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.

Peer advice can provide emotional, social and practical assistance for the sustained self-management of chronic conditions. For stigmatised diseases such as HIV, finding support can be challenging. Women living with HIV in the Southern USA are additionally impacted upon by region-specific barriers such as stigma, poverty and limited access to services. The effectiveness of peer advice has been studied, yet little is known about the advice shared amongst women living with HIV. Therefore, we aimed to qualitatively explore the context and content of the advice participants offered to other women. With the assistance of a Community Clinician Advisory Board, women were recruited from across the US Centers for Disease Control and Prevention South Census Region. In-depth interviews were conducted with (N = 40) participants, aged 23 to 72 years (M = 51.2). Qualitative inductive thematic analysis was used to explore both the solicited and unprompted advice shared during individual interviews. Analysis of interview transcripts revealed three advice themes: Consistency in disease management Practical, non-medical advice; and Emotional and social support. The findings are valuable in shaping future peer-delivered programmes and interventions to enhance HIV care engagement, medication adherence, and the well-being of women living with HIV in the Southern USA.

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.

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.

Introduction: Older women living with HIV (WLWH) experience a heightened burden of stigma, compounded by age, gender, social isolation, and depression. Despite growing recognition of these challenges, few stigma reduction interventions are specifically designed for this population, particularly in the Southern United States.Methods: We explored the acceptability, personal relevance, and perceived effectiveness of a stigma reduction video series tailored for older WLWH. The videos were developed based on findings from a prior qualitative metasynthesis and reflected the lifecycle of stigma across key themes. A single in-person focus group with 18 older WLWH was conducted at an HIV service organization in the Southern U.S. Participants viewed the videos and provided feedback through structured discussions. Qualitative descriptive analysis and thematic analysis were used to identify key themes.Results: Participants, predominantly African American/Black women with a mean age of 59 years and an average of 24 years since HIV diagnosis, responded positively to the videos. Four major themes emerged: (1) resurfacing memories of early HIV-related stigma; (2) the persistence of internal and perceived stigma; (3) growth, acceptance, and advocacy with aging; and (4) preferences for video format and content, including a desire for more dynamic visuals, expanded educational material, and representations of the full journey of living with HIV from diagnosis to long-term survivorship.Discussion: Brief, narrative-driven videos rooted in lived experiences show promise as a stigma reduction strategy for WLWH. Future interventions should incorporate multigenerational perspectives, expand educational content, and leverage visually engaging formats to enhance relevance and impact.

Purpose: Early detection and management of hypertensive disorders during pregnancy and postpartum are essential. This systematic review and meta analysis aimed: (1) to examine the state of 24-hour ambulatory blood pressure (ABP) use, and (2) in a subset of studies, evaluate 24-hour ABP parameters in the prediction and identification of Hypertensive Disorders of Pregnancy (HDP). Methods: A comprehensive literature search was conducted in March of 2022 for English language studies published after 2000. In a subset of studies in this review, we conducted a meta analysis summarizing 24-hour, day, and night standardized mean difference (hedge’s g) in systolic and diastolic blood pressure during pregnancy for individuals later diagnosed with HDP and those without. Results: A total of 69 articles met all established criteria and were included in this systematic review, and a subgroup of studies that reported HDP outcomes (n=14) were included in the meta analysis. Out of the 69 studies, 31 (45.61%) used 24-hour ABP devices that are not validated for pregnant individuals. Birthing individuals diagnosed with HDP had elevated 24-hour, day, and night systolic and diastolic blood pressure during second and third trimesters of pregnancy. Conclusion: A noticeable gap exists in the utilization of validated 24-hour ABP devices for pregnant and postpartum populations. Variations exist regarding the timing of 24-hour ABP measurements, particularly across trimesters. Implications for practice: 24-hour ABP monitoring could serve as one of the tools to identify and manage pregnant individuals at risk of HDP and ultimately reverse the current trend in maternal mortality.