Abstract
Purpose: Youth living with HIV experience stigma, mental health challenges, and barriers to engagement in care. Silver linings are positive shifts in perception, connection, or opportunity that arise from adversity. This project examined silver linings across two studies of youth living with HIV and explored associations with stigma, trust, mental health, and viral suppression.
Methods: An integrated mixed methods design was used. The first study (Colorado, USA) was a cross-sectional survey of 109 youth that assessed stigma, mental health, trust in the healthcare relationship, viral load, and one open-ended item on silver linings. The second study (Texas, USA) included semi-structured interviews with a separate group of youth with HIV. Quantitative analyses included chi-square, Fisher's exact, and Wilcoxon rank sum tests, along with mean differences and correlation strength. Qualitative data from free-text responses and interviews were analyzed using reflexive thematic analysis.
Results: Youth who reported silver linings had lower HIV stigma scores (p = 0.03) and lower mean viral load values (0.25 vs. 0.43). Silver linings were moderately correlated with viral suppression (r = −0.22, p = 0.028). Trust scores were also higher in the silver lining group. Youth who did not report silver linings described higher stigma and emotional distress. Qualitative findings reflected themes of gratitude, advocacy, health awareness, and stronger relationships. A central theme described taking better care of oneself and others, including attention to medication adherence and health behaviors. A separate theme reflected the absence of silver linings among youth who continued to encounter stigma, isolation, mistrust, and cultural barriers.
Implications for Nursing: Strength-based and relationship-centered approaches can support youth engagement in HIV care. Silver linings were linked with lower stigma, stronger trust, and favorable viral patterns, suggesting that positive meaning-making may support adherence. Taking better care of oneself and others aligns with core HIV goals, since adherence promotes personal health, reduces transmission risk, and supports infant health. These findings reinforce the public health principle that an undetectable viral load prevents sexual transmission (U=U). Nurses can foster silver linings by reducing stigma, building trust, supporting culturally aligned communication, and helping youth identify sources of meaning and connection.
Notes
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References:
Barskova, T., & Oesterreich, R. (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health. Disability & Rehabilitation, 31(21), 1709–1733. https://doi.org/10.1080/09638280902738441
Barr, E. A., Raybin, J. L., Bennett, C. R., & Smith, M. C. (2024). Silver linings: A principle-based concept analysis examining the emergence of positive changes that accompany adversity. International Journal of Nursing Studies Advances, 7, 100243. https://doi.org/10.1016/j.ijnsa.2024.100243 Drewes, J., Langer, P. C.,
Ebert, J., Kleiber, D., & Gusy, B. (2021). Experienced and internalized HIV stigma, adversarial growth, and health outcomes among people aging with HIV in Germany. AIDS and Behavior, 25(4), 1037–1046. https://doi.org/10.1007/s10461-020-03061-3
Lennon-Dearing, R. (2022). “HIV is a gift”: Posttraumatic growth in women with HIV. Illness, Crisis & Loss, 30(2), 224–239. https://doi.org/10.1177/1054137320906559
Milam, J. E. (2004). Posttraumatic growth among HIV/AIDS patients. Journal of Applied Social Psychology, 34(11), 2353–2376. https://doi.org/10.1111/j.1559-1816.2004.tb01981.x
Pieta, M., & Rzeszutek, M. (2022). Posttraumatic growth and well-being among people living with HIV: A systematic review and meta-analysis in recognition of 40 years of HIV/AIDS. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 31(5), 1269–1288. https://doi.org/10.1007/s11136-021-02990-3
Sodergren, S. C., & Hyland, M. E. (2000). Positive consequences of illness. Psychology & Health, 15(1), 85–97. https://doi.org/10.1080/08870440008400290
Yang, X., Wang, Q., Wang, X., Mo, P. K. H., Lau, J. T. F., & Wang, L. (2020). Interpersonal resources and posttraumatic growth among women living with HIV in China. AIDS and Behavior, 24(6), 1687–1700. https://doi.org/10.1007/s10461-019-02694-3
Sigma Membership
Gamma Kappa
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Health Equity or Social Determinants of Health, Public and Community Health, Theory, HIV-Positive Youth, Medical Care, Social Stigma
Recommended Citation
Barr, Emily Anne; Lingwall, Mary Catherine; Basani, Himabindu Reddy; Vennekotter, Joanna S.; Goldsmith, Alyssa; Crane, Joseph; Anthony, Leah Jane; Malone, Re'Undre; and Brady, Veronica, "Silver Linings Among Youth Living With HIV: An Integrated Mixed Methods Analysis" (2026). International Nursing Research Congress (INRC). 146.
https://www.sigmarepository.org/inrc/2026/presentations_2026/146
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-12
Silver Linings Among Youth Living With HIV: An Integrated Mixed Methods Analysis
Toronto, Ontario, Canada
Purpose: Youth living with HIV experience stigma, mental health challenges, and barriers to engagement in care. Silver linings are positive shifts in perception, connection, or opportunity that arise from adversity. This project examined silver linings across two studies of youth living with HIV and explored associations with stigma, trust, mental health, and viral suppression.
Methods: An integrated mixed methods design was used. The first study (Colorado, USA) was a cross-sectional survey of 109 youth that assessed stigma, mental health, trust in the healthcare relationship, viral load, and one open-ended item on silver linings. The second study (Texas, USA) included semi-structured interviews with a separate group of youth with HIV. Quantitative analyses included chi-square, Fisher's exact, and Wilcoxon rank sum tests, along with mean differences and correlation strength. Qualitative data from free-text responses and interviews were analyzed using reflexive thematic analysis.
Results: Youth who reported silver linings had lower HIV stigma scores (p = 0.03) and lower mean viral load values (0.25 vs. 0.43). Silver linings were moderately correlated with viral suppression (r = −0.22, p = 0.028). Trust scores were also higher in the silver lining group. Youth who did not report silver linings described higher stigma and emotional distress. Qualitative findings reflected themes of gratitude, advocacy, health awareness, and stronger relationships. A central theme described taking better care of oneself and others, including attention to medication adherence and health behaviors. A separate theme reflected the absence of silver linings among youth who continued to encounter stigma, isolation, mistrust, and cultural barriers.
Implications for Nursing: Strength-based and relationship-centered approaches can support youth engagement in HIV care. Silver linings were linked with lower stigma, stronger trust, and favorable viral patterns, suggesting that positive meaning-making may support adherence. Taking better care of oneself and others aligns with core HIV goals, since adherence promotes personal health, reduces transmission risk, and supports infant health. These findings reinforce the public health principle that an undetectable viral load prevents sexual transmission (U=U). Nurses can foster silver linings by reducing stigma, building trust, supporting culturally aligned communication, and helping youth identify sources of meaning and connection.
Description
This presentation explores silver linings, defined as positive shifts that arise from adversity, using two complementary studies of youth living with HIV. Silver linings were linked with lower stigma, stronger trust, and HIV viral suppression. Themes included gratitude, advocacy, health awareness, and caring for oneself and others, including greater attention to medication adherence.