Despite improved antiretroviral treatments, people living with HIV (PLWH) continue to suffer from HIV-related fatigue and sleep disturbances. We first reviewed the definition, etiology, and research breakthroughs of HIV-related fatigue and sleep disturbances, then analyzed nurse-led symptom management studies to describe their efficacy and make recommendations for future symptom research. We searched PubMed, CINAHL, PsycInfo, Psych and Behavioral Sciences Collection, and Scopus to identify nurse-led studies on symptom management for PLWH in the past 20 years. A total of 13 experimental or quasi-experimental studies were identified. The types of interventions included exercise, cognitive behavioral therapy, coaching, and symptom management manualized self-care activities. Currently, we cannot recommend with certainty any of the tested symptom management strategies to reduce fatigue or sleep disturbances. The current findings need to be confirmed and expanded to understand optimal dosing and sustainability.

Our goal was to synthesize qualitative studies on HIV-related stigma as experienced by women living with HIV (WLWH) in the U.S. Qualitative metasynthesis techniques as developed by Sandelowski et al. (Res Nurs Health 30(1):99–111, 2007) were used to integrate and update findings on stigma in WLWH in the U.S. in 43 reports of qualitative studies conducted between 2004 and 2023 with 1118 participants. Developed themes explored a collective narrative of women first surviving the intersectionality of multiple sources of stigma, discovering non-linear pathways to transcend their stigma, and finally experiencing resilience through their transcendence of stigma. While this metasynthesis revealed similarities to an earlier metasynthesis in the ubiquity and persistence of stigma, they differ primarily in women’s abilities to find agency in managing and opposing their stigma. This cognitive reframing of their stigma helped women to redefine stigma as ignorance and move towards a more positive assessment of the self. In doing so, they separated themselves from their stigma and the damaging effects of it. Findings from this metasynthesis may serve as a useful tool for the development of stigma reduction interventions specific to the needs and experiences of WLWH in the U.S.

HIV care engagement and antiretroviral therapy (ART) adherence interventions aimed at decreasing viral suppression disparities for women living with HIV (WLWH) in the Southern United States (i.e., the South) are few and seldom consider diverse social locations. These refer broadly and dynamically to contextual factors and the position people occupy in a social hierarchy based on intersecting systems of oppression and social determinants of health like gender, race/ethnic, and class inequities; geographic location; and HIV-related stigma. Using an intersectional approach, we conducted in-depth interviews and used a phased approach to directed content analysis to describe women’s perceptions of their social location and how it impacts their decision-making about HIV care engagement and ART adherence. Participants were recruited to participate from a broad geographic area and represented the diverse social locations occupied by WLWH in the South. Findings from 40 in-depth interviews include descriptions of how geographic context impacts HIV care engagement and medication adherence through access to care, quality of care, and the place-based context of day-to-day experiences of living with HIV. Participants spoke of multilevel power relationships based on their gender and racial identities, and how social determinants and intersecting identities occur simultaneously and vary as a function of one another to impact health and HIV care decision-making. The findings offer a nuanced understanding of how WLWH perceive their contextually specific social locations and make critical decisions about their HIV care engagement and medication adherence.

Background: Women living with HIV in the Southern United States, or the South, face persistent and overlapping challenges to care engagement and antiretroviral therapy adherence, including HIV-related stigma, poverty, and inequitable access to health care. While mobile health (mHealth) interventions show promise for enhancing self-management and care engagement among people living with HIV, interventions tailored to women living with HIV remain limited, particularly those developed through participatory approaches that center their lived experiences. Objective: This study sought to evaluate the acceptability, comprehensibility, and personal relevance of targeted health messages developed for a proposed mHealth app tailored to women living with HIV in the South. In addition, it explored participants’ perceptions of the feasibility and desirability of the proposed intervention. Methods: This study represents phase 3 of a multistage, mixed methods project. Message content was informed by earlier phases, which included individual interviews, surveys, perceptual mapping with women living with HIV, and input from a community and clinician advisory board. In this phase, 3 focus groups (2 virtual and 1 in person) were conducted with 30 women living with HIV recruited from Southern HIV clinics and community organizations. Participants reviewed prototype wireframes and health messages, including SMS text message–style content, and provided feedback on all content. Data were analyzed using conventional content analysis. Results: Participants expressed strong interest in the proposed mHealth app and emphasized the importance of health messaging that is clear, supportive, and personally meaningful. Four key categories emerged: (1) acceptability of a tailored mHealth app, with participants noting the value of privacy, accessibility, and convenience; (2) acceptability of message content, including preferences for affirming, uplifting language and images; (3) personal relevance, particularly for messages addressing stigma, spirituality, family, and empowerment; and (4) comprehensibility, highlighting the need for plain language and visual clarity. Conclusions: These findings support the development of a tailored mHealth intervention for women living with HIV in the South. Co-designed messages that center affirmation, spirituality, and real-life challenges were perceived as acceptable, comprehensible, and highly relevant. Future work will focus on refining the content and prototype testing.

Breastfeeding is a complex task that requires proficiency at several key developmental skills to feed successfully. It is unclear how Autism Spectrum Disorder (ASD) affects an infant’s breastfeeding experience and conflicting reports exist on shortened breastfeeding duration in infants later diagnosed with ASD. The purpose of this study was to describe the experiences of mothers breastfeeding both their autistic and neurotypical children to better understand the differences in their breastfeeding experiences and maternal and infant factors that contributed to breastfeeding cessation in their autistic child. Twenty-four mothers of an autistic child who had feeding difficulties in the first 12 months of life, initiated breastfeeding, and also had a neurotypical child participated in semi-structured interviews regarding breastfeeding initiation, cessation, and challenges encountered during breastfeeding. Analysis revealed four major themes: (1) the struggle with latch, including infant behavior that hindered latching; (2) breastfeeding challenges, including problematic breastfeeding behavior by the infant; (3) cessation of breastfeeding, including physical symptoms of the infant that lead to breastfeeding cessation; and (4) breastfeeding the neurotypical sibling, including mother’s detection of different breastfeeding behaviors in neurotypical and autistic child. Breastfeeding behaviors described by mothers may indicate early signs of autism including early sensory sensitivity, lack of regulation, repetitive behaviors, and impaired social behaviors. Further research is needed to discern if these breastfeeding behaviors can be used to help identify early signs of autism and employed as additional surveillance for neurodevelopmental concerns at a young age.