A Scoping Review of HIV Pre-exposure Prophylaxis Stigma and Implications for Stigma-Reduction Interventions for Men and Transwomen Who Have Sex with Men.

HIV remains a public health concern in the United States. Although pre-exposure prophylaxis (PrEP) can be expected to reduce HIV incidence, its uptake, adherence, and persistence remain limited, particularly among highest priority groups such as men who have sex with men and transwomen (MSMTW). Using a socioecological framework, we conducted a scoping review to examine PrEP-related stigma to inform future research, policy, and programmatic planning. Using the PRISMA extension for scoping reviews, we conducted database searches from August 2018 to April 2020 for articles addressing PrEP stigma. Studies were independently screened and coded by three authors, resulting in thematic categorization of several types of PrEP stigma on four socioecological levels. Of 557 references, a final sample of 23 studies was coded, 61% qualitative, and 87% focusing exclusively on MSMTW. Most instances of PrEP-related stigma occurred on the interpersonal level and included associations of PrEP with risk promotion, HIV-related stigma, and promiscuity. Other frequent themes across socioecological levels included provider distrust and discrimination, government and pharmaceutical industry distrust, internalized homonegativity, PrEP efficacy distrust, and anticipated homonegativity. Notably, PrEP was also framed positively as having physical and psychological benefits, and assuming responsibility for protecting one's community via PrEP awareness-raising. PrEP-related stigma persists, demanding interventions to modify its impact. Leveraging PrEP-positive discourses to challenge PrEP stigma is an emerging avenue, alongside efforts to increase provider willingness to promote PrEP routinely by reducing provider bias, aligning with the national strategy to End the HIV Epidemic.

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US.

Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

The effectiveness of shared clinical teaching in nursing.

AIM: Clinical learning is a critical component of a nursing curriculum. Student satisfaction in clinical environment is crucial to foster a positive learning experience. Faculty shortages have made clinical teaching more challenging; as such, alternate models of clinical teaching must be explored by nursing programs. The purpose of this study was to measure the perception of student satisfaction in regard to the effectiveness of shared clinical teaching in nursing. METHODS: Utilizing Chan's Clinical Learning Environment Inventory (CLEI), this quantitative comparative study examined nursing students' preferred and actual clinical learning environment. The CLEI contains 42 questions in six subscales: Individualization, Innovation, Involvement, Personalization, Task Orientation, and Satisfaction in both the actual and preferred clinical learning environment. The sample consisted of 202 nursing students in two groups: the first group had 91 students who experienced shared clinical teaching with two faculty, whereas the second group had 111 students who experienced the traditional, single faculty model. The results were analyzed using independent sample T-tests. RESULTS: The preferred learning environment was rated highest in all six subscales. Scores of the Satisfaction subscale and the Innovation subscale for Actual Learning Environment, and the score of the Innovation subscale for Preferred Learning Environment of students experiencing shared clinical teaching with two faculty were higher than the scores of students experiencing traditional, single faculty model, with statistically significance (P＜0.05). CONCLUSION: The results indicated students preferred the shared clinical teaching model with two faculty over the single faculty model. Nursing programs can utilize this model and apply these results to develop and maintain quality clinical teaching.

Cultural Predictors of Resilience in a Multinational Sample of Trauma Survivors.

The present study aims to fill a gap in the study of resilience to trauma by examining resilience in a culturally diverse population. Approximately 70% of adults across the globe experience at least one traumatic event in their lifetime, yet resilience is a common response trajectory. This pilot study explored reactions to trauma and psychological resilience in an international sample of trauma-exposed participants. Participants were recruited online using the Amazon Mechanical Turk software and after completing an informed consent, were determined eligible to participate if they endorsed experiencing at least one traumatic event. Eligible participants then completed The Stressful Life Events Questionnaire, Brief Resiliency Scale, Ego Resiliency Scale, Posttraumatic Stress Disorder Checklist-Civilian Version, Brief Religious Coping Scale, and Multigroup Ethnic Identity Measure. The final sample included 200 trauma exposed adults from nineteen different countries worldwide, with a majority hailing from the United States, India, Sri Lanka and the Philippines. Results revealed that Asian participants scored significantly higher on resilience scales and endorsed higher levels of spiritually focused coping than other subgroups. Multivariate analyses revealed that these differences in resilience remained significant even after controlling for sense of ethnic identity and spiritual coping, suggesting that there may be culturally specific predictors of resilience within the Asian subgroup. Understanding variations in resilience will aid in developing culturally tailored interventions and pursuing a strengths-based approach to recovery from trauma. Limitations and implications are discussed.