Researcher:
Turan, Bülent

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Bülent

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Turan

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Turan, Bülent

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2021 - 202314

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    Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV
    (Lippincott Williams and Wilkins (LWW), 2022) Pala, Andrea Norcini; Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Wilson, Tracey E.; Tien, Phyllis C.; Wingood, Gina; Neilands, Torsten B.; Johnson, Mallory O.; Weiser, Sheri D.; Logie, Carmen H.; Turan, Janet M.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Objectives: To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). Design: We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. Methods: Participants were WHIV (N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. Results: We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. Conclusion: The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
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    Relationships between patient race and residential race context with missed Human Immunodeficiency Virus (HIV) care visits in the United States, 2010-2015
    (Oxford University Press (OUP), 2023) Crockett, Kaylee B.; Schember, Cassandra O.; Bian, Aihua; Rebeiro, Peter F.; Keruly, Jeanne; Mayer, Kenneth; Mathews, Christopher; Moore, Richard D.; Crane, Heidi; Geng, Elvin; Napravnik, Sonia; Shepherd, Bryan E.; Mugavero, Michael J.; Pettit, April C.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Background Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Methods Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Results Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Conclusions Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources. In multilevel analyses, residing in census tracts with more Black residents increased the likelihood of missed HIV care visits for Black people with HIV (PWH) but not non-Black PWH. This relationship was attenuated when patient-reported behavioral outcomes were included.
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    The role of social support on cognitive function among midlife and older adult MSM
    (Lippincott Williams and Wilkins, 2023) Henderson E.R.; Haberlen S.A.; Coulter R.W.S.; Weinstein A.M.; Meanley S.; Brennan-Ing M.; Mimiaga M.J.; Turan J.M.; Teplin L.A.; Egan J.E.; Plankey M.W.; Friedman M.R.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Objective: This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.Design:We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. Methods: We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. Results:Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. Conclusion:Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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    Living with hiv during COVID-19: knowledge and worry about COVID-19, adherence to COVID-19-related precautions, and hiv health outcomes
    (Taylor & Francis, 2023) Nemli, Salih Atakan; Yigit, Ibrahim; Agrali, Burcu; Gokengin, Deniz; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    The COVID-19 pandemic has been profound impacts on mental and physical health of individuals with chronic diseases. Thus, it is important to understand the effects of the COVID-19 pandemic on people living with HIV. We aimed to assess the association between COVID-19-related knowledge and worry, HIV-related health practices and outcomes, and adherence to precautions related to COVID-19, and possible associations of these factors with HIV treatment outcomes (ART adherence and viral load). A cross-sectional survey was conducted between October 2020 and February 2021 among 291 PLWH at two large university hospital HIV clinics in Izmir, Turkey. Additionally, the most recent HIV-RNA load, CD4 count was recorded using medical records. Logistic regression analyses were performed to determine predictors of self-reported adherence to COVID-19-related precautions, ART adherence and undetectable viral load. COVID-19-related worry, COVID-19-related knowledge, and ART adherence were significant predictors of adherence to COVID-19-related precautions. Furthermore, adherence to COVID-19-related precautions was a significant predictor of both ART adherence and undetectable viral load. Findings provide a unique aspect of the interrelations of COVID and living with HIV. Since health behaviors and outcomes for COVID-19 and HIV seem to be interrelated, treatment practices and interventions that address these simultaneously may enhance their efficacy.
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    Examining the relationships between experienced and anticipated stigma in health care settings, patient-provider race concordance, and trust in providers among women living with HIV
    (Mary Ann Liebert Inc., 2021) Budhwani, Henna; Yigit, Ibrahim; Ofotokun, Igho; Konkle-Parker, Deborah J.; Cohen, Mardge H.; Wingood, Gina M; Metsch, Lisa R.; Adimora, Adaora A.; Taylor, Tonya N.; Wilson, Tracey E.; Weiser, Sheri D.; Kempf, Mirjam-Colette; Sosanya, Oluwakemi; Gange, Stephen; Kassaye, Seble; Turan, Janet M.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B =-0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to-0.624); Black patient-White provider: B =-0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to-0.062); and Black-Black: B =-0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to-0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B =-0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to-0.289); Black patient-White provider: B =-0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to-0.106); and Black-Black: B =-0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to-0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
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    Internalized HIV-related stigma and neurocognitive functioning among women living with HIV
    (Mary Ann Liebert Inc., 2022) Thompson, Emma C.; Muhammad, Josh N.; Adimora, Adoara A.; Chandran, Aruna; Cohen, Mardge H.; Crockett, Kaylee B.; Goparaju, Lakshmi; Henderson, Emmett; Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Kwait, Jennafer; Mimiaga, Matthew; Ofotokun, Igho; Rubin, Leah; Sharma, Anjala; Teplin, Linda A.; Vance, David E.; Weiser, Sheri D.; Weiss, Deborah J.; Wilson, Tracey E.; Turan, Janet M.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    The prevalence of HIV-Associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-Test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
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    The relationship between hiv pre-exposure prophylaxis stigma and treatment adherence among current HIV pre-exposure prophylaxis users in the southeastern US
    (Springer/Plenum Publishers, 2023) Van Gerwen, Olivia T.; Yiğit, İbrahim; Crockett, Kaylee B.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Despite efficacy in HIV prevention, Pre-exposure Prophylaxis (PrEP) is underutilized in the US, especially among populations at highest risk. PrEP-related stigma may play a role. We developed measures of PrEP-related stigma dimensions and PrEP adherence. We administered them to current PrEP users. We hypothesized that PrEP-related stigma would negatively impact PrEP adherence. Questionnaire measures were developed using data from previous qualitative work and existing validated HIV-related stigma measures. The resultant survey was administered to current PrEP users from two Birmingham, Alabama PrEP clinics. Plasma tenofovir disoproxil fumarate levels were collected to measure PrEP adherence. Exploratory factor analyses were performed to determine the factor structure of each PrEP-related stigma dimension (internalized, perceived, experienced, anticipated, disclosure concerns). Separate binary logistic (or linear) regressions were performed to assess associations between PrEP-related stigma dimensions and adherence (treatment adherence self-efficacy, self-reported adherence, and plasma tenofovir levels), adjusting for education, race, and time on PrEP. In 2018, 100 participants completed the survey, with 91 identifying as male and 66 as white. Only internalized stigma was associated with lower self-reported PrEP adherence. Exploratory mediation analyses suggested that the association between all stigma dimensions and self-reported PrEP adherence is mediated by PrEP adherence self-efficacy. No associations were found between any PrEP-related stigma measures and plasma tenofovir levels. Internalized PrEP stigma may reduce PrEP adherence, possibly by reducing PrEP adherence self-efficacy among experienced PrEP users. Further investigation of how stigma dimensions affect PrEP adherence in populations at risk for HIV may shed light on drivers of PrEP underutilization.
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    Patient and provider perspectives on hiv stigma in healthcare settings in underserved areas of the us south: a mixed methods study
    (Springer, 2022) Crockett, Kaylee B.; Whitfield, Samantha; Kay, Emma Sophia; Budhwani, Henna; Fifolt, Matthew; Hauenstein, Kris; Ladner, Murray D.; Sewell, Joshua; Payne-Foster, Pamela; Nyblade, Laura; Batey, D. Scott; Turan, Janet M.; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
    Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.
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    To blame or not to blame: the role of belief in free will in substance use and suicide stigma
    (Springer, 2022) N/A; N/A; N/A; N/A; Department of Psychology; Department of Psychology; Department of Psychology; Özkök, Maide Hazal; Tatar, Burcu; Ayyıldız, Tuğba Naz; Eskin, Mehmet; Turan, Bülent; Master Student; PhD Student; PhD Student; Faculty Member; Faculty Member; Faculty Member; Department of Psychology; Graduate School of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; College of Social Sciences and Humanities; College of Social Sciences and Humanities; College of Social Sciences and Humanities; N/A; N/A; N/A; 2210; 222027; 219712
    Belief in free will reflects the view that behaviors can be controlled via willpower. If a condition is thought to result from a lack of willpower, individuals with that condition may be subject to higher levels of stigma due to greater attribution of blame. In a study conducted online, we manipulated belief in free will experimentally by giving 200 Turkish participants a list of sentences about free will and asking them to explain why these statements are either true or false (depending on their randomly assigned condition). The manipulation did change significantly belief in free will and substance use stigma, but not suicide stigma. Furthermore, belief in free will mediated the effect of the manipulation on stigma related to both substance use and suicide. Efforts to reduce stigma related to substance use and suicide may include strategies to change beliefs about the role of free will in these conditions.
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    Hair cortisol feasibility and demographic correlates in a sample of older adults from Puerto Rico
    (Oxford University Press (OUP), 2022) Ballard, Erin; Crowe, Michael; Department of Psychology; Turan, Bülent; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 219712
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