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Burnout among nurses is prevalent and has worsened during the COVID-19 pandemic. Trauma-informed care (TIC) is an approach that can bring healing to people and systems who have been impacted by trauma and traumatic events. Nurses working in hospitals experience vicarious trauma and secondary traumatic stress as they witness what their individual patients experience; however, nurses themselves experience traumatic events and that has only escalated with the current pandemic. Working from a model of Trauma-Informed Healthcare (TIHC) and SAMSHA foundations of a trauma-informed approach (TIA) we identify opportunities for organizations such as hospitals to integrate TIA towards altering the system to better provide for nursing staff who are suffering from burnout and exhaustion. We offer an exemplar of an organizational-level approach to supporting nursing staff through TIA.

This study examines healthcare providers' perceptions regarding experiences and factors that contribute to adherent and non-adherent behaviors to HIV treatment among women living with HIV infection in Puerto Rico and describes strategies implemented to improve adherence. Providers' accounts revealed that women with HIV infection are living "beyond their strengths" attempting to reconcile the burden of the illness and keep adherent. Factors putting women beyond their strengths and influencing non-adherence behavior were: gender-related demands, fear of disclosure, and treatment complexity. Strategies to improve adherence included: ongoing assessment, education, collaborative work, support groups, networking, disguising pills, readiness, and seeking medications outside their towns. Provider-patient interactions are critical for women's success and must assess all these factors in developing and providing health services.

Medication adherence is an effective approach to prevent HIV transmission. In Mozambique, a country with a generalized epidemic, the government has adopted Positive Prevention (PP) training for clinicians as part of its national strategy. Our study, conducted after trainings in five clinics, examined the understanding of trained health care staff and their patients about the importance of adherence to antiretroviral therapy (ART), a key element of PP. Interviews with trained clinicians (n = 31) and patients (n = 57) were conducted and analyzed. Clinicians and patients demonstrated an understanding that ART adherence could decrease HIV transmission. However, participants also highlighted the difficulties of adherence when patients had limited access to food. At the same time that treatment as prevention awareness was increasing, poverty and widespread food insecurity were barriers to taking medications. In Mozambique, the full benefits of treatment as prevention may not be realized without adequate access to food.

Persons of color incarcerated in prisons and jails in the United States continue to be disproportionately affected by the HIV epidemic. Several state and city departments of health have received federal funding to develop and implement or to expand innovative strategies or models of HIV prevention, case management, and discharge planning services for racial/ethnic minority inmates in correctional facilities. This article provides an overview of service models for county jails and emphasizes the need for strategies to improve the health of the inmate and the community to which he or she will return.

AbstractIntroductionTo examine the HIV care continuum for transwomen living in San Francisco and to determine factors associated with poor HIV‐related health outcomes.MethodsData were collected from 2016 to 2017 with transwomen in San Francisco. Respondent‐driven sampling (RDS) was used to recruit a population‐based sample. Bivariate associations were assessed, and RDS‐weighted multivariable logistic regression was used to identify associations between exposures and outcomes along the HIV care continuum.ResultsOf the 123 self‐identified transwomen in this analysis, ages ranged from 23 to 71 years with a majority identifying as Latina (40.8%) and African American (29.2%). An estimate of 14.3% of participants were not engaged in care, 13% were not currently on antiretroviral therapy (ART), 22.2% had a self‐reported detectable viral load and 13.5% had unknown viral load. Those using hormones had lower odds of not being on ART compared to those who did not use hormones. Those with unstable housing had a higher relative risk ratio of having a detectable viral load. Those who experienced both anti‐trans discrimination and racism had higher odds of not being in HIV care.ConclusionsSan Francisco has made substantial progress engaging transwomen in the HIV care continuum, but the final push to ensure viral suppression will require addressing social determinants. Future interventions to increase HIV care engagement, ART use and viral suppression among transwomen must address housing needs and risks related to the overlapping effect of both anti‐trans discrimination and racism.

Social media tools have been touted as an approach to bring more democratic, and effective, communication networks to health care and to improve the experiences of those either receiving or delivering it. At the same time there are risks associated with social media use. We conducted a multi-site cross-sectional study among persons living with HIV (PLWH) to understand their social media use. We conducted a secondary analysis of data collected from the parent study to understand technology use among PLWH in the US and the association between social media use and body-mass index (BMI). Our primary predictor variable was social media use. Our primary outcome was BMI measured through height and weight during the study visit. Descriptive statistics were used to describe the demographic profiles of the study participants and linear regression models were used to analyze associations between the outcome and predictor variables controlling for demographic characteristics. Study participants (N=606) across 6 study sites in the United States (US) were predominately 50–74 years old (67%). 33% of study participants had a normal weight (BMI 18.5–25), 33% were overweight (BMI 25–30), and 32% were obese (BMI>30). Participants used several social media sites with Facebook (45.6%) predominating with more than five-times as many people using this site than Google+ (8.4%) and Instagram (6.1%). Social media use was associated with higher BMI in study participants (p<.001) and this effect persisted, although not as strongly, when limiting the analysis to those who only used Facebook (p=.03) or only used other social media sites (not including Facebook) (p=.03). Further consideration of social factors that can be ameliorated to improve health outcomes are timely and needed.

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care. ; This work was supported by the HIV/AIDS nursing Care and Prevention, National Institutes of Health [J32 NR007081] (Portillo); Irwin Belk Distinguished Professorship, University of North Carolina Wilmington; K24DA037034 (Johnson); and the Government of Botswana Human Resources Development Council.