People Living With HIV Or AIDS Research Articles

Stigma, discrimination and HIV or AIDS: an empirical investigation of Asian immigrants and refugees in Canada

PurposeHIV or AIDS remains invisible and dismissed by most South Asians living in Canada as HIV or AIDS issues are perceived as an offshoot of Western lifestyle linked with drug use and promiscuity. This paper aims to look into how people living with HIV or AIDS (PLWHA) cope with prejudice and stigma.Design/methodology/approachTo guide this research, a constructivist grounded theory approach was adopted as the theoretical and methodological framework. The authors reached the participants through a Toronto-based group that works with PLWHA. The authors chose their respondents in a snowball method and interviewed them both in person and online.FindingsThis paper identifies how South Asian immigrants and refugees/refugees with HIV or AIDS claimants are vulnerable to discrimination in Canada due to the following factors, which include but are not limited to: a lack of information about HIV and AIDS incidence in the community; and the Canadian health system's inability to respond appropriately to the lack of information.Practical implicationsHIV service engagements should take place within the context of a constellation of local traditions, or standardized expectations of patient engagement with HIV services can be counterproductive.Originality/valueIt is critical that governmental action prioritizes increasing public understanding of stigma. To minimize the consequences of HIV-related discrimination and stigma, misconceptions about HIV transmission must be debunked.

Case report: dual primary AIDS-defining cancers in an HIV-infected patient receiving antiretroviral therapy: Burkitt\u2019s lymphoma and Kaposi\u2019s sarcoma

BackgroundThe incidence of AIDS-defining cancers (ADCs) has decreased markedly in the era of highly active antiretroviral therapy (HAART). The occurrence of two ADCs is rare in people living with HIV or AIDS (PWHA) who are severely immunosuppressed or have incomplete virologic suppression.Case presentationWe report a case of dual primary ADCs, especially NHL followed by KS, in a 70-year-old HIV-infected man who was on antiretroviral therapy and had successful virologic suppression. During HAART, he presented with generalized myalgia and abdominal pain. Multiple liver masses were detected and a biopsy revealed Burkitt’s lymphoma. After three cycles of anticancer chemotherapy with a favorable response, he was diagnosed with cytomegalovirus retinitis and the anti-cancer chemotherapy was discontinued. Despite successful virologic suppression with HAART, human herpes virus-8 associated Kaposi’s sarcoma was diagnosed in his right thigh. He underwent radiation therapy.ConclusionThese findings suggest that multiple ADCs can occur in PWHA who are receiving HAART and have successful virologic suppression. Healthcare providers caring for PWHA should maintain vigilance for the development of a broad spectrum of cancers.

Risk of Breast, Prostate, and Colorectal Cancer Diagnoses Among HIV-Infected Individuals in the United States.

Although people living with HIV or AIDS (PLWHA) are at higher risk for many cancers, breast, prostate, and colorectal cancer rates are lower in this patient population. Because these tumors are often screen-detected, these inverse associations could be driven by HIV-related differences in utilization of cancer screening. We ascertained incident breast, prostate, and colorectal cancer in PLWHA using data from the HIV/AIDS Cancer Match Study (1996-2012). Comparisons with general population cancer rates were made using standardized incidence ratios (SIRs), overall and stratified by tumor stage/size, breast cancer estrogen receptor status, and colorectal site. We also examined the potential effect of study design and unmeasured confounding on inverse standardized incidence ratios. Compared with the general population, PLWHA had lower rates of invasive breast (SIR = 0.63, 95% confidence interval [CI] = 0.58 to 0.68), prostate (SIR = 0.48, 95% CI = 0.46 to 0.51), proximal colon (SIR = 0.67, 95% CI = 0.59 to 0.75), distal colon (SIR = 0.51, 95% CI = 0.43 to 0.59), and rectal cancers (SIR = 0.69, 95% CI = 0.61 to 0.77). Reduced risk persisted across tumor stage/size for prostate and colorectal cancers. Although distant-stage breast cancer rates were not reduced (SIR = 0.94, 95% CI = 0.73 to 1.20), HIV-infected women had lower rates of large (>5 cm) breast tumors (SIR = 0.65, 95% CI = 0.50 to 0.83). The magnitude of these inverse standardized incidence ratios could not plausibly be attributed to case underascertainment, out-migration, or unmeasured confounding. Breast, prostate, and colorectal cancer rates are markedly lower among PLWHA, including rates of distant-stage/large tumors that are not generally screen-detected. This set of inverse HIV-cancer associations is therefore unlikely to be due primarily to differential screening and may instead represent biological relationships requiring future investigation.

Medical Discrimination Affects the HIV/AIDS Epidemic Control: A Study of Self-Perceived Medical Discrimination on People Living with HIV or AIDS.

People living with HIV or AIDS (PLWHA) experienced severe medical discrimination which is seriously affecting their lives. However, few studies examined the epidemic characteristics of self-perceived medical discrimination from the discrimination objects such as PLWHA. Therefore, we aimed to investigate the epidemiological status and analyze the influential factors of the self-perceived medical discrimination on PLWHA in South China. The self-designed questionnaire was used to investigate the medical discrimination status of the 443 infected persons, who were randomly recruited from the representative AIDS designated hospitals in Guangdong Province in South China. The results showed that 49.0% of PLWHA experienced medical discrimination, and 55.3% received discriminatory treatment, 48.4% experienced refusal of treatment, 36.4% had private information leaked and 12.9% received mandatory test. However, 52.2% patients chose to endure discrimination in silence. Compared with the Asymptomatic HIV-infected patients, AIDS patients perceived more medical discrimination. The Logistic regression analysis indicated that PLWHA self-perceived medical discrimination status was influenced by 4 factors: the voluntary of first medical detection, the route of transmission, the stage of the disease and the familiarity with the HIV/AIDS-related law. Additionally, the two dimensions of the life quality scale were influenced by medical discrimination, namely, overall function and disclosure worry. Ultimately, our study provides a better understanding of the relationship between infection status, quality of life and the medical discrimination they experienced or perceived. It will help health professionals and policy makers to develop tailored behavioral and policy-oriented intervention strategies for PLWHA to tackle different types of medical discrimination in high-risk settings.

Willingness to take care of HIV positive people: Responses from Russian nursing students

This article is a report of a study on Russian nursing students’ willingness to take care of people living with HIV or AIDS (PLWHA). HIV and AIDS are continuing to spread in Russia. Nursing students’ willingness to care for people living with HIV or AIDS is one aspect that should also be taken in consideration on this transmission situation. In total, 102 nursing students participated in the study (the response rate was 95.3%). The data were collected using the Nurse Willingness Questionnaire (NWQ) and analysed using SPSS version 15 for Windows. The study showed that nursing students’ willingness to care for PLWHA was low when asked with one general question but quite high when asked more specifically related to some nursing activities. Nursing students were more willing to perform clean nursing activities than activities with infectious risk. There is a great need for improving understanding of and proficiency in safety work with HIV-infected patients.

Healthcare costs associated with antiretroviral adherence among medicaid patients.

The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients. This study examined Medicaid-insured HIV-positive and AIDS-diagnosed patient groups to determine the association of ART adherence to mean monthly total healthcare expenditures in the 24-month measurement period, controlling for demographic, geographic, insurance, and clinical factors. The present study extends the existing literature by analyzing the relationship of ART adherence to total healthcare costs for asymptomatic HIV-positive patients separately from those patients with AIDS-defining conditions. This retrospective study utilized claims data from Florida Medicaid claims from July 2006 through June 2011. All patients (n=502) were HIV-positive, aged 18-64years, non-pregnant, and ART naïve for at least 12months prior to the measurement period. Each patient was categorized, based on medication possession ratios, as adherent (≥90%) or non-adherent (<90%), and were divided into two groups: HIV positive (n=232) and AIDS diagnosed (n=270). Generalized linear models predicted the mean monthly total expenditures for the non-adherence group versus the adherence group. For the HIV-positive group, the adjusted mean monthly expenditures for the non-adherent group were US$1,291; the adherent group adjusted mean monthly expenditures were US$1,926. The HIV-positive non-adherent group adjusted mean monthly expenditures were significantly less than the adherent group (-40%, p<0.001). However, for the AIDS-diagnosed group, there was not a statistically significant association of ART adherence to total healthcare expenditures (p=0.29). The results show that the relationship of ART adherence to healthcare costs is more complex than previously reported.

Using an innovative mixed method methodology to investigate the appropriateness of a quantitative instrument in an African context: Antiretroviral treatment and quality of life

The relationship between quality of life (QoL) and antiretroviral treatment (ART) has mainly been studied using quantitative scales often not appropriate for use in other contexts and without taking peoples' lived experiences into consideration. Sub-Saharan Africa has the highest incidence of HIV and AIDS yet there is paucity in research done on QoL. This research report is intended to give an account of the use of a mixed method convergent parallel design as a novice approach to evaluate an instrument's context specificity, appropriateness and usefulness in another context for which it was designed. Data were collected through a qualitative exploration of the experiences of QoL of people living with HIV or AIDS (PLHA) in Africa since being on ART, as well as the quantitative measurements obtained from the HIV/AIDS-targeted quality of life (HAT-QoL) instrument. This study was conducted in three African countries. Permission and ethical approval to conduct the study were obtained. Purposive voluntary sampling was used to recruit PLHA through mediators working in community-based HIV/AIDS organisations and health clinics. Interviews were analysed through open coding and the quantitative data through descriptive statistics and the Cronbach's alpha coefficient. A much wider range and richness of experiences were expressed than measured by the HAT-QoL instrument. Although an effective instrument for use in the USA, it was found not to be sensitive, appropriate and useful in an African context in its present form. The recommendations focus on adapting the instrument using the data from the in-depth interviews or to develop a context-sensitive instrument that could measure QoL of PLHA in Africa

‘Before HIV you're a human being’ – PLWHA and reproduction in Jamaica

HIV sensitisation campaigns often aim to empower people living with HIV or AIDS (PLWHA) to enable them to cope with their illness by getting on with normal life as best as they can. However, contained within these messages are implicit assumptions about the needs of PLWHA. This research found that in Jamaica PLWHA's reproductive health needs are considered to be met largely by condoms. However, PLWHA respondents in this study expressed desires to have children and felt that their right to this was being denied. As such, dominant HIV sensitisation messages fail to respond to Jamaican PLWHA's own perceptions of their needs. This information is of importance, as the focus of the international HIV response moves away from simply preventing new infections to supporting those who have already been infected through locally appropriate interventions. As part of this, local perceptions need to be acknowledged ‘up-stream’ in HIV programming.

Enacting support within church communities for people living with HIV or AIDS

Social support is important in managing HIV and AIDS. Some people living with HIV or AIDS (PLWHA) have sought support from churches, despite their reputation for stigmatising PLWHA. Semi-structured interviews were conducted with 21 PLWHA and 21 church leaders to identify ways that churches can effectively enact support for PLWHA through improved communication about HIV, AIDS, and related issues. Church leaders also were asked about the institutional barriers to enacting support for PLWHA. Implementing these strategies consistently and holistically will require intentional efforts to address the barriers within church organisations to create environments that are welcoming to and supportive of PLWHA.

Key quality indicators of the China Comprehensive AIDS Response 2008 - 2011 Program

To analyze the key indicators of China Comprehensive AIDS Response Program (China CARES) and the effects of this program during 2008 and 2011. Data were obtained from National AIDS Comprehensive Prevention and Control Information System. The general population HIV test rate and spouse of people living with HIV or AIDS (PLWHA) HIV test rate were chosen as the indicators for HIV testing expansion; anti-retroviral therapy (ART) coverage and PLWHA CD4 test rate during the past 6 months as the indicators for treatment expansion; femal sex worker (FSW) intervention coverage and injection drug users (IDU) intervention coverage as the Indicators for behavior intervention expansion. The Key working quality indicators of 309 program sites were calculated and the results were compared. During 2008 and 2011, for China CARES, the Median of general population HIV test rate were 1.8%, 2.5%, 3.2% and 5.5%, the Median of spouse of PLWHA HIV test rate were 80.9%, 85.7%, 91.8% and 100.0%, the Median of ART coverage were 60.0%, 66.7%, 76.1% and 92.0%, the Median of PLWHA CD4 test rate during the past 6 months were 27.7%, 45.4%, 58.6% and 75.3%, the Median of FSW intervention coverage were 43.8%, 67.8%, 73.3% and 90.9%, the Median of IDU intervention coverage were 18.2%, 24.0%, 34.0% and 72.4%. The indicators of China CARES increased steadily from 2008 to 2011 in HIV testing expansion, treatment expansion and behavior intervention expansion; Compared to 2008, the percentage of the China CARES which had great progress of the 6 indicators were 98.4% (304/309), 98.3% (286/291), 94.0% (281/299), 93.5% (288/308), 91.8% (279/304) and 90.0% (223/247). in 2008, 3 indicators which were ART coverage, PLWHA CD4 test rate during the past 6 months and FSW intervention coverage were lower than national average (6.9%, 17.9% and 30.9%), the general population HIV test rate, spouse of PLWHA HIV test rate and IDU intervention coverage were higher than national average (3.4%, 64.3% and 22.8%), with the China CARES project going on, in 2011, key indicators which were general population HIV test rate, spouse of PLWHA HIV test rate, ART coverage, PLWHA CD4 test rate during the past 6 months, FSW intervention coverage and IDU intervention coverage were all higher than national average (6.5%, 80.6%, 81.9% and 55.9%).the proportions of China CARES sites whose 6 indicators were higher than national average in 2008 were 32.7% (101/309), 60.6% (149/246), 37.4% (99/265), 61.1% (181/296), 64.0% (174/270) and 45.3% (73/161), and the proportions increase annually to 2011 were 44.0% (136/309), 89.3% (260/291), 76.6% (229/299), 77.9% (240/308), 91.4% (278/304) and 64.8% (160/247). An obvious achievements have been made in the areas of HIV/AIDS prevention and control among China CARES sites during 2008 and 2011 than the national average.

Quality of life and its influencing factors of people living with HIV or AIDS in Beijing

To assess the quality of life of people living with HIV or AIDS (PLWHA) and to identify influencing factors. During September to December 2010, by a convenience sampling, a questionnaire survey was undertaken in 310 PLWHA living in Beijing, which included the general questionnaires, SF-36 for assessing quality of life and Berger-HIV stigma scale. T test and multivariable linear regression model were used to analyze the results. For the subjects investigated, the age was (32.87±8.76) years old. Homosexual behavior was the main dissemination (84.52%, 262/310). The results of SF-36 questionnaire were: the summary score 66.75±15.70; physical function 93.00±9.49, role physical 66.53±40.26, bodily pain 73.88±22.63, general health 50.06±22.75, vitality 61.11±19.67, social function 69.50±24.24, role emotional 59.68±42.38, mental health 60.63±19.81. Except physical functioning, the scores of every scale were lower than general persons (P<0.05). Multivariable linear regression analysis showed that the stronger stigma, the lower the summary score (standardized coefficients (β')=-0.38), role physical (β'=-0.21), bodily pain (β'=-0.13), general health (β'=-0.33), vitality (β'=-0.31), social function (β'=-0.34), role emotional (β'=-0.31), mental health (β'=-0.47) (all P values<0.05). The higher expend on treating HIV, the lower the summary score (β'=-0.17), physical function (β'=-0.28), role physical (β'=-0.15), bodily pain (β'=-0.19), general health (β'=-0.15), social function (β'=-0.11), role emotional (β'=-0.16) (all P values<0.05). Who having work got higher score in the summary score (β'=0.13), physical function (β'=0.13), role physical (β'=0.12), bodily pain (β'=0.12), vitality (β'=0.13), social function (β'=0.12), role emotional (β'=0.12) than others (all P values<0.05). The quality of PLWHA's life was low. High stigma feeling, high expend on treating HIV, having a job were the main influencing factors of quality of life in PLWHA.

Evaluation of a Health Setting-Based Stigma Intervention in Five African Countries

The study aim is to explore the results of an HIV stigma intervention in five African health care settings. A case study approach was used. The intervention consisted of bringing together a team of approximately 10 nurses and 10 people living with HIV or AIDS (PLHA) in each setting and facilitating a process in which they planned and implemented a stigma reduction intervention, involving both information giving and empowerment. Nurses (n = 134) completed a demographic questionnaire, the HIV/AIDS Stigma Instrument-Nurses (HASI-N), a self-efficacy scale, and a self-esteem scale, both before and after the intervention, and the team completed a similar set of instruments before and after the intervention, with the PLHA completing the HIV/AIDS Stigma Instrument for PLHA (HASI-P). The intervention as implemented in all five countries was inclusive, action-oriented, and well received. It led to understanding and mutual support between nurses and PLHA and created some momentum in all the settings for continued activity. PLHA involved in the intervention teams reported less stigma and increased self-esteem. Nurses in the intervention teams and those in the settings reported no reduction in stigma or increases in self- esteem and self-efficacy, but their HIV testing behavior increased significantly. This pilot study indicates that the stigma experience of PLHA can be decreased, but that the stigma experiences of nurses are less easy to change. Further evaluation research with control groups and larger samples and measuring change over longer periods of time is indicated.

The phenomenology of body image in men living with HIV

Research into how people living with HIV or AIDS (PLWHA) experience and make sense of feared or actual body changes, such as lipodystrophy, is limited. The present study conducted in-depth interviews with gay men living with HIV. Interpretative phenomenological analysis (IPA) yielded themes across five domains. The ambiguity of early-stage lipodystrophy was a cause of distress. There was a drive to detect changes early, leading to anxiety, uncertainty and negative feelings about the body as well as possible misperception of change. In later stages, lipodystrophy was felt to be highly distinctive. Participants struggled to live with a shape that transgressed a body ideal. Feelings of loss of control were evident in both the increased ineffectiveness of strategies to maintain a desirable appearance and in the tendency for such changes to act as a visible marker of status. Conflicting feelings emerged in ideas of thinness and of health, with loss of fat seen as desirable in certain contexts. The study builds on previous research suggesting that the high value of appearance, particularly within gay communities, may lead to extreme compensatory behaviours. HIV places increased risk on a group highly vulnerable to body dissatisfaction and eating disorders. The study concludes with a cognitive-behavioural model of body image for PLWHA and suggestions for intervention. Further research is needed to validate the model and investigate whether the findings are generalisable. However, body image concerns should be acknowledged when addressing HIV-related health.

The effectiveness of a national communication campaign using religious leaders to reduce HIV-related stigma in Ghana

This article describes the effects of a national mass media and community-level stigma-reduction programme in Ghana, in which national and local religious leaders urged their congregations and the general public to have greater compassion for people living with HIV or AIDS (PLHA). Data were collected from men and women living in three regions, first in 2001 (n = 2 746) and again in 2003 (n = 2 926). Attitudes related to a punitive response to PLHA both improved over time and were positively associated with exposure to the programme's campaign, controlling for potential confounding variables. Respondents in the 2003 survey were 20% more likely than respondents in the 2001 survey to be willing to care for an HIV-infected relative in their own household and 40% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Overall, respondents exposed to the campaign were 45% more likely than those not exposed to it to be willing to care for a HIV-infected relative, and 43% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Respondents exposed to the campaign also had significantly more favourable scores on an attitude scale measuring the belief that HIV-infected individuals should be isolated from others. The results of this evaluation suggest that mass media channels and religious leaders can effectively address HIV-related stigma on a national scale.

Information in the HIV+ community

Information in the HIV+ community