title: Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning, Meaningfulness of Life, Seroconcordance, Social Support and Considering the Need for Integrated Care.
abstract: As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.
authors.affiliation: University of Texas Medical Branch, Galveston, TX, 77550, USA. migoodma@utmb.edu.|Sodzo International, Houston, TX, 77002, USA. migoodma@utmb.edu.|, 301 University Blvd, Marvin Graves 4.314c, Galveston, TX, 77555, USA. migoodma@utmb.edu.
authors.forename: Michael L
authors.identifier: 0000-0003-1779-4698
authors.initials: ML
authors.lastname: Goodman
authors.affiliation: University of Texas Medical Branch, Galveston, TX, 77550, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Serag
authors.affiliation: Maua Methodist Hospital, Maua, Meru County, Kenya.
authors.forename: Stanley
authors.initials: S
authors.lastname: Gitari
authors.affiliation: University of Texas Medical Branch, Galveston, TX, 77550, USA.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Keiser
authors.affiliation: University of Texas Medical Branch, Galveston, TX, 77550, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dacso
authors.affiliation: University of Texas Medical Branch, Galveston, TX, 77550, USA.
authors.forename: Ben G
authors.initials: BG
authors.lastname: Raimer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D005195:Family Relations; D005260:Female; D006679:HIV Seropositivity; D006296:Health Services; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D036301:Qualitative Research; D012944:Social Support
keywords: HIV; Kenya; Mediation analysis; Overall wellness; Women