People Living With HIV And AIDS Research Articles

“Not easy at all but I am trying”: barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme

The promotion of physical activity is encouraged in people living with HIV and AIDS (PLWHA) as a means of promoting wellness and health. Adherence to programmes that promote exercise is often reduced, and home-based programmes are suggested to improve adherence. This study investigated the personal and environmental factors that cause barriers and facilitators of physical activity in a home-based pedometer walking programme as a means of highlighting adherence challenges. An observational study nested in a randomised controlled trial was conducted in a cohort of South African PLWHA on antiretroviral therapy over a six-month period. Descriptive analysis and qualitative content analysis of 42 participants who underwent physical activity modification assisted with data review. The mean age of the sample was 38.7 (±8.9) years, consisted mostly of women (n = 35; 83.3%) who were employed (n = 19; 45.2%) but earning very little (less than R500 per month) and often single or widowed (n = 23; 54.8%). Barriers to physical activity identified included physical complaints, e.g., low-energy levels; psychological complaints, e.g., stress levels; family responsibility, e.g., being primary caregivers; the physical environment, e.g., adverse weather conditions; social environment, e.g., domestic abuse and crime; and workplace, e.g., being in a sedentary job. Facilitators of physical activity included support and encouragement from friends and family, religious practices during worship and community environment, e.g., having access to parks and sport fields. The study is of benefit as it highlights personal and environmental factors that need to be considered when developing or implementing a home-based walking programme in PLWHA.

The relationship between CAM use and adherence to antiretroviral therapies among persons living with HIV.

The use of complementary and alternative medicine (CAM) among people living with HIV and AIDS (PLWHA) may undermine other adaptive illness management behaviors, such as treatment adherence. The present study tests the hypothesis that CAM use is associated with intentional lapses in adherence (e.g., "medication vacations"), perhaps due to negative beliefs about antiretroviral therapy (ART). Cross-sectional interviews with 116 PLWHA were completed using a computerized assessment of self-reported CAM use and ART adherence. Almost half of participants used CAM to treat or manage HIV-related health concerns in the past month, and 78% had used CAM since being diagnosed with HIV. Seventy-one percent of participants endorsed at least one domain of intentional nonadherence since starting HIV treatment. As hypothesized, CAM users did not differ from nonusers on overall ART adherence. Contrary to hypotheses, CAM users were less likely to report taking medication vacations or having stopped taking HIV medications without their doctor's approval compared with nonusers. CAM intensity was also related to intentional nonadherence, such that patients who engaged in more CAM tended to report fewer skipped doses and fewer nonprescribed adjustments to their medication regimen in the past month. Findings suggest that PLWHA use CAM as an adjunct to ART and that CAM use does not undermine ART adherence. Needed now is longitudinal research to determine how a proactive, holistic approach to HIV care interacts with conventional HIV treatment over time, and whether CAM use impacts long-term quality of life and health outcomes.

HIV stigma among substance abusing people living with HIV/AIDS: implications for HIV treatment.

HIV-related stigma has a major impact on quality of life and health among people living with HIV and AIDS (PLWHA). This study examines demographic, mental health, behavioral, contextual, and HIV care-related correlates of HIV stigma among 503 substance abusing PLWHA. Stigma was measured with the HIV Internalized Stigma Measure which has four subscales: stereotypes about HIV, self-acceptance, disclosure concerns, and social relationships. Severe substance dependence (55.3%) and depression (54.7%) were associated with higher HIV stigma across all domains. 49.9% of the sample reported antiretroviral (ARV) medication diversion (the unlawful sale and trading of ARV medications); diverters endorsed significantly higher stigma related to disclosure. 54.1% of the sample reported ≥95% ARV adherence; these individuals reported significantly lower stigma for self-acceptance, disclosure, and social relationships. Multivariate linear regression showed that depression and social support demonstrated significant main effects across stigma domains. Findings suggest that interventions to decrease HIV related stigma may be an important component of initiatives to increase engagement in HIV care.

Sexual risk behavior among people living with HIV and AIDS on antiretroviral therapy at the regional hospital of Sokodé, Togo

BackgroundSeveral studies on the sexual risk behaviors in sub-Saharan Africa have reported that the initiation of antiretroviral therapy leads to safer sexual behaviors. There is however a persistence of risky sexual behavior which is evidenced by a high prevalence of sexually transmitted infections among people living with HIV and AIDS (PLWHA). We sought to determine the factors associated with risky sex among PLWHA on antiretroviral therapy in Togo.MethodsAn analytical cross-sectional survey was conducted from May to July 2013 at regional hospital of Sokodé, Togo, and targeted 291 PLWHA on antiretroviral therapy for at least three months.ResultsFrom May to July 2013, 291 PLWHA on antiretroviral treatment were surveyed. The mean age of PLWHA was 37.3 years and the sex ratio (male/female) was 0.4. Overall, 217 (74.6%) PLWHA were sexually active since initiation of antiretroviral treatment, of which, 74 (34.6%) had risky sexual relations. In multivariate analysis, the factors associated with risky sex were: the duration of antiretroviral treatment (1 to 3 years: aOR = 27.08; p = 0.003; more than 3 years: aOR = 10.87; p = 0.028), adherence of antiretroviral therapy (aOR = 2.56; p = 0.014), alcohol consumption before sex (aOR = 3.59; p = 0.013) and level of education (primary school: aOR = 0.34 p = 0.011; secondary school: aOR = 0.23 p = 0.003; high school: aOR = 0.10; p = 0.006).ConclusionThere was a high prevalence of unsafe sex among PLWHA receiving ART at the hospital of Sokodé. Factors associated with sexual risk behaviors were: low education level, non-adherence to ART, alcohol consumption before sex and the duration of ART. It is important to strengthen the implementation of secondary prevention strategies among this population group.

HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: does social support play a mediating or moderating role?

HIV stigma plays a major role in the etiology of psychological distress among persons living with HIV, but may be ameliorated by social support. This cross-sectional study examined whether social support mediates or moderates the relationship between HIV stigma and psychological symptoms. We recruited a convenience sample of 210 individuals living with HIV in three peri-urban communities in the Western Cape, South Africa. People living with HIV and AIDS (PLWHA) completed self-report questionnaires that assessed HIV-related stigma, social support, post-traumatic stress disorder (PTSD) and depression. Product-term regression analyses showed that social support played a mediating role in the relationship between HIV-related stigma and symptoms of PTSD (not depression). Social support did not, however, moderate the relationship between HIV-related stigma and PTSD or depression. The results indicate that perceived HIV-related stigma may decrease PLWHA's perceived level of social support, which in turn may increase PTSD symptoms. Moreover, these findings suggest that despite the protective role of social support, there are other factors that affect the relationship between HIV-related stigma and mental health that hinder the buffering role of social support in this relationship. These findings may have implications for designing and implementing interventions that increase perceived social support and decrease perceived HIV-related stigma, which in turn may decrease symptoms of PTSD among PLWHA.

Education Levels among Parents and Misconceptions on HIV and AIDS

This study investigated the association between Parents’ education levels and beliefs towards HIV/AIDS and People Living with HIV and AIDS (PLWHA). Data was collected using a set of questionnaire. Five points Likert was used to measure parents’ attitudes and beliefs towards HIV/AIDS and PLWHA. Findings from this study show that age, sex, religion, and occupations had no significant influence on beliefs but differences in education level exerted difference in beliefs of respondents towards HIV and AIDS and PLWHA (p = 0.010). Misconceptions and negative beliefs towards HIV/AIDS and PLWHA among parents with no formal education should be fought.  

Perceived Social Support among HIV Positive and HIV Negative People in Ibadan, Nigeria

Background: People living with HIV and AIDS (PLWHA) are assumed to have poor social support. This study compared the satisfaction with perceived social support of people living with HIV and AIDS with HIV negative patients. Method: 150 HIV positive patients were age and sex matched with 150 HIV negative patients in a cross sectional comparative study. Information on socio-demography and social support was assessed with questionnaire including multidimensional scale of perceived social support (MSPSS). Chi square test, student t-test, and linear regression analysis were done at p = 0.05 level of significance. Result: Mean age of the HIV positive versus HIV negative patients is 38.1 ± 9.0 years versus 37.7 ± 9.2 years. Both groups had the lowest social support scores from family, (FA): 3.81 ± 1.08 vs 3.95 ± 0.89, p = 0.240. Perceived support from friends (FR) was higher in the HIV negative group 7.41 ± 1.99 vs 5.55 ± 2.34, p = 0.000 as well as perceived total support (TS), 3.94 ± 0.68 vs 3.59 ± 0.77, p = 0.000. Linear regression for all the respondents revealed HIV status contributed the most and predicted TS and FR scores respectively (β =-0.181 95% C.I = -5.843 to -0.766, p = 0.010 and β = -0.317, 95% C.I, -4.260 to -1.792, p = 0.000). For PLWHA group, employment contributed most to perceived TS (β = -0.181 95% C.I -11.812 to -0.0361, p = 0.049). However, in HIV negative group, TS and FR had the greatest contribution from marital status, (β = -0.416 95% C.I -6.157 to -1.829, p = 0.000) and(β -0.381 95% C.I -2.851 to -0.756, p = 0.001). Also, the current living status (β = -0.268, 95%C.-3.238 to -0.360, p = 0.015, and β = -0.241 95% C.I -1.48 to -0.09, p = 0.027). Conclusion: All respondents had the poorest perception of support from family (FA). Lack of employment is the most important factor identified in this group of PLWHA, responsible for the poor TS. For the HIV negative group, not being married and living outside family setting were the strongest factors for poor social support.

Stigmatization of people living with HIV/AIDS by healthcare workers at a tertiary hospital in KwaZulu-Natal, South Africa: a cross-sectional descriptive study

BackgroundThe issue of stigma is very important in the battle against HIV/AIDS in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral (ARV) medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS (PLWHA) by health care workers (HCWs) at a tertiary hospital in KwaZulu-Natal (KZN) province, South Africa. The study investigated the impact of knowledge of HIV/AIDS by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/AIDS although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/AIDs (p ≤ 0.001); occupation and knowledge of HIV/AIDS (p ≤ 0.001); and gender and knowledge of HIV/AIDS (p = 0.004). Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA (p = 0.003). The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA.

This is My Story: participatory performance for HIV and AIDS education at the University of Malawi

University students represent a subset of young men and women at risk for HIV in high prevalence settings. Innovative programs are needed to raise awareness on the unique issues around HIV and AIDS in the university campus, while training student leaders for peer-based education. The Process and Collaboration for Empowerment and Discussion (PACED) method engages artists and people living with HIV and AIDS (PLWHA) to create a performance that encourages community dialog about HIV and AIDS and empowers PLWHA. 'This is My Story' was a program at the University of Malawi, Chancellor College, which adapted the PACED approach for university students. A qualitative evaluation conducted 1 year later among students and PLWHA participants and audience members demonstrated retention of the following themes: (i) trust in a relationship and how it affects women,(ii) equality for PLWHA and (iii) life after HIV and AIDS. All of the PLWHA and 90.9% of student participants reported a greater sense of empowerment. Of the audience members, 82.1% discussed the performance with friends and family. We thus present the PACED approach as a valuable tool in HIV and AIDS education and prevention among university students in Malawi.

P2.156 Place of Nurses in the Management of People Living with HIV and AIDS (PLHA)In Developing Countries: Case of a Regional Hospital, Burkina Faso (West Africa)

BackgroundManagement of people living with HIV and AIDS (PLHA) in the Tenkodogo regional hospital was carried out by a team of 7 nurses and 4 physicians engaged also about their...

P4.110 Sexual Risk Behavior and the Efficacy of Psycho-Education in Improving Adherence to Secondary Prevention Information Among People Living with HIV/AIDS in Ibadan, Nigeria

BackgroundFindings have shown that adherence to secondary prevention information is low among people living with HIV and AIDS (PLWHAs) in Sub Saharan Africa including Nigeria. However, the effectiveness of Psycho-education...

Learning about Barriers to Care for People Living with HIV in Egypt

The purpose of this study was to identify obstacles health care workers face in providing care for people living with HIV and AIDS (PLWHA). Based on these findings, health authorities can design interventions to support health care workers in providing better medical care for PLWHA. Thirty in-depth interviews were conducted with physicians and nurses in one 300-bed tertiary care public hospital in Giza, Egypt. Thematic analysis was conducted by 2 investigators. Five main themes were identified (1) fear of infection; (2) disbelief in effectiveness of infection control measures to protect against HIV; (3) misconceptions regarding medical care for PLWHA; (4) fear of secondary stigma; and (5) moral judgments toward PLWHA and negative connotations related to HIV. Interventions targeting health care workers should be multidimensional, including knowledge and skills building as well as value and attitude change. Reducing stigma among health care workers will improve access to care for PLWHA.

Inequalities in access to healthcare services among people living with HIV/AIDS in Nigeria

The study investigated the magnitude of social inequities in access to subsidised healthcare services among people living with HIV and AIDS (PLWHA) in Nigeria. Structured interviews were conducted with 1 056 PLWHA selected from 60 community based support groups in 12 local government areas across 3 Nigerian states and the federal capital territory, using a multi-stage cluster sampling method. Data were collected on socio-economic characteristics of the respondents; awareness about location of health facilities; current health status; distance to facilities; and utilisation and expenditure on healthcare. The socio-economic characteristics of the respondents were used to compare their level of access to healthcare services from antiretroviral therapy (ART) sites and government hospitals.Awareness about location of health facilities was generally high (≥79%) among the respondents but higher among males, urban dwellers and those in highest wealth class (p < 0.05). About 60% of rural PLWHA and 55.2% of those in the lowest wealth class reported illness compared with 49.4% of urban residents and 47.4% of those in the highest wealth class. However, PLWHA in urban areas utilised government hospitals more than those in rural areas while rural PLWHA and those in the lowest wealth class travelled longer distances to ART sites (p < 0.05). PLWHA in lowest wealth class and females faced catastrophic health expenditure of 67.6% and 55.5% of their monthly income respectively.Social inequities were observed in the subsidised HIV-treatment programme in Nigeria. Expansion of ART sites in rural areas and decentralisation of HIV care at government hospitals will reduce travel distance and transport costs and ensure universal access to healthcare services among PLWHA.

A qualitative study of community home‐based care and antiretroviral adherence in Swaziland

IntroductionAntiretroviral therapy (ART) has rendered HIV and AIDS a chronic condition for individuals in many parts of the world. Adherence, however, is integral to achieving chronicity. Studies have shown both relatively high ART adherence rates in sub-Saharan Africa and the importance of community home-based care (CHBC) to facilitating this process. In light of diminished HIV and AIDS funding globally and increased reliance on CHBC throughout Africa, a better understanding of how CHBC may strengthen ART adherence is essential to improving patients’ quality of life, tending to the needs of care supporters and achieving healthier populations.MethodsThis article reports findings from a qualitative study of a CHBC organiztion serving an estimated 2500 clients in rural Swaziland. Semi-structured questionnaires with 79 HIV-positive clients [people living with HIV and AIDS (PLWHA)] yielded data on diverse aspects of being HIV positive, including insights on whether and how PLWHA perceived care supporters to facilitate ART adherence in a high stigma and structurally impoverished setting.ResultsNinety-two percent of participants said their health had improved since care supporters came into their lives. A major finding was that an estimated 53% of participants said they would have died, a few from suicide had the care supporter never intervened. More than one in four participants (27.9%) sought HIV testing after a care supporter began visiting them. Nearly a third (31%) commenced ART after and largely as a consequence of care supporter intervention. Approximately one in four (23%) reported that their care supporter had helped them to disclose their HIV-positive status to family members. Twenty-seven percent said they had felt discouraged or had been discouraged from taking ART by members of their family or community.DiscussionGeneral inductive analysis of participant reports suggested two social mechanisms of CHBC impact on ART adherence: (i) cultivating client-care supporter “talk” to enhance treatment uptake and literacy, reduce felt stigma and challenge social pressures to desist from ART and (ii) real-time interactions between clients and care supporters whereby the care “relationship” was itself the “intervention,” providing lay counsel, material and financial assistance, and encouragement when clients suffered stigma, side effects and other obstacles to adherence. These social dynamics of adherence generally fall outside the purview of conventional clinical and public health research.ConclusionsPLWHA reports of care supporter practices that enabled ART adherence demonstrated the pivotal role that CHBC plays in many PLWHA lives, especially in hard to reach areas. Relative to clinic personnel, care supporters are often intensely engaged in clients’ experiences of sickness, stigma and poverty, rendering them influential in individuals’ decision-making. This influence must be matched with on-going training and support of care supporters, as well as a clear articulation with the formal and informal health sectors, to ensure that PLWHA are correctly counselled and care supporters themselves supported. Overall, findings showed that PLWHA experiences of CHBC should be captured and incorporated into any programme aimed at successfully implementing the Joint United Nations Programme on HIV and AIDS (UNAIDS) Treatment 2.0 agenda Pillar 4 (increasing HIV testing uptake and care linkages) and Pillar 5 (strengthening community mobilization).

Condom use among HIV sero-concordant couples attending a secondary health facility in North-Central Nigeria

Background: Condom use during intercourse is perceived as unnecessary in sexual encounters involving a regular partner. The non-use of condom among HIV-positive people has been found to increase the risk of resistance to anti-retroviral therapy. The objective of this study was to determine the pattern of condom use among HIV sero-concordant couples attending a secondary health facility in North-Central Nigeria. Materials and Methods: This is a cross-sectional survey that was carried out among people living with HIV and AIDS (PLWHA) who have been enrolled into care and treatment at General Hospital Abejukolo in Kogi State, Nigeria. The data instrument used was self-/interviewer-administered questionnaire. The data obtained were analysed using EPI-INFO version 3.4.1 software package. Chi-square test was used and P < 0.05 was considered significant for the study. Results: Assessment of knowledge of the respondents on the correct use of condom showed that two-thirds (60; 65.9%) had good knowledge and 70 (79.6%) of them demonstrated positive attitude towards the use of condom during sexual intercourse. About one-third of the respondents (32; 35.2%) would oblige the spouse sexual intercourse without condom mainly because they are both positive, to fulfil marital obligations and to avoid problems in marital relationship. Less than two-thirds (59.3%) of sero-concordant spouse used condom during sexual intercourse for reasons of preventing re-infection and pregnancy. Conclusion: With one-third of respondents not using condom during sexual intercourse, there is a great challenge for spread of HIV infection and risk of drug resistance in HIV care and management. Therefore, stakeholders at various levels should intensify efforts and support research towards behavioural modification in addressing the existing lacunae in HIV control.

Stigma, medication adherence and coping mechanism among people living with HIV attending General Hospital, Lagos Island, Nigeria

BackgroundPeople living with HIV and AIDS (PLWHA) experience some form of stigma which could lead to poor medication adherence.ObjectivesThis study assessed the various domains of stigma experienced by PLWHAs attending an HIV clinic at General Hospital, Lagos Island, their medication adherence patterns and their coping mechanisms for ensuring adherence to antiretroviral therapy.MethodA cross-sectional study design with a sample size of 200 was used. Respondents were selected using systematic random sampling. Interviewers administered structured questionnaires were used to collect information on the domains of stigma. Data was analysed using EPI info©. This was followed by a focus group discussion (FGD) with seven participants at the clinic using an interview guide with open-ended questions.ResultsOverall, stigma was experienced by 35% of the respondents. Within this group, 6.6%, 37.1%, 43.1% and 98.0% of the respondents reported experiencing negative self image stigma, personalised stigma, disclosure stigma and public attitude stigma respectively. Almost 90% of the respondents were adherent. The FGD revealed that disclosure was usually confined to family members and the coping mechanism for achieving adherence was to put antiretroviral (ARVs) in unlabelled pill boxes.ConclusionThis study found that stigma was low and that the most common domain of stigma experienced was public attitude stigma. Medication adherence of respondents was good as a result of the coping mechanism, which involves putting ARVs in unlabelled pill boxes.

More Than 20 Years of Research into the Quality of Life of People with HIV and AIDS—A Descriptive Review of Study Characteristics and Methodological Approaches of Published Empirical Studies

The quality of life of people living with HIV and AIDS (PLWHA) is becoming increasingly important--a fact that is also reflected in extensive research efforts. Owing to the almost complete lack of systematic integration of research findings, it is hardly possible to provide an overview of the current status of research, or to derive valid statements about research results. A literature search regarding the quality of life of PLWHA was performed in two international research databases. After checking their relevance, 852 publications appearing in scientific journals and explicitly measuring the quality of life of PLWHA were categorized on the basis of various study characteristics. The number of publications per year in our study pool has been rising steadily since 1989. Well over 40 established instruments were used to determine the quality of life, most frequently the MOS-HIV, followed by the SF-36. The great majority of the studies are correlation studies. CD4 cells, gender, and age are the most common variables for which correlations with quality of life are reported. Our descriptive review stresses both the increasing significance and the challenges of research into quality of life of PLWHA such as the great variety of instruments used. The limits of this review are discussed and we conclude with the formulation of research desiderata concerning comparative review studies on instruments and systematic reviews of frequent research questions.

Social support and the psychological wellbeing of people living with HIV/AIDS in Ghana

The current study sought to investigate the association between age, gender, social support and the psychological wellbeing of people living with HIV and AIDS (PLHA) in Ghana. Cross-sectional data containing information on demographics, social support and psychological well-being (stress, depression, and anxiety), were collected from 107 men and women living with HIV/AIDS. To explore age group differences, participants were stratified by age (< 39 vs. 40+ years). Three anonymous self-administered questionnaires were used, namely the demographic data questionnaire, Sources of Social Support Scale, and the Depression Anxiety Stress Scale (DASS- 42). Correlation analysis revealed that social support was negatively associated with depression, stress and anxiety. Compared with males living with HIV, women reported higher levels of stress, depression and anxiety. Female gender and low social support were significant predictors of depression and stress after controlling for selected independent variables. Older participants experienced higher levels of stress than their younger counterparts. Public health personnel and AIDS professionals may consider further interventions to promote psychological health in HIV/AIDS-positive individuals. More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.

Barriers to participate in support groups for people living with HIV: a qualitative study with men receiving antiretroviral treatment in a HIV clinic in Mthatha, South Africa.

Support groups are the most common and popular way of providing social support for people living with HIV and AIDS (PLWHI). Nevertheless, HIV positive men are reluctant to attend support groups, and in most mixed gender support groups, women outnumber men. The study used a sample of men accessing antiretroviral treatment (ART) from a HIV clinic in South Africa, to examine their perceptions of support groups and explore their reasons for nonparticipation in such groups. Five focus groups interviews were conducted with 50 HIV positive men. Their age ranged from 28-70 years, all had disclosed their HIV status to partners and family members and were receiving ART for more than a year. The main barriers for nonparticipation related to issues on support groups were; Unavailability of support groups in local communities including; no access, the timing of meetings and lack of transport money. Fear of unintended disclosure of HIV status due to breach of confidentiality with resulting stigma and social rejection. On a personal level, participants felt that they had adequate support at home. Participants would consider participating if men only support groups are initiated, support groups are held on weekends, and they are provided with more information on support groups. Health care providers have a critical role to play in creating awareness of and education on the role of support groups for PLWHI. Support group planners should consider men only support groups which has been shown to have positive outcomes and facilitates member participation.

Improving adherence to ante-retroviral treatment for people with harmful alcohol use in Kariobangi, Kenya through participatory research and action.

BackgroundHarmful alcohol use has been linked to the spread of HIV in Kenya. It also adversely affects those on antiretroviral (ARV) treatment through poor compliance. This study using participatory research and action (PRA) methods sought to understand factors related to alcohol abuse and non-adherence and to formulate appropriate interventions in a sample of people living with HIV and AIDS (PLWHA) who were also abusing alcohol, at Kariobangi in Nairobi, Kenya.MethodsEntry into the community was gained through previous PRA work in that community and PLWHA were recruited through snowballing. Working together with the community members, the researchers explored the participants’ understanding of alcohol use problem, its effects on compliance to ARV treatment and discussed possible action areas through PRA techniques that included focus group and market place discussions; visual aids such as spider diagrams, community mapping and ranking. Follow-up meetings were held to discuss the progress.ResultsBy the final meeting, 67 PLWHA and 19 community members had been recruited. Through discussions, misconceptions regarding alcohol use were identified. It emerged that alcohol abuse was poorly recognised among both the community and health workers. Screening for alcohol use was not routinely done and protocols for managing alcohol related disorders were not available at the local health centres providing ARVs. The study participants identified improving communication, psychoeducation and screening for alcohol use as possible action areas. Poverty was identified as a major problem but the interventions to mitigate this were not easy to implement.ConclusionWe propose that PRA could be useful in improving communication between the health workers and the clients attending primary health care (PHC) facilities and can be applied to strengthen involvement of support groups and community health workers in follow up and counselling. Integrating these features into primary health care (PHC) would be important not only to PLWHA but also to other diseases in the PHC setting . Longer term follow up is needed to determine the sustained impact of the interventions. Problems encountered in the PRA work included great expectations at all levels fostered by handouts from other donors and cognitive impairment that interfered with constructive engagement in some of the PLWHA.