HIV Health Literacy Research Articles

HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South.

HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.

Developing critical HIV health literacy: insights from interviews with priority migrant communities in Queensland, Australia

In Australia, surveillance data establish that there are higher rates of late HIV diagnoses among heterosexual migrants from Sub-Saharan Africa and new HIV diagnoses among gay and bisexual men (GBM) from Southeast and Northeast Asia and Latin America. Together, these groups are identified as priority migrant communities in current efforts to eliminate HIV transmissions. HIV health literacy is recognised as a key means of improving access to services and health outcomes. This qualitative paper explores critical HIV health literacy among priority migrant communities in Queensland, Australia. To foreground community voices, peer researchers from priority migrant communities participated in the project design, data collection and analysis, with 20 interviews completed. The findings demonstrate how participants’ engagement with HIV health information and services is highly relational and situated within the framework of sexual health and wellbeing. Participants strategically selected where to seek information and who they trusted to help them appraise this information. They further demonstrated reflective capacities in identifying the contextual barriers that inhibit the development of their HIV health literacy. The findings highlight the need for HIV health promotion strategies that embrace a sex positive approach, promote cultural change, and involve collaboration with general practitioners (GPs).

Responding to the HIV Health Literacy Needs of Clients in Substance Use Treatment: The Role of Universal PrEP Education in HIV Health and Prevention.

Health literacy, particularly HIV health literacy, is a key social determinant of health and can be significantly improved through targeted health education. This paper explores the often-overlooked potential of pre-exposure prophylaxis (PrEP) education as a powerful tool to enhance HIV health literacy among people with substance use disorders (PWSUD), a population notably susceptible to HIV. Given the syndemic interplay of substance use disorders (SUDs) and HIV, health professionals, especially substance use counselors, are uniquely positioned to bolster HIV health literacy and positively influence health outcomes. This article offers a brief introduction to PrEP, delineates potential barriers and facilitators to its use and education, and proposes strategies for effective PrEP education, implementation, and adherence. By equipping substance use counselors with essential knowledge and skills, we aim to encourage and promote the integration of PrEP education into substance use treatment. The overarching objective is to empower counselors to proactively engage in HIV prevention efforts, thereby fulfilling pressing health literacy needs and contributing to improved health outcomes among PWSUD.

Health Literacy in People Living with Human Immunodeficiency Virus Infection: A Narrative Review

Overall literacy talents comprise an individual’s capacity to read, write and recognise written information (print literacy), articulate and interpret oral language (oral literacy) and interpret and apply for numbers in everyday activities (numeracy). Health literacy, a subset of overall literacy talents, is relatively correlated with it and has been described as the extent to which people can gain, approach, and understand introductory medical information and services required to take health decisions. Concerning HIV, people with low health literacy have less information on the illness and their medical care needs. Moreover, they show poor drug compliance, potentially leading to treatment failure and lack of achievement of the target viral load reduction. The shortfall of non-conceptual models of health literacy is an issue in the utilization of general proficiency instruments. HIV disease-specific health literacy instruments would be more useful and likely to provide more meaningful results rather than those obtained through the use of general instruments. Further exploration of HIV health literacy is demanded. Prospective studies should involve different geographical areas with different socioeconomic characteristics, societal structures and regional healthcare settings. This narrative review has limitations. The vast majority of the HIV research referenced in this study was conducted among the western and African populations with HIV. The studies generally excluded individuals over 50 years of age, restricting the applicability of the study findings.

Comprehensive Knowledge of HIV and AIDS and Related Factors in Angolans Aged between 15 and 49 Years.

A comprehensive knowledge of HIV and AIDS among men and women in Africa is reportedly low. To the best of our knowledge, no studies using any definition of comprehensive knowledge of HIV and AIDS have been conducted in Angola. To address this gap, we aimed to describe the comprehensive knowledge held by individuals aged between 15 and 49 years regarding HIV and AIDS and some associated factors, using the most recent Angolan demographic and health survey (DHS). Using an observational, cross-sectional design, we analyzed data collected from 19,785 individuals aged between 15 and 49 years for the 2016 DHS in Angola. We conducted a logistic regression analysis of descriptive and complex samples to examine the data and to unravel possible factors associated with having a comprehensive knowledge of HIV and AIDS. Almost half of the respondents (47.7%) had a general comprehensive knowledge of HIV and AIDS. Individuals who watched television (adjusted odds ratio [aOR]: 2.40; 95% CI: 2.11, 2.72) or read newspapers and magazines (aOR: 1.99; 95% CI: 1.72, 2.30) more than once a week had higher odds of having a comprehensive knowledge of HIV and AIDS compared to those who did not. Similarly, having completed primary education and above (aOR: 1.83; 95% CI: 1.67, 2.00) or living in urban areas (aOR: 1.51; 95% CI: 1.34, 1.71) increased the likelihood of individuals having a comprehensive knowledge of HIV and AIDS compared to their counterparts. These results reflect inequalities that require further attention at either a research or a political level. Nevertheless, we consider that these results can assist decision-makers in advocating for continuous investment in HIV health literacy and in adapting global solutions to local Angolan contexts.

HIV-Response Intergenerational Participation Intervention Among Black Men in Ontario, Canada: Protocol for a Pilot Intervention Study.

Black men and their communities are more affected by HIV. Although they constitute less than 5% of the Ontarian population, they accounted for 26% of new HIV diagnoses in 2015, nearly half of which (48.6%) were attributed to heterosexual contact. HIV stigma and discrimination reinforce African, Caribbean, and Black men's HIV vulnerability by creating unsafe environments that deter them from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes. In response to these challenges, intergenerational strategies were identified from previous community-based participatory studies as best practices to reduce HIV vulnerabilities and promote resilience among heterosexual Black men and communities. The proposed intervention is premised on this recommendation of intergenerational intervention. The overarching objective is to engage heterosexual Black men and communities in cocreating a community centered, culturally safe intergenerational intervention to reduce HIV vulnerabilities and related health disparities. We will engage 12 diverse community stakeholders in Ontario, inclusive of heterosexual Black men, in 8 weekly sessions to evaluate existing evidence of effective HIV health literacy interventions, identify essential and relevant aspects, and work collaboratively to co-design the HIV-Response Intergenerational Participation (HIP) intervention for use with Black men and communities. Next, we will recruit 24 self-identified heterosexual Black men aged 18-29, 29-49, and ≥50 years. We will pilot and evaluate the HIP intervention with 24 heterosexual Black men from these 3 age groups (split as 2 events: a total of 12 participants in person in Toronto and 12 participants on the web in Windsor, London, and Ottawa). We will use the data obtained along with questionnaires from validated scales and focus groups to evaluate the effectiveness of HIP. The data will include HIV knowledge, perceived stigma toward people living with HIV, acceptance and uptake of HIV testing, preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and condom use. We will also collect data related to perceptions about system-level factors such as discrimination, socially misconstrued masculine identity, etc. Quantitative analysis will essentially be a univariate descriptive analysis. We will use thematic analysis to highlight the results of the focus group discussions. Finally, we will disseminate the evaluation results and engage researchers, leaders, Black men, and communities to expand the project team and scale up the intervention in Ontario and across Canada. Implementation commences by May 2023, and by September 2023, we should have produced, among others, an evidence-informed HIP intervention that can be adapted for use by heterosexual Black men and communities beyond Ontario. The pilot intervention will strengthen critical health literacy and build resilience against HIV through intergenerational dialogue among heterosexual Black men of all ages. PRR1-10.2196/48829.

Understanding Health Literacy among Bisexual Living with HIV: A Preliminary study

OBJECTIVES: This preliminary study aims to evaluate health literacy among bisexual men living with HIV. MATERIALS AND METHODS: A cross-sectional survey was conducted among 26 adult bisexual male HIV-infected patients in the HIV Clinic from October 2021 to May 2022. We applied the Thai version of the HIV-HLT to investigate health literacy among bisexual men living with HIV. RESULTS: The average age of the participants was 41.34 ± 12.41 years. 61.5% were single and 34.6% had divorced marital status. 50% had finished their bachelor degrees. Approximately half of the participants had been diagnosed with HIV infection for more than 5 years. 57.7% had adequate HIV health literacy and 26.9% had inadequate HIV health literacy, respectively. The laboratory outcome showed that 96.2% had a CD4 count of more than 200 cells/cm3 and 76.9% had a viral load of less than 20 copies/ ml. CD4 and viral load were not associated with the level of health literacy. However, all participants had no previous history of opportunistic infections within the past 6 months. CONCLUSION: Most bisexual men living with HIV have adequate health literacy. The level of health literacy is not associated with CD4 and viral load. However, opportunistic infections within the past 6 months are not reported. Therefore, a Thai version of HIV-HLT may be applied to measure health literacy among bisexual men living with HIV and could be a potential for clinical use.

HIV-related challenges and women's self-response: A qualitative study with women living with HIV in Indonesia.

HIV infection is a major public health concern, with a range of negative impacts on People Living with HIV (PLHIV). A qualitative study in Yogyakarta, Indonesia, using in-depth interviews with 26 Women Living with HIV (WLHIV) was conducted to understand HIV risk factors and impact and their access to HIV care services. This paper describes the self-response of WLHIV towards negative HIV-related experiences facing them and adds to the existing literature which tends to focus on HIV impact only, as opposed to strategies that many WLHIV have used to empower and educate themselves and their family/community. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. Our study highlighted that WLHIV experienced psychological challenges, stigma and discrimination. However, they demonstrated remarkable self-response and capacity in pursuing effective strategies and support to protect themselves, and educating themselves and others around them to rebuild trust and regain respect and acceptance. Our findings indicate that the needs of WLHIV should be addressed through policy and practice to help them cope with HIV-related psychological and social challenges effectively. Family and community members seem to play an important role in those negative challenges against WLHIV, thus there is also a need for HIV education programs for family and community members to enhance their HIV-health literacy and acceptance of PLHIV.

HIV Health literacy beyond the biomedical model: an innovative visual learning tool to highlight the psychosocial complexities of care

ABSTRACT The HIV care continuum represents a linear clinical pathway from testing to viral suppression; however, it does not capture the psychosocial complexities of contemporary HIV care. We developed an innovative and appealing visual learning resource to extend the scope of HIV health literacy beyond biomedical constructs. Based on the lived experiences of recently diagnosed people living with HIV in Queensland, the “Journeys through the HIV Care Continuum” Map presents the continuum as a complex journey incorporating challenges such as poor health literacy, health service access and stigma alongside facilitators to care, including emotional and peer support. Designed for audiences who may not access academic literature, the Map can be used to facilitate conversations between recently diagnosed people living with HIV and peer navigators, and as a learning tool for health professionals, carers and students. The Map highlights opportunities to support PLHIV in meaningful ways that will reduce stigma and promote care access.

"I Haven't Been Ill, I Know It's There": a Case Study Examination of the Social, Behavioral, Clinical, and Structural Factors that Contribute to Sustained Viremia Among Women Living with HIV.

Compared to their HIV-seropositive male counterparts, HIV-seropositive women are less likely to achieve and retain viral suppression (VS). Data regarding the social, behavioral, clinical, and structural factors that facilitate or impede viral suppression among HIV-seropositive women is needed. This study aims to examine HIV-seropositive women's perceptions regarding factors that contribute to their HIV treatment decisions. Two case studies describe the HIV treatment decision-making of two never suppressed, HIV-seropositive women aged 65 and 54. The framework method of analysis was employed to obtain a descriptive overview of three interrelated areas of inquiry: (1) the meanings women give to VS; (2) social, behavioral, clinical, and structural obstacles related to HIV medication adherence; and (3) women's perceptions of what they need to achieve and sustain (VS). The meaning of VS for both women is influenced by how they currently feel. Women's general feeling of wellness detracts from any sense of urgency that may be associated with engaging in HIV treatment. Mistrust of medical providers and unstable housing/unemployment pose as obstacles to medication adherence. Finally, women's accounts of what they need to achieve and remain virally suppressed are influenced by a gap in understanding related to HIV treatment. HIV clinicians should routinely measure their patients' HIV health literacy to ensure patients understand when to begin and why they should continue an HIV treatment regimen. To increase their capacity to provide appropriate HIV care, providers should take into consideration how patients' life experiences and social locations influence their HIV treatment decision-making.

HIV health literacy and knowledge of young adults studying at a US university

Health literacy is an individual’s understanding of and ability to make decisions related to health information. High levels of health literacy are beneficial in making informed health-related decisions. Knowledge related to HIV is relevant to society as >36 million individuals are estimated to be living with HIV worldwide. This research study explored HIV knowledge of young adults enrolled at a university in the US. Study participants (N = 105) completed the Brief HIV-Knowledge Questionnaire. While the mean survey score was 77%, participants aged 18–19 years scored an average of 54%. Those who had been tested for HIV scored significantly higher than those who had not been tested. Moreover, 64% reported having an HIV-negative status but only 39% reported having been tested for HIV. The results indicate that HIV education related to transmission, protection, and testing are needed.

Journeys to HIV testing and diagnosis among adults aged 50+ years in England: A qualitative interview study.

ObjectivesIn England, older adults (aged ≥50 years) are at greater risk of being diagnosed with advanced stage HIV infection than younger adults. We explored journeys to testing and diagnosis among older adults, examining factors associated with late HIV diagnosis in this age group.MethodsSemi-structured qualitative interviews were performed with 12 adults diagnosed with HIV at age 50+ years and 12 health care professionals working in sexual health/HIV services. Data were analysed thematically, using the Model of Pathways to Treatment as a framework for analysis.ResultsOlder adults were often found to experience non-linear and complex diagnostic journeys. Pathways to diagnosis were affected by 6 factors: (i) the non-specific nature of HIV symptoms and their misattribution as being age-related; (ii) symptom severity, impact, and visibility; (iii) HIV health literacy; (iv) perceptions of HIV risk; (v) geographical location; and (vi) assessment in non-specialist settings.ConclusionsOlder adults appear to encounter additional barriers to HIV testing compared with younger people, particularly when they are not part of a group targeted in HIV prevention and testing campaigns. To diagnose HIV more promptly in adults aged 50+ years, HIV knowledge and risk perception must increase in both older people and health care professionals. Health care professionals need to look beyond the ‘high risk’ groups that are most affected by HIV and consider HIV more readily in the diagnostic process.

Feasibility and Acceptability of an Adolescent-Friendly Rap Video to Improve Health Literacy Among HIV-Positive Youth in Urban Peru

Clinical outcomes among adolescents living with HIV (ALHIV) might be improved by interventions aimed at addressing limited health literacy. We developed a Spanish-language rap video on HIV concepts and examined its acceptability and feasibility as a learning tool among ALHIV in Lima, Peru. Twenty-eight ALHIV receiving care at an urban pediatric hospital and ten stakeholders engaged in the care of adolescents watched the video. Adolescents completed a pre- and post-video questionnaire. We conducted focus groups with ALHIV and in-depth interviews with stakeholders and analyzed transcripts to identify themes. ALHIV described concepts of CD4 cell count and viral load as they were portrayed. Participants reported the video was relatable, accessible, and provided hope that ALHIV could lead healthy lives and advocated for future videos to address topics such as transmission and sexual health. Questionnaires indicated some improvement in viral load knowledge. An HIV health literacy music video intervention was feasible to implement and accepted by ALHIV and their healthcare providers. Communicating HIV knowledge via music videos may be promising; further study is needed to optimize implementation.

Can a brief peer-led group training intervention improve health literacy in persons living with HIV? Results from a randomized controlled trial

ObjectiveThe goal of this study was to determine if a 6-week, peer-led intervention improves health literacy and numeracy among people living with HIV (PLWH). MethodsWe used a randomized controlled trial with repeated measurements, which included six, 90-minute, group-based training sessions. We recruited PLWH participants (n = 359) from safety-net practices in the New York City Metropolitan area and Rochester, NY. Participants were randomly assigned (1:1) to an intervention group (n = 180) or a control group (n = 179). Outcome measures were collected at baseline, eight weeks post-baseline, and at six months using the Brief Estimate of Health Knowledge and Action-HIV (BEHKA-HIV), the Electronic Health Literacy Scale (eHEALS), the Rapid Estimate of Adult Literacy (REALM), and the Newest Vital Sign (NVS). ResultsThe intervention group had statistically significant improvements in eHealth literacy and BEHKA-HIV compared to the control group. There were no statistically significant changes in general health literacy or numeracy in either group. The intervention had the greatest impact on participants with the lowest levels of eHealth literacy at baseline. ConclusionThe intervention had a positive impact on participants’ HIV health literacy and eHealth literacy. Practice implicationsOur findings have implications for broadening the function of peer-workers in the health care continuum.

Preliminary Study: Reliability of HIV Health Literacy Test (HIV-HLT) among People Living with HIV

OBJECTIVE: The aim of this study is to test validity and reliability of HIV-HLT among people living with HIV. MATERIALS AND METHODS: All 42 participants who visit HIV clinic, Thammasat University Hospital, October 2019 were enrolled. Participants were patients aged 18 - 64 years old, diagnosed with HIV infection. We developed a 20-item scale in 2019. The principal components analysis was used to assess the construct validity and reliability of the 20-item scale. The HIV health literacy test is to assess health literacy needed to participate in HIV care. RESULTS: A total of 42 participants were included in this study. A mean age was 44.95±12.31 years old. 42.8% of the participants graduated with a bachelor's degree. One third of the participants had an income of ≥25,000 baht per month. Of all participants, 42.9% had been diagnosed with HIV for ≥5 years. 92.9% had a CD4 count more than 200 cells/cm3 and 81% had viral load below 20 copies/ml. The corrected item-total correlation of 20 items were higher than 2 with Cronbach’s alpha of 0.89. CONCLUSIONS: HIV-HLT was a reliable instrument. A further study is required to confirm whether items are appropriately under each domain.

HIV stigma reduction and health literacy education program with a cross-generational populaton in an African American faith-based church

The aim of this study was to implement a HIV stigma reduction/health literacy educational program to investigate HIV stigma reduction and HIV knowledge and health literacy expansion within a cross-generational African American faith center on the west side of Chicago. The study included a community-based mixed method design, enveloped with elements of “stigma reduction, intergroup contact and religious social capital” theories, analyzed a sample size of fourteen (N = 14) faith center participants’ pre- and post-assessment scores and their direct quotes gathered from focused observations. The study presented significant difference found in HIV knowledge (p = .007), and (HIV) health literacy (p = .041). Additionally, significant difference was found in four out of fifteen HIV stereotypes subscales scores on the Stereotype About AIDS Questionnaire. The study suggests that HIV stigma has potentiality to reduce within the African American faith center population contrary to previous studies where HIV stigma reduction was not evident. The intervention model provided a protocol for partnership development between this faith center and the local community hospital infectious disease program to address HIV stigma, HIV knowledge and health literacy (HIV health literacy).

HIV health literacy, sexual behaviour and self-reports of having tested for HIV among students

The HIV prevalence among young South African adults makes it important to understand their HIV knowledge, sexual behaviour and HIV counselling and testing (HCT) behaviour in this group. This paper presents the demographics, knowledge, sexual behaviour and cues to action as reported by sexually active students’ who had HCT. A cross-sectional study conducted in 10 high schools in the eThekwini and Ugu districts, KwaZulu-Natal, surveyed students’ HIV knowledge, sexual behaviour and HCT behaviour. Complete information was available from 1 114 (97.9%) students who participated in the survey. Of these, 378 (33.9%) were sexually active and were included in this analysis. Logistic regression models tested for significant associations between the independent and the dependent variables under study, nesting the students within schools and controlling for age, sex, grade and school location (urban/rural).The median age of students was 17 years (range: 14–23 years) with most being male (n=287; 75.9%). The lifetime median number of sexual partners of students was 3 (range: 1–27). Students who used condoms with their regular partners were more likely to have had counselling for HIV (OR :1.79; 95% CI: 1.06–3.01). Those students who were more likely to have been tested for HIV were female (OR: 44.90; 95% CI: 7.77–259.38), those who had always used a condom with their non-regular partner (OR: 2.75; 95% CI: 1.01–7.47), and those who knew a person who had tested for HIV (OR: 15.28; 95% CI: 5.16–45.23). Targeting students, especially males early in adolescence and reinforcing safe sex behaviour messages through their high school years, can encourage HCT among students.

Health Literacy as a Process: Caseworker Perspectives on HIV Health Literacy

Health status and health literacy are interrelated. Previous research suggests that this relationship must be considered when providing services to HIV positive individuals. However, the pathways through which health literacy affects HIV remain unclear. This study seeks to understand the connections between health literacy and HIV from a caseworker perspective. Results suggest that caseworkers reject static definitions of health literacy by conceptualizing it as an emergent process. Caseworkers also expressed the need for development of subcomponents upon which health literacy is founded: (a) the building of trust, and (b) understanding clients' hierarchy of needs.

Effects of a Treatment Adherence Enhancement Program on Health Literacy, Patient–Provider Relationships, and Adherence to HAART among Low-Income HIV-Positive Spanish-Speaking Latinos

The impact of an adherence enhancement program for low income HIV-infected Spanish-speaking Latinos on health literacy, patient-provider relationships, and adherence to HAART was examined. Evaluations were conducted at baseline, 6 weeks, and 6 months for participants (n = 85) randomly assigned to either the intervention group or a comparison group; 69 (81%) remained in the study for the entire 6-month duration. The intervention group scored significantly better than the comparison group on 3 of 5 measures of HIV health literacy at 6 weeks and on 2 of 5 measures, at 6 months. While there was a weak trend for the intervention group to report an increase in self-efficacy of medication adherence management, baseline to 6 weeks, no other changes were significant. Perceptions of the quality of relationship and communications with their HIV-treating physicians improved both at 6 weeks (p = 0.04) and at 6 months (p < 0.001). The comparison group showed little change baseline to 6 weeks and baseline to 6 months. While there was a trend for the pilot group to report better medication adherence, these differences were not statistically significant. Further evaluation of the impact of this adherence enhancement program is needed.