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Stress Among a Sample of Returning Citizens Living with HIV and Substance Use Disorder: A Mixed Methods Analysis

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Abstract

This mixed-methods study asks: among a sample of returning citizens living with HIV and substance use disorder, how is stress experienced; and what are the leading stressors and stress-coping strategies? Data is from a parent study that randomized 36 people to a yoga intervention and 36 people to treatment as usual. Qualitative analysis found that securing basic life needs was more acute in early reentry, and challenges with HIV acceptance were greater among those with a more recent HIV diagnosis. Social support was the most widely employed coping strategy but many lacked social networks. Post-program, multiple regression found older age(β = − 0.38, p < .05), greater income(β = − 0.002, p < .01), shorter incarceration(β = .03, p < .01) and randomization to yoga(β = 6.92, p < .01) predicted lower levels of stress. Results indicate that reentry needs for people living with HIV and substance use disorder include basic life needs, social supports, and stress-coping interventions that address physical and mental stress symptoms (such as yoga).

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Funding

Funding for this study was provided by NIDA (Grant F31 DA038426), NIH (Grant 5T32DA037801), The Peter F. McManus Charitable Trust, and The National Coalition of Independent Scholars. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

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Authors and Affiliations

  1. School of Social Work, University of Maryland, Baltimore, MD, USA

    Alexandra S. Wimberly, Orrin D. Ware & Alicia Bazell

  2. Johns Hopkins School of Medicine, Baltimore, MD, USA

    Erica M. S. Sibinga

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  1. Alexandra S. Wimberly
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  2. Orrin D. Ware
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Correspondence to Alexandra S. Wimberly.

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Approval was obtained from the ethics committee of the University of Pennsylvania and the service provider. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Appendices

Appendix A: Interview Questions

Stress

  1. 1)

    How do you define stress?

  2. 2)

    What are stressors that you experience during community reentry?

  3. 3)

    Do you experience certain physical and/or mental sensations when you are under stress? If yes, talk about what those sensations are.

  4. 4)

    What are ways in which you cope with stress?

  5. 5)

    In what ways do or don’t these coping mechanisms alleviate the stress successfully?

  6. 6)

    Provide an example of a recent stressor and how you dealt with that stressor.

  7. 7)

    Are there certain resources (people, programs, activities) that provide support in dealing with stress? If yes, what are those resources?

Substance Use

  1. 1)

    Does the existence of stress in your life affect your substance use?

Yoga

  1. 1.

    For people who participated in the yoga intervention of the study:

  2. •

    Did you practice anything you learned in the yoga classes outside of class? If yes, what did you practice?

  3. •

    How do you think the yoga classes affected your substance use? Your ART adherence?

Note: Qualitative interviews asked more questions about substance use and reactions to the yoga intervention, but only the questions that are relevant to this manuscript’s exploration of stress are included here.

Appendix B: questions to address potential biases

  • How do you define stress?

  • What are your experiences with people living with HIV? people with criminal justice involvement? people with substance use problems? (i.e. do you know people in the latter categories? If so, in what context- family, work, school, friends?)

  • In what way do you think social categories (i.e. race, gender, sexual identity, religion, age, etc.) that you identify with play a role in how you look at this data (just choose social categories that you think are relevant)?

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Wimberly, A.S., Ware, O.D., Bazell, A. et al. Stress Among a Sample of Returning Citizens Living with HIV and Substance Use Disorder: A Mixed Methods Analysis. Community Ment Health J 57, 884–897 (2021). https://doi.org/10.1007/s10597-020-00667-8

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