Experiences of HIV among global Indigenous populations through the lens of the UN Declaration on the Rights of Indigenous Peoples.

Since its introduction in 2007, the UN Declaration on the Rights of Indigenous Peoples (UNDRIP) has been adopted by 144 countries worldwide. In a ten-point statement released in 2017, Indigenous leaders in the HIV and AIDS community established a list of truths and actions to be used for advocacy to end AIDS among Indigenous Peoples through self-determination, justice, and human rights. 15 years after the UNDRIP and 5 years after the 10-point statement, this Review asks where we are in terms of upholding the UNDRIP and the International Indigenous HIV and AIDS Community statement in relation to HIV and AIDS, and what is needed to better uphold and respond to these directives. HIV in Indigenous populations continues to intersect with multiple forms of oppression, racism, and discrimination, which are yet to be eliminated from laws, policies, and practices. Eradicating white supremacy and Indigenous-specific racism across all health systems is a bare minimum requirement to uphold Indigenous rights within health care, and must be accompanied by support for Indigenous, self-determined, culturally tailored, and community-specific health and wellness services.

Anxiety symptoms and theory of mind in older and younger adults: curvilinearity moderated by age group.

OBJECTIVES: Theory of mind (ToM), the ability to reason about mental states, declines in later life. While anxiety symptoms may predict ToM abilities, the nature of associations requires more elucidation. Further, it is unknown whether age group moderates associational patterns. We examined associations between anxiety symptoms (linear and curvilinear) and cognitive ToM (C-ToM) and affective ToM (A-ToM); and moderation by age group (older vs. younger adults). METHODS: In a sample of healthy younger (n = 90, Mage = 20.17 years) and older adults (n = 87, Mage = 71.52), we used hierarchical regressions with polynomial and interaction terms to assess the association between anxiety symptoms and ToM in younger and older adults. RESULTS: Anxiety symptoms were associated with C-ToM but not A-ToM. Age group interacted linearly with anxiety (ß = -1.64, p = .02), and with anxiety's quadratic polynomial (ß = .84, p = .04). The inverted-U shaped association in younger adults (highest C-ToM at moderate anxiety) contrasted with older adults' linear decline in C-ToM with increasing anxiety. CONCLUSION: We highlight the importance of anxiety symptoms for predicting ToM, and clarify that associations vary by age. Elucidating associations may be critical to developing interventions that improve social wellbeing.

Finding the Balance: Embracing the Two-Eyed Seeing Approach to Understand what Cultural Safety in Care Means to Older Adults Living with HIV.

Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes-Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles-indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).

Depressive symptoms among people living with HIV in permanent supportive housing: Findings from a community-based participatory study in Vancouver, Canada.

Permanent supportive housing (PSH) is an intervention addressing housing needs among marginally housed individuals. Little is known about whether and how PSH influences depressive symptoms among people living with HIV (PLHIV). This article shares results from a community-based study that, in 2016-2017, interviewed 24 residents of a PSH facility designated for PLHIV in Vancouver, Canada. The themes of taking control; social connectedness; conviviality; and relationships and supports described how the PSH environment affected depressive symptoms among the residents.

A Computerized Frailty Assessment Tool at Points-of-Care: Development of a Standalone Electronic Comprehensive Geriatric Assessment/Frailty Index (eFI-CGA).

Background: Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. Methods: An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. Results: The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Discussion: Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.