HIV-positive Family Members Research Articles

Delayed ART initiation in "Test and Treat era" and its associated factors among adults receiving antiretroviral therapy at public health institutions in Northwest Ethiopia: A multicenter cross-sectional study.

Antiretroviral therapy (ART) has shown promising effects on the reduction of new HIV infection as well as HIV-related morbidity and mortality. In order to boost the effect of ART on ending HIV epidemics by 2030, the World Health Organization (WHO) indeed introduced a universal test and treat strategy in 2015 that recommends rapid (within seven days) initiation of ART for all HIV-positive patients. However, in low-income countries, a substantial number of HIV-positive patients were not enrolled in time, and information on delayed ART initiation status in Ethiopia is limited. A multicenter cross-sectional study was conducted on 400 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northwest Ethiopia. A structured checklist was used to extract data from the patient's medical record. Data was entered into Epi-data version 4.6 and exported to SPSS version 26 for further analysis. Both simple and multivariable binary logistic regressions were executed, and variables with a p-value < 0.05 in the final model were considered significant predictors of delayed ART initiation. The magnitude of delayed ART initiation was 39% (95% CI: 34%-44%). Being male [Adjusted odds ratio(AOR) = 1.99, 95%CI:1.3-3.2], having opportunistic infections (OIs) [AOR = 2.50, 95%CI:1.4-4.6], having other chronic diseases [AOR = 3.70,95%CI:1.7-8.3], substance abuse [AOR = 3.79, 95%CI: 1.9-7.4], having ambulatory functional status [AOR = 5.38, 95%CI: 1.4-9.6] and didn't have other HIV-positive family member [AOR = 1.85, 95%CI: 1.2-2.9] increases the odds of delayed ART initiation. The burden of delayed ART initiation is found to be high. The presence of OIs and other chronic problems, substance abuse, ambulatory functional status, being male, and not having other HIV-positive family members were identified as significant predictors of delayed ART initiation. Special emphasis needs to be considered for those individuals with the identified risk factors.

Assessment of Health-Related Quality of Life and Associated Factors Among HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) at Ambo General Hospital, West Shewa, Ethiopia.

BackgroundDetermining the degree of health-related quality of life (HRQoL) and associated factors in human immunodeficiency virus (HIV)-positive people is of great importance.ObjectiveThe aim of this study was to assess the HRQoL and associated factors among HIV-infected patients who were on highly active antiretroviral therapy (HAART) at Ambo General Hospital.MethodsA study with a cross-sectional design was conducted on 296 HIV-infected patients who were on HAART at Ambo General Hospital from February 20 to May 20, 2019. Patients were recruited by a random sampling technique and a P-value <0.05 was set as statistically significant. Th main outcome measure was HRQoL.ResultsThe majority of study participants were female (56.8%). More than half (53%) of the participants had low overall HRQoL. Those who were married and who earned <1500 ETB were less likely to experience low overall HRQoL than single people (AOR: 4.41, P=0.024) and those who earned more (AOR: 4.27, P=0.000), respectively. Those with current illness and who had no HIV-positive family members were more likely to experience lower overall quality of life than those with no current illness (AOR: 32.29, P=0.000) and with one HIV-positive family member (AOR: 4.03, P=0.003), respectively. Those with recent WHO clinical stage I were less likely to experience a lower overall quality of life than those with stage II (AOR: 0.07, P=0.000).ConclusionCurrent illness, recent WHO stage and having no HIV-positive family members were found to be strongly associated with lower quality of life in HIV-positive patients on antiretroviral therapy.

HIV/AIDS-related stigma, immediate families, and proactive coping processes among a clinical sample of people living with HIV/AIDS in Philadelphia, Pennsylvania.

People living with HIV/AIDS (PLWHA) engage in proactive coping behaviors to minimize the risk of interpersonal stigma. This study explores proactive coping processes in navigating HIV/AIDS-related stigma within immediate families. Data for this study come from 19 one-on-one, qualitative interviews with a diverse, clinical sample of PLWHA in Philadelphia, PA. Thematic analysis indicated that participants continue to experience enacted, anticipated, and internalized forms of HIV/AIDS-related stigma. Participants discussed status concealment and selective disclosure as proactive coping resulting from anticipated stigma and physical distancing as proactive coping motivated by internalized HIV/AIDS-related stigma. Study findings demonstrate how living with a stigmatized condition can affect PLWHA social interactions with close networks like immediate families, specifically in eliciting stigma-avoidant behaviors. Anti-stigma efforts that educate immediate families to overcome stigmatizing attitudes and provide HIV-positive family members with high-quality social support should be coupled with efforts that target health-promotive self-management strategies for PLWHA.

Change in knowledge and attitude about HIV/AIDS in sub-Saharan Africa, 1990–2017: an analysis of national survey data

Abstract Background People's knowledge of and attitude to HIV/AIDS are key contributors to the success of public-health interventions. However, evidence on country-level HIV/AIDS knowledge and attitudes is still scarce across sub-Saharan countries. To address this knowledge gap, we have gathered evidence to estimate national trends in HIV/AIDS knowledge and attitude from 1990 to 2017 across 46 sub-Saharan African countries. Methods We retrieved national surveys that have indicators of HIV/AIDS knowledge and attitude from Global Health Data Exchange (GHDx). There are ten indicators of knowledge of HIV transmission and risk reduction and four indicators that reflect attitude towards people living with HIV/AIDS. We extracted individual-level data on knowledge and attitude in a systematic and consistent way and collapsed these into country-level estimates. Multi-level multiple imputation was used to impute missing indicators on country level and we used spatial-temporal Gaussian process regression (ST-GPR) to estimate the trend of each indicator in each country. Findings We included 313 national surveys in the study. From 1990 to 2017, most knowledge indicators slightly increased across all countries. However, the trends of knowledge on HIV mother-to-child transmission during pregnancy vary between countries, with significant decreasing trends in 18 of 46 countries including Kenya, Rwanda, and Zambia. For the attitude factors, we noted that the factors “willing to frequent a HIV-positive vendor”, “willing to take care of a HIV-positive family members in the house”, and “belief that a HIV-positive teacher should continue to work” all increased across countries. However, across the study period, people have become more reluctant to reveal a family member's positive status. In addition, our results indicate that men are slightly more knowledgeable about HIV/AIDS than are women. Interpretation In sub-Saharan African countries, knowledge of HIV/AIDS increased slightly between 1990 and 2017, with people becoming more accepting of people with HIV/AIDS. Of concern is that knowledge about prevention of mother-to-child HIV transmission during pregnancy has not been improving as much, and is even decreasing in some countries. Of similar concern is that people are now less likely to reveal a family member's positive HIV status, suggesting that discrimination against people living with HIV/AIDS is still persistent and may be becoming worse. Efforts and resources are still needed to turn the tide in these areas. Funding US National Institutes of Health and Bill & Melinda Gates Foundation.

The psychosocial impact of caregiving on the family caregivers of chronically ill AIDS and/or HIV patients in home-based care: A qualitative study in Zimbabwe.

The family caregiver has a pivotal role to play in the management of the chronically ill HIV and/or AIDS patients. The wellbeing of caregivers is therefore crucial because impairment of their physical or mental health could impact negatively on the management of their HIV-positive family member. The purpose of this qualitative study was to explore the psychosocial impact of caregiving on the family caregiver of the chronically ill HIV and/or AIDS patients in home-based care. Unstructured interviews were conducted with 11 caregivers recruited at an adult HIV clinic at United Bulawayo Hospitals, Bulawayo, Zimbabwe. Relevant demographic information was collected from each participant. The interviews were then transcribed and analysed. Caregivers' biggest challenge was meeting care costs such as food, transport and medical costs. Certain conditions relating to the care-recipient's health and family issues, such as abandonment of the ill patient as well as that of orphans, added to the burden of care. Carers also had to deal with their own health and physical problems. All the above resulted in a spectrum of emotions such as helplessness, sadness, anxiety and anger. Despite this, caregivers also reported on the positive aspects regarding their caregiving role. There were both negative and positive psychosocial experiences by caregivers of HIV and/or AIDS patients. The study highlighted practical areas where support could be provided.

Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa.

IntroductionWe aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa.MethodsIndividuals ≥16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm.ResultsOverall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n=488) linked to care <3 months of referral (similar by sex). In adjusted analyses (n=1222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (<33% vs. >42%, p<0.001). Linkage to care was lower in students (adjusted odds-ratio [aOR]=0.47; 95% confidence interval [CI] 0.24–0.92) than in employed adults, in adults who completed secondary school (aOR=0.68; CI 0.49–0.96) or at least some secondary school (aOR=0.59; CI 0.41–0.84) versus ≤ primary school, in those who lived at 1 to 2 km (aOR=0.58; CI 0.44–0.78) or 2–5 km from the nearest TasP clinic (aOR=0.57; CI 0.41–0.77) versus <1 km, and in those who were referred to clinic after ≥2 contacts (aOR=0.75; CI 0.58–0.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR=1.45; CI 1.12–1.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR=2.16; CI 1.13–4.10) versus not.ConclusionsFewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care.

Utilization of and Barriers to HIV and MCH Services among Community ART Group Members and Their Families in Tete, Mozambique

Mozambique continues to face many challenges in HIV and maternal and child health care (MCH). Community-based antiretroviral treatment groups (CAG) enhance retention to care among members, but whether such benefits extend to their families and to MCH remains unclear. In 2011 we studied utilization of HIV and MCH services among CAG members and their family aggregates in Changara, Mozambique, through a mixed-method assessment. We systematically revised all patient-held health cards from CAG members and their non-CAG family aggregate members and conducted semistructured group discussions on MCH topics. Quantitative data were analysed in EPI-Info. Qualitative data were manually thematically analysed. Information was retrieved from 1,624 persons, of which 420 were CAG members (26%). Good compliance with HIV treatment among CAG members was shared with non-CAG HIV-positive family members on treatment, but many family aggregate members remained without testing, and, when HIV positive, without HIV treatment. No positive effects from the CAG model were found for MCH service utilization. Barriers for utilization mentioned centred on insufficient knowledge, limited community-health facility collaboration, and structural health system limitations. CAG members were open to include MCH in their groups, offering the possibility to extend patient involvement to other health needs. We recommend that lessons learnt from HIV-based activism, patient involvement, and community participation are applied to broader SRH services, including MCH care.

The role of sympathy on avoidance intention toward persons living with HIV/AIDS in Jamaica

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Jamaica, concerns of attitudes become more important. As such, the objective of the present study is to examine the attitudes of university students in Jamaica toward PLWHA including sympathy and avoidance intentions. A large sample of university students (N=1,252) was surveyed between June 2001 and February 2002 using a 193-item questionnaire that measured HIV-related knowledge, attitudes and behaviors. Results revealed that less than half of the students reported sympathetic attitudes toward homosexual males or female prostitutes living with HIV/AIDS (41% and 44%, respectively) while the majority reported sympathetic attitudes toward heterosexual males and non-prostitute females living with the disease (67% and 81%, respectively). Most students (80%) reported no avoidance intentions toward family members or friends living with the disease. Sympathy, HIV knowledge, education and awareness were associated with no avoidance intention of HIV-positive family members and friends. These findings suggest that sympathy could be important in improving prosocial intentions toward PLWHA and warrants further research.

The work profile of family caregivers of persons affected by HIV/AIDS

In Switzerland, HIV incidence has increased considerably during the past two years. This fact has raised concern both in the media and in the health care system. However family caregivers have not been considered in these debates, although their figures are increasing as well. In Switzerland, a few research studies were conducted focussing on the situation of family caregivers affected by HIV/AIDS. This particular qualitative research project focuses on the questions as to what kind of work these family caregivers are doing, under which conditions they are working, and which consequences arise from their work. Data were collected by conducting eleven semi-structured interviews, and data analysis was done through a content analysis. Results show that family caregivers provide a wide range and a large amount of family work. Not only are family caregivers working for the HIV-positive persons, but also for the benefit of other family members and friends as well as for themselves. Family caregivers achieve mainly stable life situations for their HIV-positive family member. The discussion focuses on the dynamics of family work which requires constant adaptations in daily life. In addition, ordinary family work needs to be noticed and appreciated in symbolic, social, and financial terms. Finally, implications for nursing practice are considered.

HIV infection in families of HIV-positive and 'at-risk' HIV-negative women

Research of HIV infection within the family has focused upon sexual partners and vertical transmission. The scope of the problem of multiple infections and clustering of HIV among family members has, thus far, been less extensively explored. The objectives of this study are to investigate HIV infection in family members of HIV-seropositive and HIV-seronegative high-risk women and to consider the impact of multiple HIV infections within the family. Baseline data were evaluated from a prospective observational cohort of 871 HIV-seropositive and 439 seronegative at-risk women who are participants in a longitudinal study of HIV in women at four sites in the USA (Montefiore, Bronx, NY; Johns Hopkins University, Baltimore, MD; Brown University, Providence, RI; Wayne State University, Detroit, MI). Women were asked if anyone close to them had HIV/AIDS or had died from HIV/AIDS. Responses which included HIV-positive family members were analyzed. In the seropositive cohort, 35% (307/871) of the women had a family member with HIV infection. Of these 307 women, 38% reported having a sibling, 24% a husband and 27% had more than one family member with HIV/AIDS. Forty-nine per cent of Latina women, 34% of black women, and 21% of white women reported having a family member with HIV/AIDS. Using logistic regression analysis, we found that Latina and black women were significantly more likely than white women to have a sibling, extended family member or more than one family member with HIV/AIDS. Compared to seropositive women, seronegative high-risk women enrolled in this study appear equally likely to have an HIV-infected family member. In this study of HIV-positive women and high-risk seronegative women, a third reported having multiple family members with HIV infection, most often in a sibling. The high prevalence of HIV within families, particularly in the families of Latina and black women, mandates attention in planning both prevention and care.