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Characteristics of HIV+ Women of Color in Medical Care Settings with Unmet Core Needs for Self-Determination. Evelyn Byrd Quinlivan, Lynne C. Messer, Heather Parnell, and Katya Roytburd University of North Carolina – Chapel Hill, Duke University. Presenter Disclosures. Evelyn Byrd Quinlivan.

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  1. Characteristics of HIV+ Women of Color in Medical Care Settings with Unmet Core Needs for Self-Determination Evelyn Byrd Quinlivan, Lynne C. Messer, Heather Parnell, and Katya Roytburd University of North Carolina – Chapel Hill, Duke University

  2. Presenter Disclosures Evelyn Byrd Quinlivan • The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months No relationships to disclose

  3. HIV and Women • 33% HIV + Maryland, Connecticut, New Jersey, Delaware, Virgin Is. • 25% of USA HIV population • AIDS rates are • 35 times higher for black women • 5 times higher for Latinas • 2 times higher for Native Americans freeclipart.com

  4. HIV Women of Color Initiative • Special Project of National Significance, HRSA • Increase entry and retention in care • 11 sites in USA • 1 North Carolina site

  5. Requirements to be “In Care” • Medical visits • Blood draws • Medication adherence • Coordination of resources • Sharing of personal story

  6. MOTIVATION CONTINUUM(Ryan and Deci) • Amotivation: No intention • External:Compliance, External Rewards /Punishments • Introjected:Self control, Internal rewards/punishment • Identified:Personal Importance, Values • Integrated:Synthesis w/ self • Intrinsic:Interest, Enjoyment, Satisfaction

  7. Self-Determined Behavior wikipedia

  8. Guide to Healing • Nurse Guide • Systems Navigation • Education • Relationship building • Autonomy support womenshistory.about.com

  9. Methods • 186 unique HIV+ WOC attending medical clinic • 99% were African- American. • Interviews: • Self-determination Needs • (Basic Psych Needs, in general) • Trauma • WHO Trauma Scale • Psychological Abuse • Index of Psychological abuse • Other items • Linear regression models for predictors of self-determination constructs.

  10. Demographics 10% in Non-permanent Housing

  11. Autonomy Scale Tier 1 N=17 b6 Baseiine

  12. Relatedness Scale Tier 1 N=176 Baseline

  13. Competency Scale Tier 1 N=176 Baseline

  14. Trauma Tier 1 N=176 Baseline

  15. Autonomy & Low Education. Tier 1+2 N=189 (Baseline)

  16. Adult trauma does not alter autonomy. Tier 1+2 N=189 (Baseline)

  17. Child trauma & autonomy. Erased by demographics and psychological abuse. Tier 1+2 N=189 (Baseline)

  18. Psychological Abuse & Reduced Autonomy. Tier 1+2 N=189 (Baseline)

  19. Relatedness & low education, unemployment. Tier 1+2 N=189 (Baseline)

  20. Adult trauma & relatedness Assoc. erased by child trauma. Tier 1+2 N=189 (Baseline)

  21. Child trauma & reduced relatedness. Tier 1+2 N=189 (Baseline)

  22. Psychological Abuse, no effects seen. Tier 1+2 N=189 (Baseline)

  23. Competency, education, unemployment. Tier 1+2 N=189 (Baseline)

  24. Adult trauma, erased by child trauma. Tier 1+2 N=189 (Baseline)

  25. Child trauma erased by adult trauma. Tier 1+2 N=189 (Baseline)

  26. Psychological Abuse , Competency Tier 1+2 N=189 (Baseline)

  27. Summary • Low Autonomy, Relatedness, Competency are expressed by HIV+ women of color. • Less than HS<=> Autonomy, Relatedness, Competency. • Not working <=> Relatedness. • Adult trauma <=> no independent effect • Child trauma <=> lowered Relatedness • Psychological Abuse <=> low Autonomy and Competence

  28. Cons and Pros • Women in clinic • Associations are seen; can not conclude causality • African-American population, can not make conclusions about other populations • 189 / 380 women • Standard instruments used • Diversity in age, education

  29. Conclusions • Addressing self-determination needs may promote • Retention-in care • Adherence to medication • Engagement in healthy living • Future directions: • Clinical assessment tools • Intervention tools

  30. Acknowledgements • Ryan White Program SPNS program (HA15148) • Center for AIDS Research (P30-A150410). • Clinic staff advisors • Lynda Bell, NP, Natasha Bowditch, LCSW, Jonah Pierce, RN • Collaborations • AdaAdimora • Data Management • Donna Safely, Sammy Tcwhenko, Darren Weber, Kim Walker • Interviewers • Randi Gordan, DeaPapjorgii, Nancy DeSousa, Jenn Huff, Mary Key • Patients who share their stories with courage.

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