Care For People Living With HIV/AIDS Research Articles

Psychological Distress in a Population of People Living with HIV/AIDS in Nigeria: Association with Socio-demographics and Perceived Social Support

Background: Recent improvement in the care of People living with HIV/AIDS (PLHA) continues to change the face of HIV infection from a deadly disease to a chronic illness with attendance psychological sequelae. The objective of this present study was to examine the rate of psychological distress (PD), and its association with socio-demographics and perceived social support among PLHA. Methods: This cross-sectional study was conducted among a population of PLHA in Ado-Ekiti, Nigeria. Participants completed a socio-demographic questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), and the 10-item Kessler Psychological distress scale. Relationship between sociodemographic variables, social support and PD were examined using bivariate and multivariate analyses. Results: Of 324 participants, 26.5% were experiencing PD. Being a female, unemployed, having no spouse, no post-test counseling or non-disclosure of status increases the odds of developing PD while the absence of complications significantly reduces the risk of developing psychological distress [OR=0.31 (95% CI: 0.17-0.56), AOR=0.20 (95% CI: 0.09-0.45)]. There was a significant negative correlation between PD and MSPSS (r= -0.116, p=0.037) and its Significant others subscale (r= -0.276, p=0.001). Conclusions: The study findings emphasize the importance of enhancing social support systems for people living with HIV/AIDS in a bid to reduce psychological distress. Similarly, disclosure of illness and ensuring post-test counseling are essential in preparing PLHA to cope effectively after testing. Incorporating psychological assessment as well as care for PLHA will go a long way in improving treatment outcomes.

Viruses and oral diseases in HIV-infected individuals on long-term antiretroviral therapy: What are the risks and what are the mechanisms?

As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS-defining cancers, some non-AIDS-defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non-HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high-risk human papillomaviruses (HR-HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non-invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.

The Roles of Spirituality in People Living with HIV/AIDS: A Qualitative Meta-synthesis

This qualitative research synthesis was conducted to explore the roles of spirituality in people living with HIV/AIDS (PLWHA) by using a systematic literature review and a meta-ethnographic method. CINAHL, PubMed, Science Direct, Clinical Key, Wiley Library Online, Thai LIS and Thai Jo databases were searched for articles published from 2000 to 2018. Eleven studies involving 310 participants were included. According to the findings, the following positive roles of spirituality for PLWHA were identified: 1) enhancing peace and happiness; 2) cultivating inner strength; 3) illness understanding and self-acceptance; 4) improving self-healthcare; 5) developing a sense of compassion; 6) finding purpose in life; 7) maintaining hope; and 8) creating relationships and a sense of connection. Nevertheless, a negative role of spirituality for PLWHA, internalized conflict, was also identified. Evidence from this study can provide in-depth understanding for healthcare providers to create spiritual care for PLWHA. Keywords spirituality, spiritual roles, HIV/AIDS, qualitative meta-synthesis DOI: 10.31524/bkkmedj.2019.02.020

Dynamics of Treatment Supporters and Patients Starting HIV Therapy in Lima, Peru.

As per the National HIV Program in Peru, the designation of a patient-elected treatment supporter is a requisite for starting antiretroviral therapy (ART). These individuals are expected to aid the patient in medical and social support. This qualitative study examines the interaction between treatment supporters and people living with HIV/AIDS (PLWHA) to elucidate key dynamics contributing to care. Twenty individual interviews with treatment supporters were analyzed alongside 5 group interviews: 2 groups of treatment supporters, 2 groups of PLWHA, and 1 group of community health workers. Findings characterized formal means of treatment support and informal emotional and instrumental support. Gradual transfer of treatment responsibilities from supporters to PLWHA was found to foster a sense of self-efficacy among PLWHA, and when paired with open communication and committed emotional support, created an ideal reciprocal relationship. However, lack of HIV-related knowledge among treatment supporters was detrimental. More training and systemic support for treatment supporters may optimize their role as informed participants in the care of PLWHA.

Analysis on funds application of community based organizations involved in HIV/AIDS response and government financial investment in China, 2014

Objective: To understand the government financial investments to community based organizations (CBO) involved in HIV/AIDS Control and Prevention of China and its influencing factors. Methods: Questionnaire of the situation of CBO involved in HIV/AIDS control and prevention were designed, and filled by the staff of Provincial Health Administrative Departments of 31 provinces (autonomous regions and municipalities). The research focused on the fields of CBO involved in HIV/AIDS response in 31 provinces (autonomous regions and municipalities), including intervention on HIV/AIDS high risk population (female sex worker (FSW), man who sex with man (MSM), drug user (DU) and case management and care for people living with HIV/AIDS (PLWH)). 29 valid questionnaires were collecting, with Shanxi Province and Inner Mongolia Autonomous Regions not filled. Questionnaire included financial supports from local governments, transfer payment from central government for CBO involved in HIV/AIDS response in 2014, and unit cost for CBO involved in HIV/AIDS control and prevention. Multivariate analysis was conducted on the project application and financial investment of community based organizations involved in HIV/AIDS control and prevention in 2014. Results: The total amount of CBO to apply for participation in AIDS prevention and control was 64 482 828 Yuan in 2014. The actual total amount of investment was 50 616 367 Yuan, The investment came from the central government funding, the provincial level government funding, the prefecture and county level government funding investment and other sources of funding. 22 of 28 provinces (autonomous regions and municipalities) received the funds from the central government finance, and median of investment funds 500 000 Yuan. 15 provinces (autonomous regions and municipalities) gained the funds from the provincial government finance, and median of investment funds 350 000 Yuan. 12 provinces (autonomous regions and municipalities) got the funds from the prefecture and county level government finance, and median of investment funds 408 750 Yuan. 12 provinces (autonomous regions and municipalities) acquired the funds from other sources, and median of investment funds 228 400 Yuan. The median (P(25), P(75)) unit costs of intervention for FSW from 16 provinces (autonomous regions and municipalities) was 70 (23, 280) Yuan per year; DU from 14 provinces (autonomous regions and municipalities) was 83 (44, 200 ) Yuan per year; MSM from 16 provinces (autonomous regions and municipalities) was 100 (35, 280) Yuan per year; the follow-up and care for PLWH from 17 provinces (autonomous regions and municipalities) was 200 (45, 500) Yuan per year. Multivariate linear regression analysis results showed that the amount of PLWH in 2014 influenced on the total number of application funds of CBO involved in HIV/AIDS response (b=178.11, 95% CI: 51.86-305.36) and the amount of PLWH (b=77.72, 95% CI: 16.28-139.16), and Gross Domestic Product (GDP) per capita of the province (b=36.20, 95% CI: 4.60-67.80) impacted financial investment to CBO involved in HIV/AIDS response, respectively. Conclusion: Funds application and financial investment of CBO involved in HIV/AIDS control and prevention were huge. Financial investment from government was main resources for CBO in 2014. The amount of financial investment funds from governments was influenced by the HIV/AIDS epidemic situation and the development level of local economic.

Knowledge and psychosocial wellbeing of nurses caring for people living with HIV/AIDS (PLWH)

The challenges of caring for people living with HIV (PLWH) in a low-resource setting has had a negative impact on the nursing profession, resulting in a shortage of skilled nurses. In response to this shortage and perceived negative impact, we conducted a descriptive, cross-sectional study to describe the level of knowledge and psychosocial wellbeing of nurses caring for PLWH at a regional hospital in Limpopo Province, South Africa. A total of 233 nurses, the majority being female, participated and were stratified into professional nurses (n =108), enrolled nurses (n = 58) and enrolled nursing auxiliaries (n = 66). Data were collected using HIV/AIDS knowledge questionnaire, Maslach Burnout Inventory; AIDS Impact Scale and Beck's Depression Inventory. The total knowledge score obtained by all the participants ranged from 2 to 16, with an average of 12.93 (SD = 1.92) on HIV/AIDS knowledge. Depersonalization (D) (83.7%) and emotional exhaustion (EE) (53.2%) were reported among participating nurses caring for PLWH. Burnout was higher among professional nurses as compared to both enrolled nurses and enrolled nursing auxiliaries. There was a moderate negative significant correlation between HIV knowledge with the nurses' emotional exhaustion (r = 0.592), depression (r = 0.584) and stigma and discrimination (r = 0.637). A moderate to high level of burnout was evident among all levels of nurses. These findings lead to the recommendations for support of nurses caring for PLWH that include structured nursing educational support, organisational support with respect to employee wellness programmes that address depression and work burnout, as well as social support. The provision of these support mechanisms has the potential of creating a positive practice environment for nurses in the Vhembe District of the Limpopo Province in particular, and South Africa in general, and in improved care for PLWH.

Book Review: Stigma, Discrimination, and Living with HIV/AIDS: A Cross-Cultural Perspective

Book Review: Stigma, Discrimination, and Living with HIV/AIDS: A Cross-Cultural Perspective

HIV/AIDS and psychological distress: The experience of outpatients in a West African HIV clinic

BackgroundThe experience of psychological distress by People Living with HIV/AIDS (PLWHA) often impacts the HIV care outcome negatively. This study was set out to determine the prevalence and correlates of psychological distress among PLWHA attending an outpatient clinic. Material and methodsThree hundred participants who consented and met the inclusion criteria were recruited using systematic random sampling method. The participants were administered questionnaires to elicit their socio-demographic/clinical profile. This was followed by the administration of 12-item General Health Questionnaire (GHQ-12) to assess for the presence of psychological distress. Data were analyzed using Statistical Package for Social Sciences version 15 (SPSS-15). ResultsThree in every ten participants were observed to experience psychological distress. Socio-demographic and clinical factors, which include lack of family support, unemployment, family history of mental illness and co-morbidity of other medical conditions were associated with psychological distress among the participants (p≤0.05). On the other hand, factors like being married, absence of other medical conditions and longer duration of Highly Active Anti-retroviral Therapy (HAART) seem protective against psychological distress. ConclusionsThe adoption and practice of a holistic approach, with inclusion of psychosocial dimension in the care of PLWHA is advocated.

The Role of Cultural Practices and the Family in the Care for People Living With HIV/AIDS Among the Igbo of Anambra State, Nigeria

The HIV/AIDS pandemic is one of the worst epidemics that have been experienced by humankind. It is indeed a major event of our time. The pandemic has killed so many people around the world and Sub-Saharan Africa is the worst hit. The nature of the pandemic lent it to stigma and discrimination, which have made caring for people living with HIV/AIDS (PLWHA) a big problem. It has also brought so much suffering on PLWHA around the world. This article examines the role of culture and the family in the care for PLWHA in Anambra State. Quantitative and Qualitative data collection methods (questionnaire and in-depth interviews) are used to elicit information from respondents. A total of 1000 copies of a questionnaire were administered on adult males and females and 914 were completed and analyzed. Furthermore, in-depth interviews were conducted on 10 opinion leaders using an interview guide. Data were analyzed in themes based on the objectives and the data from in-depth interviews were used to support data from the questionnaire. The results showed that certain cultural practices such as cultural obligations to sick, blood relations, collective ownership of children, affinity to blood relations, and strong marital bond enhance care and support for PLWHA. Also, the burden of care for PLWHA was found to be on the family in the study area. In conclusion, cultural practices and the family play major roles in the care for PLWHA in the area and should be harnessed in order to make life more comfortable for PLWHA.

Neurocognitive impairment in PLWHA: Clinical features and assessment

No Abstract Available

Institutionnalisation d'un continuum de prise en charge des séropositifs VIH/sida à Hanoï (Viêt-Nam)

Caring for people living with HIV/AIDS (PLWHA) encompasses various tasks, from prevention to palliative care. It involves a set of consistent and coordinated actions. This article presents the first free-of-charge management programme including antiretroviral treatment in Vietnam (as opposed to research and evaluation programmes). It was launched in 2004 in Hanoi. Our study was conducted in 2003-2004 as part of a collaborative research programme led by IRD (Research Institute for Development) and the National Economic University in Hanoi and was funded by ESTHER (Together for a Therapeutic Solidarity in Hospital Network) group. Data collection included 68 qualitative interviews with patients, members of their families and members of the hospital staff, observations of outpatient consultations, and analysis of inpatient files. The results show that patients, their families and hospital staff members all perceive a comprehensive care and treatment programme as very important and consider that it should include social and psychological care as well as an integrated set of actions involving various types of participants. Outpatient and inpatient care are closely linked: they take place in the same hospital department, they involve patients with similar social and demographic characteristics marked by multiple risk behaviours and recourse to several kinds of healthcare services. The observation of outpatient consultations showed the limitations of strictly biomedical care to which social and psychological care were added only lately. One of the principal difficulties is patients' difficulties in keeping their outpatient appointments. Overall, patients consider themselves lucky to able to receive care and treatment with antiretroviral drugs. They nevertheless complain about the lack of social and psychological support, which they expect should help them to tolerate and adapt to their biomedical treatment and to include counselling and information about this treatment and its consequences. Hospital staff with the greatest contact with PLWHA report more frequent attempts to avoid this contact. This stigmatisation is due to lack of information, failure to implement workplace safety measures, and to pejorative representations of HIV/AIDS. Official and unofficial discourse still follows the Ministry of Health in associating HIV/AIDS with drug use and commercial sex, and HIV/AIDS prevention and control policy is still linked to the "social evils" policy. Hospital staff also emphasized the importance of community care for PLWHA in their interviews. Informal care for PLWHA by family, close relatives, close friends and members of non-official groups complements hospital care, which is sometimes limited to its biomedical component and provides the material, moral, financial, social, economic and relational care essential for PLWHA and their close relatives and friends. This informal care has also some pernicious effects and leads to internal contradictions due to the multiple social roles played by the many and various participants involved. HIV/AIDS prevention and control policy relies on a series of choices between more specificity through vertical programmes specialised in HIV/AIDS and the synergy that can develop through more integrated health services. Vietnam has developed links between HIV/AIDS prevention and control programmes on the one hand, and harm reduction programmes for injecting drug users (access to substitution products such as methadone) and condom distribution, on the other. Nonetheless, HIV/AIDS prevention and control policy faces difficulties in reaching its objectives. The results of this policy, intended to help achieve Millennium Development Goal (MDG) n degrees 6, depends partly on the success for other MDGs, including the fight against poverty, the promotion of gender equality and empowerment of women, and the improvement of reproductive health. To be able to succeed in implementing the continuum of care necessary for treating HIV/AIDS within its institutions, Vietnam can apply the lessons of international experience, adapted to fit local constraints and the social, cultural and political context. The shortcomings encountered in this endeavour shows how difficult it is for this country to implement such a complex set of measures at an accelerated pace. They should not, however, hide or minimize the great efforts, the vigour, and the capacity to adapt already demonstrated by local participants.

Stress, needs, and quality of life of family members caring for adults living with HIV/AIDS in Taiwan

The stress, needs and quality of life (QoL) of family members of people living with HIV/AIDS (PLWHA) are critical to explore in Taiwan where home care projects are not available to help the PLWHA families. We examined the extent of stress, needs, QoL and its correlates that family caregivers of PLWHA experienced with structural questionnaires survey. A total of 50 family caregivers of PLWHA visiting a medical center in Taiwan participated in the study from October 2005 to August 2006. Family caregivers felt most stressful on disclosure and stigma issues, and most worried about patients’ interpersonal relationships. The most important needs were care-related needs including knowledge of the disease progression, methods of examination and treatment, and the related side effects. The level of stress significantly positively correlated with needs, and negatively correlated with QoL. Availability of alternative manpower to care PLWHA and being PLWHA's parents were two significant factors affecting family caregivers’ QoL. In conclusion, family members of PLWHA experienced high level of stress, enormous caring needs, and poor QoL. A family-centered care for PLWHA and their families in the community is crucial to improve quality of care and to prevent family's overload, particularly for families with no alternative manpower and for those being PLWHA's parents.

Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria

Objectives The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria.Methods A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted.Results Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p < 0.05).Conclusions Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.

Vulnerable Populations in Thailand: Giving Voice to Women Living With HIV/AIDS

Thailand was the first Asian country hit by the AIDS epidemic, and in the 1990s reported the fastest spread of HIV/AIDS in the world. According to Thailand's Ministry of Public Health, women, primarily between the child-bearing ages of 15 and 49, are increasingly becoming infected with HIV. A number of factors contribute to the increasing AIDS epidemic, including the rise of the commercial sex industry in Thailand; social disparities that have existed between men and women throughout Thailand's history; and the gender-expectations faced by Thai women toward family and society. Thailand enjoys one of the oldest, reputedly successful primary health care delivery systems in the world; one that relies on community health workers to reach the most rural of populations. In the mid-1990s, day care centers were established at district hospitals by the Thai government to provide medical, psychological, and social care to people living with HIV/AIDS (PWA). Buddhist temples also provide a source of alternative care for PWAs. However, the AIDS policy of the Thai government relies on families to care for the country's sick. Although poor women are a vulnerable population in Thailand, they are changing the paradigm of AIDS stigma while providing a significant cost-savings to the Thai government in their caregiving activities. Based on existing nursing studies on Thailand, this chapter gives voice to poor Thai women living with HIV/AIDS, and examines how they make sense of their gendered contract with society and religion while being HIV/AIDS caregivers, patients, or both.

Pain and Palliative Care for People Living with HIV/AIDS in Asia

Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. Access to adequate pain relief and palliative care is impeded by the barriers which face PLHA in Asia. These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.