%0 Journal Article %J Cogn Behav Pract %D 2013 %T The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence. %A Shiu, Cheng-Shi %A Chen, Wei-Ti %A Simoni, Jane %A Fredriksen-Goldsen, Karen %A Zhang, Fujie %A Zhou, Hongxin %X

China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence-favorably evaluated in the West-for Chinese HIV-positive patients. The adaptation process was theory-driven and covered several key issues of cultural adaptation. We considered the importance of interpersonal relationships and family in China and cultural notions of health. Using an evidence-based treatment protocol originally designed for Western HIV-positive patients, we developed an 11-step Chinese Life-Steps program with an additional culture-specific intervention option. We describe in detail how the cultural elements were incorporated into the intervention and put into practice at each stage. Clinical considerations are also outlined and followed by two case examples that are provided to illustrate our application of the intervention. Finally, we discuss practical and research issues and limitations emerging from our field experiments in a HIV clinic in Beijing. The intervention was tailored to address both universal and culturally specific barriers to adherence and is readily applicable to generalized clinical settings. This evidence-based intervention provides a case example of the process of adapting behavioral interventions to culturally diverse communities with limited resources.

%B Cogn Behav Pract %V 20 %P 202-212 %8 2013 May %G eng %N 2 %R 10.1016/j.cbpra.2012.05.005 %0 Journal Article %J AIDS Patient Care STDS %D 2012 %T Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. %A Rao, Deepa %A Desmond, Michelle %A Andrasik, Michele %A Rasberry, Tonya %A Lambert, Nina %A Cohn, Susan E %A Simoni, Jane %K Acquired Immunodeficiency Syndrome %K Adaptation, Psychological %K Adult %K African Americans %K Feasibility Studies %K Female %K Focus Groups %K HIV Seropositivity %K Humans %K Medication Adherence %K Middle Aged %K Patient Acceptance of Health Care %K Prejudice %K Social Stigma %K Stereotyping %K Surveys and Questionnaires %K Women's Health %X

Observational studies have examined the prevalence and impact of internalized stigma among African American women living with HIV, but there are no intervention studies investigating stigma reduction strategies in this population. Based on qualitative data previously collected, we adapted the International Center for Research on Women's HIV Stigma Toolkit for a domestic population of African American women to be consistent with Corrigan's principles of strategic stigma change. We implemented the intervention, led by an African American woman living with HIV, as a workshop across two afternoons. The participants discussed issues "triggered" by videos produced specifically for this purpose, learned coping mechanisms from each other, and practiced them in role plays with each other. We pilot tested the intervention with two groups of women (total N=24), measuring change in internalized stigma with the Stigma Scale for Chronic Illness before and after workshop participation. Sixty-two percent of the participants self-reported acquiring HIV through heterosexual sexual contact, 17% through intravenous drug use, 4% in utero, and 13% did not know the route of transmission. The intervention was feasible, enthusiastically accepted by the women, and led to decreased stigma from the start of the workshop to the end (p=0.05) and 1 week after (p=0.07) the last session of workshop. Findings suggest the intervention warrants further investigation.

%B AIDS Patient Care STDS %V 26 %P 614-20 %8 2012 Oct %G eng %N 10 %R 10.1089/apc.2012.0106 %0 Journal Article %J Cultur Divers Ethnic Minor Psychol %D 2011 %T Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale. %A Balsam, Kimberly F %A Molina, Yamile %A Beadnell, Blair %A Simoni, Jane %A Walters, Karina %K Adaptation, Psychological %K Adolescent %K Adult %K Aged %K Aggression %K Bisexuality %K Ethnic Groups %K Female %K Focus Groups %K Homosexuality %K Humans %K Male %K Middle Aged %K Prejudice %K Self Report %K Sex Factors %K Social Desirability %K Stereotyping %K Stress, Psychological %K Surveys and Questionnaires %K Washington %K Young Adult %X

Lesbian, gay, and bisexual individuals who are also racial/ethnic minorities (LGBT-POC) are a multiply marginalized population subject to microaggressions associated with both racism and heterosexism. To date, research on this population has been hampered by the lack of a measurement tool to assess the unique experiences associated with the intersection of these oppressions. To address this gap in the literature, we conducted a three-phase, mixed method empirical study to assess microaggressions among LGBT-POC. The LGBT People of Color Microaggressions Scale is an 18-item self-report scale assessing the unique types of microaggressions experienced by ethnic minority LGBT adults. The measure includes three subscales: (a) Racism in LGBT communities, (b) Heterosexism in Racial/Ethnic Minority Communities, and (c) Racism in Dating and Close Relationships, that are theoretically consistent with prior literature on racial/ethnic minority LGBTs and have strong psychometric properties including internal consistency and construct validity in terms of correlations with measures of psychological distress and LGBT-identity variables. Men scored higher on the LGBT-PCMS than women, lesbians and gay men scored higher than bisexual women and men, and Asian Americans scored higher than African Americans and Latina/os.

%B Cultur Divers Ethnic Minor Psychol %V 17 %P 163-74 %8 2011 Apr %G eng %N 2 %R 10.1037/a0023244 %0 Journal Article %J AIDS Patient Care STDS %D 2011 %T "You must take the medications for you and for me": family caregivers promoting HIV medication adherence in China. %A Fredriksen-Goldsen, Karen I %A Shiu, Cheng-Shi %A Starks, Helene %A Chen, Wei-Ti %A Simoni, Jane %A Kim, Hyun-Jun %A Pearson, Cynthia %A Zhao, Hongxin %A Zhang, Fujie %K Adult %K Anti-HIV Agents %K Caregivers %K China %K Family %K Female %K Health Knowledge, Attitudes, Practice %K HIV Infections %K Humans %K Incidence %K Interviews as Topic %K Male %K Medication Adherence %K Middle Aged %K Motivation %X

China is experiencing a rapid increase in the incidence of HIV infections, which it is addressing proactively with broad implementation of antiretroviral therapy (ART). Within a cultural context extolling familial responsibility, family caregiving may be an important component to promote medication adherence for persons living with HIV in China. Based on 20 qualitative interviews with persons living with HIV and their family caregivers and a cross-sectional survey with 113 adults receiving HIV care at Beijing's Ditan outpatient clinic, this mixed-methods study examines family caregivers' role in promoting adherence to ART. Building upon a conceptual model of adherence, this article explores the role of family members in supporting four key components enhancing adherence (i.e., access, knowledge, motivation, and proximal cue to action). Patients with family caregiving support report superior ART adherence. Also, gender (being female) and less time since ART initiation are significantly related to superior adherence. Since Chinese cultural values emphasize family care, future work on adherence promotion in China will want to consider the systematic incorporation of family members.

%B AIDS Patient Care STDS %V 25 %P 735-41 %8 2011 Dec %G eng %N 12 %R 10.1089/apc.2010.0261