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    • In addition stigma experienced by the study participants can

    2018-10-24

    In addition, stigma experienced by the study participants can explain the low rate and inverse effect of purchase AKT inhibitor VIII participation. Stigma against PLWH is a known barrier to accessing HIV testing and care. Perceived stigma negatively affects the quality of life (QoL) of PLWH (Holzemer et al., 2007). A study from India explored two domains of social capital, group membership/network and collective action, and found a negative association between social capital and stigma, such as reduced fear of HIV transmission and lower levels of feelings of shame (Sivaram et al., 2009). High norms of reciprocity, higher levels of collective action, and perception of safety have been found to be related to lower HIV stigma (Chi et al., 2009; Sivaram et al., 2009). The study participants also had low education levels and were low-income. Socioeconomic status (SES), often measured by household income and education level, is known to be an independent predictor of overall health outcomes (Kawachi et al., 1999) and correlates with social capital, therefore, it is an important variable to examine. Controlling for SES may attenuate the association between social capital and health, but social capital is still an independent and significant predictor of health outcomes (Kawachi et al., 1999; Ziersch, Baum, Macdougall, & Putland, 2005). While the association between social capital and SES has been established, directionality between these two variables is not well understood. Therefore, focusing interventions on building supportive social networks for PLWH, may improve QoL, even among those with low SES. This study reinforced the significance of social capital in QoL—particularly, the role of social connection for PLWH. Building engaging and trust relationship in a health care setting is critical (Gilson, 2003), considering that PLWH have chronic health condition and are often marginalized. Also, engaging relationships with HCP is known to be one of the most important factors for improving HIV medication adherence (Corless et al., 2013). Therefore, health care service should not be limited to mere provision of medical services. Rather, helping PLWH to build strong connections with HCP should be an integral part of comprehensive HIV care. This study was based on a subsample of U.S. participants in a large international study. Webel et al. (2012) reported on study participants from the larger study, whose participants came from China, Canada, Namibia, and Thailand, as well as from the United States. The researchers found that social capital positively affected on QoL and had five factors—community participation, friends and family, tolerance and diversity, neighborhood connections and feelings of trust and safety, which explained 65% of the variance in social capital. Within the sample from the United States, social connection was the leading factor predicting QoL out of three factors. The factor, social connection, was drawn from 13 questions (Table 2). Thirteen items of social connection were drawn from neighborhood connections, family-and-friends connections, and feelings of trust and safety (Onyx & Bullen, 2000). Therefore, social connection is a rather generic, yet representative concept of social capital, which examines how people are well connected and perceive feelings of trust within their social networks.
    Conclusion
    Acknowledgement This project was supported by the International Nursing Network and NIH HIV/AIDS Nursing Care and Prevention Fellowship (T32NR007081). The contents of this manuscripts are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or any other funders. The authors would like to thank the many HIV-infected individuals who participated in the study.
    Introduction
    A compelling body of epidemiologic research indicates that exposure to stressful events contributes to poor health and health disparities over the life course (James, 2009; Miller, Chen & Cole, 2009). “Stress” refers to any threat or challenge to homeostasis (McEwen, 2013), and includes a broad range of exposures such as prenatal insults (Hilmert et al., 2008), early life adversity (Miller, Chen, & Parker, 2011), work (e.g., job strain), finances (e.g., poverty, food insecurity), interpersonal events (e.g., divorce, social isolation), trauma (e.g., emotional, physical, or sexual abuse), and experiences of discrimination (Abdou, Fingerhut, Jackson, & Wheaton, 2016; Turner, Wheaton, & Lloyd, 1995). While the neurobiological stress response (e.g., hypothalamic-pituitary-adrenal (HPA)-axis, sympathetic nervous system) is well-suited for addressing acute stressors, it is hypothesized that repeated, chronic activation of the body’s stress response (commonly operationalized as “allostatic load,” “weathering,” and related constructs) contributes to the development of cardiovascular and metabolic conditions in mid- and late-life (Geronimus, 1992; McEwen & Seeman, 1999; Miller et al., 2011). This process of “wear and tear” is often cited as an explanation of the large racial/ethnic and socioeconomic disparities in physical health seen in the US population (Geronimus, 1992).