Online Program

Reframing Positive: Exploring determinants of engagement in HIV care through photovoice

Tuesday, November 3, 2015

Jennifer Briggs, MSW, CAS-Carrera Adolescent Pregnancy Prevention Program, Community Service Council of Greater Tulsa, Tulsa, OK
Marianna Wetherill, PhD, MPH, RDN-AP/LD, Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, College of Public Health, Tulsa, OK
Samantha Franklin, AAS, Tulsa CARES, Tulsa, OK

Of the 1,448 Oklahomans diagnosed with HIV/AIDS between 2009-2013, only 57.8% are engaged in medical care.  A low-incidence state, Oklahoma communities may require different interventions to promote retention in care than other states with larger HIV incidence.  Persons living with HIV/AIDS can provide policy makers and program administrators with valuable insight into determinants of retention in care.


Photovoice, a participatory research process that combines photographs with participant narratives to stimulate social action, was used to explore patient-perceived barriers and facilitators to healthy living with HIV.  Participants were recruited from an AIDS service organization in an urban Oklahoma community (n = 7).  After orientation to the process, participants took photos to capture their experiences. Participants then collaborated to create narratives for selected photos and to identify common themes.  


Participants identified negative experiences with the health care system, including provider discrimination and a lack of autonomy in their treatment decisions, stigma, and social isolation as barriers to health. Participants identified hope, social support, and specific service agencies as supportive of health.


Program administrators working to improve retention rates should consider the lived perspectives of HIV patients. Provider discrimination and authoritarian-style treatment may deter retention in care, while strategies to engage patients in treatment decisions in a stigma-free environment may promote retention in care.  Researchers and program administrators should consider incorporating chronic disease self-management or other patient-centered interventions as a component of retention in care efforts, while working with providers to correct misperceptions about HIV.

Learning Areas:

Advocacy for health and health education
Other professions or practice related to public health

Learning Objectives:
Describe facilitators and barriers to retention in treatment and care as perceived by HIV patients. Recognize potential applications of photovoice as a community-based research method for informing retention in care initiatives

Keyword(s): Community-Based Research (CBPR), HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I served as the research coordinator for this project and was involved in its design, study recruitment, and analysis of data collected including qualitative analysis of discussion transcripts and photos. My practice-based experience includes social work, HIV/AIDS program delivery and administration, and sexual health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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