los resultados revelaron un efecto de mediaci & oacute;n significativo (B=-0.10, SE = 0.05, CI [-0.234, - 0.014]) despu & eacute;s de ajustar por el efecto de la edad y el tiempo desde el diagn & oacute;stico de VIH, sugiriendo que el estigma del VIH experimentado en entornos de atenci & oacute;n m & eacute;dica estaba asociado con un mayor estigma internalizado del VIH (B = 0.39, SE = 0.11, p = .001), vinculado posteriormente a una menor adherencia al TAR (B=-0.26, SE = 0.11, p = .016). El efecto indirecto fue significativo en niveles bajos de estigma racial (B=-0.16, SE = 0.09, CI [-0.369, - 0.001]) pero no en niveles altos de estigma racial (B=-0.06, SE = 0.05, CI [-0.175, 0.038]). Este efecto indirecto tambi & eacute;n fue significativo en niveles bajos de estigma por orientaci & oacute;n sexual (B=-0.19, SE = 0.10, CI [-0.401, - 0.023]) pero no en niveles altos de estigma por orientaci & oacute;n sexual (B=-0.04, SE = 0.06, CI [-0.160, 0.074]). Estos hallazgos sugieren que abordar el estigma del VIH experimentado en entornos de atenci & oacute;n m & eacute;dica en la Rep & uacute;blica Dominicana, junto con diversas dimensiones del estigma relacionado con el VIH (por ejemplo, estigma internalizado) y estigmas interseccionales (por ejemplo, raza, orientaci & oacute;n sexual), es vital para mejorar los resultados de salud, como la adherencia & oacute;ptima al TAR.Publication Metadata only Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: protocol for translational research(Elsevier, 2022) Budhwani, Henna; Paulino-Ramirez, Robert; Waters, John; Bond, Christyenne L.; Ruiz, Ingrid; Long, Dustin M.; Varas-Diaz, Nelson; Naar, Sylvie; Nyblade, Laura; N/A; Turan, Janet Molzan; Other; School of Medicine; N/ABackground: This protocol details the adaptation and pilot testing of the Finding Respect and Ending Stigma around HIV (FRESH) intervention in Dominican Republic. FRESH is a healthcare setting stigma-reduction intervention designed to reduce stigmas affecting people living with HIV (PLHIV), focusing on HIV and intersectional stigmas experienced by sexual and gender minority (SGM) people living with HIV. After the successful adaptation of the FRESH intervention, it will be pilot-tested through the conduct of a pilot stepped wedge cluster randomized controlled trial. Methods: Three aims are included in this study; Aim 1 includes exploratory qualitative assessment, specifically the conduct four focus groups with men who have sex with men (MSM) living with HIV (n = 24-32) and in-depth interviews with transgender women living with HIV to explore their experiences with stigma in clinics (n = 9-12). In-depth interviews will also be held with HIV healthcare workers to elucidate their perceptions and behaviors towards their SGM clients (n = 9-12). In Aim 2, informed by Aim 1 data, we will use the sequential phases of the ADAPT-ITT framework to iteratively adapt the FRESH intervention for the Dominican Republic. In Aim 3, the adapted intervention will be pilot-tested via a cluster stepped wedge randomized controlled trial to assess feasibility and acceptability of the intervention and study protocols. Conclusions: If this pilot trial is successful, next steps will include testing the adapted intervention across Dominican Republic or in similar Spanish-speaking Caribbean nations in a larger trial to assess effectiveness in reducing stigma in clinical settings towards PLHIV.Publication Metadata only Mhealth phone intervention to reduce maternal deaths and morbidity in cameroon: protocol for translational adaptation(Dove Medical Press, 2022) Bushwani, Henna; Enah, Comfort; Bond, Christyenne L.; Halle-Ekane, Gregory; Wallace, Eric; Szychowski, Jeff M.; Long, Dustin M.; Carlo, Waldemar A.; Tih, Pius M.; Tita, Alan T. N.; Turan, Janet Molzan; Other; School of Medicine; N/APurpose: The purpose of this NIH-funded protocol is to adapt (Aim 1) and pilot test (Aim 2) an mHealth intervention to improve maternal and child health in Cameroon. We will adapt the 24/7 University of Alabama at Birmingham Medical Information Service via Telephone (MIST) provider support system to mMIST (mobile MIST) for peripheral providers who provide healthcare to pregnant and postpartum women and newborns in Cameroon. Methods: In Aim 1, we apply qualitative and participatory methods (in-depth interviews and focus groups with key stakeholders) to inform the adaptation of mMIST for use in Cameroon. We use the sequential phases of the ADAPT-ITT framework to iteratively adapt mMIST incorporating qualitative findings and tailoring for local contexts. In Aim 2, we test the adapted intervention for feasibility and acceptability in Ndop, Cameroon. Results: This study is ongoing at the time that this protocol is published. Conclusion: The adaptation, refinement, and pilot testing of mMIST will be used to inform a larger-scale stepped wedged cluster randomized controlled effectiveness trial. If successful, this mHealth intervention could be a powerful tool enabling providers in low-resource settings to deliver improved pregnancy care, thereby reducing maternal and fetal deaths.