Spirituality and religion among HIV-infected individuals

Beyond HIV shame: the role of self-forgiveness and acceptance in living with HIV

Research is developing regarding the beneficial association of spirituality with numerous health outcomes in people living with HIV (PLWH); however, little attention has been paid to the association of these variables with forgiveness and acceptance of HIV status. This cross-sectional study used a sample of 648 PLWH from the United States aged 18-61 to test the mediating effects of forgiveness and acceptance of HIV status on the relationship of spirituality and life satisfaction. As expected, self-forgiveness and acceptance straightforwardly and serially explained the links between spirituality and life satisfaction, while forgiveness of others was not a significant mediator for this relationship. The data obtained suggest that spirituality and self-forgiveness are two important targets for future experimental research, and therapeutic interventions on these variables may have a synergistic effect of increasing acceptance and improving well-being in PLWH.

Relationships Between Meaning in Life and Positive and Negative Spirituality in a Field Setting in Japan

This study examined the relationships between positive/negative spirituality and meaning in life at two religious sites in Japan. Participants reported greater sadness and less meaning in life at Koyasan Okunoin, a temple with graves surrounded by nature, than at Nachi Kumano Taisha, a shrine with a waterfall. However, greater feelings of happiness protected meaning in life in the presence of sadness at Koyasan. Additionally, participants who felt a sense of awe reported greater meaning in life through self-liberation, regardless of the sites. The results provide new insights into meaning in life from the two sides of spirituality.

Structural equation modeling of microaggressions, religious and racism-related coping, medication adherence, and viral load among Black women living with HIV

Despite the disproportionate impact of HIV, microaggressions, and discrimination among Black women living with HIV (BWLWH), BWLWH have demonstrated resilience by mobilizing religious and other coping strategies. The current study sought to examine whether racism-related or religious coping moderates the relationship between latent gendered racial microaggressions (GRMs), antiretroviral therapy (ART) adherence and viral load (VL) among 119 BWLWH. Data was collected via self-report measures of GRMs and coping. ART adherence was measured via self-report and electronic monitoring and VL was measured via blood specimens. Structural equation modeling showed significant main effects of religious coping on adherence and VL. Furthermore, GRMs × racism-related coping and GRMs × religious coping significantly predicted adherence and VL. Our findings indicate the unique and culturally salient role of religious and racism-related coping among BWLWH in the context of GRMs. Such findings may be optimized in the development of culturally relevant multilevel interventions for BWLWH.

Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review

BACKGROUND

Optimum adherence to antiretroviral therapy (ART) is crucial in managing HIV. However, some people's religious beliefs can influence how they deal with HIV and the psychosocial factors influencing their adherence to ART, such as disclosure, acceptance of HIV status, belief in ART, and depression. In sub-Saharan Africa (SSA), the role of religious beliefs in ART adherence is underexplored. We aimed to identify and conceptualize the literature on religious beliefs concerning ART adherence among Pentecostal Christians living with HIV in SSA.

METHODS

We conducted a scoping review of the literature on religious beliefs and ART adherence. We searched papers from PubMed, Web of Science, Medline, Sabinet, Academic Search Complete, CINAHL Plus, Health Source/Nursing Academic, Scopus, and Google Scholar and published papers from conference proceedings and dissertations. Data were extracted according to a predetermined population, concept, context framework, and eligibility criteria for selecting or rejecting studies. We used a narrative synthesis to summarize the data on evidence and the impact of religious beliefs on ART adherence.

RESULTS

Seven papers published between January 2010 and February 2022 met the inclusion criteria. Nineteen aspects of religious beliefs were identified as negatively influencing ART adherence, while eight aspects facilitated optimal adherence. "Being saved" or "born again" enhanced coping strategies for optimal adherence through actions such as less alcohol use, fidelity to a sexual partner(s), disclosure, acceptance of HIV status, reduced depression, and facilitated PLHIV to access social support from church members or other institutions.

CONCLUSION

Religious beliefs are integral to Pentecostal Christians living with HIV and affect their adherence to ART. While some Pentecostal Christians living with HIV on ART use their religious beliefs and practices to access psychosocial support from other church members or organizations and achieve good clinical outcomes, others apply their religious beliefs and practices differently and compromise their commitments to taking ART as prescribed, thus experiencing poor viral suppression and clinical outcomes. However, more research is required to understand and theorize how religious beliefs impact ART adherence among Pentecostals living with HIV to inform guidelines for practitioners.

Relationships between spirituality and mental stress in people living with HIV in China: A cross-sectional study

There are limited reports on the relationship between spirituality and mental stress in PLWH in China, who may be subject to anti-religious pressures from the government. In this study, we aimed to understand whether spirituality influences Chinese PLWH's mental stress and, if so, at what level. We recruited 200 PLWHs from Beijing's Ditan Hospital to complete a cross-sectional survey inquiring about their practice of spirituality as well as their level of mental stress. The study found that PLWH who presented with a mid-level of spirituality have the highest mental stress when compared to those who have a low level of spiritual beliefs or a high level of spiritual beliefs. This study points to the utility of healthcare providers taking PLWH's potential spirituality into consideration, perhaps in particular for those with a moderate level of spirituality, in order to provide the most comprehensive care possible.

Improving the quality of life of people living with HIV/AIDS: A cross-sectional study of the role of religion

Background

Previous studies have found religion as a useful tool in coping with chronic medical conditions including HIV/AIDS. Aim: This study assessed how religiosity and religious coping are associated with quality of life (QOL) among people living with HIV/AIDS (PLWHA).

Patients and Methods

This was a cross-sectional study of 140 HIV clinic attendees of a Nigerian tertiary health facility. Religiosity, religious coping and QOL were measured with religious orientation scale-revised (ROS-R), Brief Religious Coping (Brief RCOPE) and World Health Organization Quality of Life-Bref (WHOQOL-BREF), respectively. Correlation analysis assessed the relationship between ROS-R, Brief RCOPE and WHOQOL-BREF.

Results

: Intrinsic religiosity (IR) scores had a moderate positive correlation with psychological health domain of QOL (r = 0.4, N = 140, and P 0.001), and a weak positive correlation with physical health domain of QOL (r = 0.2, N = 140, and P 0.05). Extrinsic religiosity (ER) scores moderately correlated positively with the psychological health domain of QOL (r = 0.03, N = 140, and P 0.002), but weakly correlated positively with the physical health domain (r = 0.2, N = 140, and P 0.02). Positive religious coping (PRC) scores moderately correlated positively with the psychological health domain (r = 0.03, N = 140, and P 0.05) and weakly correlated positively with physical health domain of QOL (r = 0.2, N = 140, and P 0.02). Extrinsic religiosity social (ERS) scores had a moderate positive correlation with the social relationships domain (r = 0.4, N = 140, P 0.001).

Conclusion

Increased ER, IR orientations and Positive Religious Coping appear to improve the psychological and physical health domains ofQOL QOL Therefore, religiosity should be encouraged among PLWHA to improve QOL.

Coping with Mental Health Problems and Medication Adherence Challenges Among Persons Receiving Antiretroviral Therapy

Although several studies have investigated common mental disorders among persons living with HIV, few have explored how they cope with both a mental health condition and treatment adherence requirements. We conducted qualitative interviews with 20 South African antiretroviral treatment (ART) users living with a mental health condition, a sub-sample from a larger study, at a community clinic and a secondary hospital in the Western Cape of South Africa. The interviews were transcribed and analysed thematically. We found that participants used a range of coping methods to manage stressors pertaining to HIV, their mental health condition, and their environments. Participants used religion more frequently than any other way of coping. Both public and self-stigma challenged individuals and impacted HIV disclosure and social support seeking behaviour. Participants reported misconceptions held by themselves and others concerning mental health problems and HIV.

Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review

OBJECTIVES

To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors.

DESIGN

We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020.

RESULTS

A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship.

CONCLUSION

These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.

A model for explaining adherence to antiretroviral therapy in patients with HIV/AIDS: A grounded theory study

Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in-depth interviews and a focus-group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long-term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long-term use of antiretroviral medications and, hence, become more resilient.

Role of religious beliefs in adherence to antiretroviral therapy in the Cape Town metropole: a study protocol

INTRODUCTION

There are presently over four million people living with HIV (PLHIV) in the South African national antiretroviral therapy (ART) programme. However, some ART programmes are battling poor ART adherence emanating from patient-related factors, including their religious beliefs. In this paper, we outline a study protocol to understand the adherence behaviours of Pentecostal Christians living with HIV to ART and to develop guidelines that can be used to strengthen ART adherence.

METHODS AND ANALYSIS

We propose an exploratory multimethod research design. In phase 1, a scoping review will be conducted. The data captured in this phase will be put into charting forms, analysed qualitatively, and then collated and summarised to hypothesise the relationship between religious beliefs and ART adherence. In phase 2, an explanatory qualitative approach will be used. Semistructured interviews will be conducted with purposefully selected religious leaders, Pentecostal Christians living with HIV who are not adhering to ART and healthcare workers delivering ART at selected healthcare facilities in the Milnerton subhealth district. The qualitative data obtained in this phase will be transcribed verbatim and analysed thematically using the ATLAS.ti V.8 software program towards strengthening the hypothesised relationship between religious beliefs and ART adherence. In phase 3, intervention mapping and nominal group techniques will be applied with purposefully selected stakeholders to develop guidelines to strengthen ART adherence among PLHIV.

ETHICS AND DISSEMINATION

Phase 1 of the study will not require ethics approval. Ethics approval for phases 2 and 3 has been received from the University of the Western Cape Biomedical Research and Ethics Committee and the Western Cape Department of Health. Informed consent forms will be obtained from all participants at the different phases of the study. The study findings will be disseminated through publications in scientific journals, presentations at conferences and workshops aimed at improving ART adherence.

"God, why?": The Experience of Mothers from the Israeli Ultra-Orthodox Sector after their Child's Disclosure of Sexual Abuse

Studies dealing with the experiences of non-offending mothers from the general population and minority groups after their child's disclosure of sexual abuse are scarce, and studies on mothers from the Jewish ultra-Orthodox community are non-existent. This study takes an initial step in filling this gap by exploring how the normalization of sexual abuse shapes these mothers' experiences. A qualitative phenomenological study was conducted on a sample of 21 mothers from the ultra-Orthodox sector whose children had been sexually abused. It consisted of in-depth, semi-structured interviews of the mothers followed by a drawing task on their experience. The analysis of the interviews yielded four central themes: the role of social stigmatization and religion on the mother's ability to share her child's abuse; the effect of the disclosure on the mothers' mental state and maternal competency; the mothers' ongoing experience in the shadow of this unprocessed/unresolved trauma; and the mothers' coping strategies, including acceptance, faith, and meaning making. The findings highlight the influence of the tension between the need to adhere to religious norms and preserve the social fabric and the need to enhance mothers' and children's well-being.

Higher religiosity and spirituality are associated with ethnic group membership among middle-aged and older adults living with HIV

Background: HIV is a chronic illness that impacts the lives of more than 1 million people in the United States. As persons living with HIV (PWH) are living longer, it is important to understand the influence that religiosity/spirituality has among middle-aged and older PWH.

Objective: Compare the degree of religiosity/spirituality among middle-aged and older PWH and HIV-negative individuals, and to identify demographic, clinical, and psychosocial factors associated with religiosity/spirituality among PWH.

Method: Baseline data on 122 PWH and 92 HIV-negative individuals (ages 36-65 years; 61.1% Non-Hispanic White) from a longitudinal study were analyzed for the current study. Recruitment occurred through HIV treatment clinics and community organizations in San Diego. Participants completed questionnaires on religiosity, spirituality, and psychosocial functioning. Independent samples t-tests, Pearson correlations, and multiple linear regression analyses were conducted to test the study objective.

Results: No significant differences in religiosity/spirituality were found between PWH and HIV-negative individuals. Demographic and psychosocial variables were unrelated to religiously/spirituality among HIV-negative individuals. Among PWH, multiple linear regression models indicated higher daily spirituality was significantly associated with racial/ethnic minority membership (Hispanic/Latino, African American/Black, or Other), fewer years of estimated duration of HIV, greater social support, and higher grit. Greater engagement in private religious practices was significantly associated with racial/ethnic minority membership and higher social support.

Conclusions: For PWH, being a racial/ethnic minority and having higher social support was associated with greater engagement in religious/spiritual practices. Future longitudinal studies should examine whether religion/spirituality impacts well-being across the lifespan among racial/ethnic minority groups of PWH.

Fear of Punishment in Another World: a Follow-Up Examination of the Religious Beliefs About HIV/AIDS-A Decade of Progress?

This study compared 2000 and 2010 data on the religious beliefs about HIV/AIDS among those with HIV in a Deep South state. The percentage agreeing that HIV/AIDS is a punishment from God had not decreased in that decade. The literature on interventions to reduce religious stigma and increase church involvement in HIV/AIDS prevention was presented. The study concluded with a set of recommendations for future research.

Indonesian Dental Students' Attitudes, Knowledge, Preparation, and Willingness to Treat HIV/AIDS Patients

OBJECTIVE

 To assess the Indonesian dental students' knowledge of HIV/AIDS in terms of transmission and oral manifestation, the attitudes toward people living with HIV/AIDS (PLWHA), the preparedness in infection control, and willingness to treat PLWHA, and assess the factors for willingness to treat PLWHA.

MATERIALS AND METHODS

 A modified version of a questionnaire used to assess dental students' knowledge, attitude, preparedness, and willingness to treat PLWHA in China was used. The questionnaire was cross-culturally adapted into Indonesian and had been pre-tested for face validity and test and retest reliability. The dental students from 32 dental schools in Indonesia were invited to participate in the study.

RESULTS

 A total of 1,280 dental students from 23 dental schools participated in the study. This study found that only 63% of students scored higher than 70% for knowledge of HIV/AIDS, and the mean score for knowledge was 15.02 (2.4). Higher than 80% of students had a positive professional attitude toward PWLHA; however, 80% of students worried about possible disease transmission in the dental office by PLWHA and 70% of students overestimated the occupational risk when treating PLWHA. The dental students had good preparedness for infection control with a mean score for preparedness of 3.19 (0.4). The mean score for willingness was 2.5 (0.9). Willingness to treat significantly differed by the type of universities, gender, age, and clinical experience. This study showed that knowledge about HIV/AIDS correlated with the willingness to treat PLWHA among dental students.

CONCLUSION

 Dental students who have good knowledge about HIV infection tend to have a good willingness to treat PLWHA. The knowledge would in turn affect their attitude, preparedness, and willingness to provide care for PLWHA with confidence and comfort. This study suggests that the improvement of dental training may play an important role in changing students' perception of willingness to treat PLWHA.

Religiosidade/Espiritualidade e Adesão à Terapia Antirretroviral em Pessoas Vivendo com HIV

Resumo Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais.

Human immunodeficiency virus-positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis

Human immunodeficiency virus (HIV)-positive women can breastfeed with minimal risk of mother-to-child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV-positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV-positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV-positive pregnant and postnatal women from all countries/settings were eligible. HIV-positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother-to-child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV-positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.

Factors Associated with Utilization of HIV Testing Services among Adolescents Aged 10-19 Years in Lira District, Northern Uganda: A Cross-Sectional Study

Background

HIV testing remains a problem among adolescents in low- and middle-income countries, and yet, HIV testing is a cornerstone in the fight against HIV. However, there is scanty literature on the utilization of HIV testing services by adolescents especially in rural settings. This study is aimed at determining the uptake of HIV testing services and associated factors among adolescents aged 10-19 years in Lira District, Northern Uganda.

Methods

This was a cross-sectional study done among 277 randomly selected adolescents aged 10-19 years attending outpatient clinics in Pentecostal Assembly of God (PAG) Mission Hospital, Ngetta Health Center III, and Boroboro Health Center III. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, history of test and receipt of HIV results in the last three months, and facility-related factors affecting uptake of HIV testing services. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25.

Results

The uptake of HIV testing services was 43% (119/277) among the study participants. Adolescents who had completed primary education (aOR: 5.47; 95% CI: 1.07-28.15; p = 0.042), are employed (aOR: 2.77; 95% CI: 1.16-6.60; p = 0.022), had used a condom in the last sexual intercourse (aOR: 4.46; 95% CI: 1.78-11.15; p = 0.001), and are involved in HIV testing outreaches (cOR: 10.86; 95% CI: 3.81-30.93; p ≤ 0.001) were more likely to uptake HIV testing services compared to those who had tertiary education, are unemployed, had never used a condom, and are not involved in HIV testing outreaches.

Conclusion

Utilization of HIV testing services by adolescents aged 10-19 in Lira District, Northern Uganda, is generally low. The Ministry of Health should strengthen HIV testing services targeting adolescents to increase uptake of HIV testing services.

Experience of religion and spirituality among socially marginalised people living with HIV in Mississippi

African Americans in Mississippi have the highest HIV-related mortality and poverty rates in the USA, and they tend to be religious. Attitudes toward gender and sexuality are changing, yet few studies have investigated religion and spirituality among special populations living with HIV. Using grounded theory and qualitative methods, we investigated the experience of health and illness of a low-income, socially marginalised population living with HIV in two locations of Mississippi in 2015. In a context of high stigma and HIV-related health disparities, individuals turned, or returned, to religion, church and spirituality as sources of community and strength, which also motivated safer health behaviours. Findings underscore how religion and spirituality are enabling social determinants of health that are under-explored, untapped, potentially culturally acceptable, sustainable interventions at the community-level. We posit, given diminished funding for community-based services, the most significant influence churches could exert is in decreasing HIV stigma. Given the current US plan to end HIV by 2030, with appropriate stakeholder participation, the role of religion, spirituality and clergy could be further amplified via linkage to care providers and the 'normalisation' of the HIV discourse, to address disparities and improve the health of African Americans.

Translation and Validation: Chinese Version of the HIV-Related Social Support Scale

Purpose

Social support is increasingly recognized to be important in care of people living with HIV/AIDS (PLWH), we firstly translate and validate the disease-targeted social support instrument in Chinese and to explore the correlation with WHOQOL-HIV.

Patients and Methods

We established content validity for HIV-related social support scale (HSSS) and administered the resultant questionnaire to 310 PLWH. Descriptive statistics were generated for each of the variables of general characteristics; student t-test was used to compare the different groups.

Results

The HSSS demonstrated a high level of internal consistency, both within each subscale and with the total score; all Cronbach’s α values exceeded a priori threshold of ≥0.70. The HSSS cores were positively correlated with WHOQOL-HIV total scores (Pearson correlation: 0.39, P < 0.001). We also found that higher educational level, personal income, CD4 cell count, and shorter duration of antiretroviral therapy are significantly associated with a higher level of social support (P < 0.05).

Conclusion

Social support may improve quality of life for PLWH, Chinese version of HIV-related social support scale can be used in future clinical practice.

Mental Health, Culture and Resilience-Approaching the COVID-19 Pandemic From a South African Perspective

It is understandable that the challenges of living through a severe contagious outbreak, like the coronavirus disease 2019 (COVID-19), cannot be tolerated for long and that some individuals may require emotional, psychological, and spiritual support in order to strengthen their resilience to navigate this difficult period. As clinicians and researchers in the field of mental health, we need to appreciate the roles that culture, spirituality, and religion play in comforting people who survive such an outbreak and provide possible solutions for public health authorities on how to promote wellness. This appreciation should direct us to seek a deeper understanding of how culture, spirituality, and religion can be used to endure an outbreak of this magnitude and how the interruption of common practices can impact the coping skills of those who are affected. Our understanding of the roles that customs, beliefs, and values of South Africans play in building resilience will help inform and strengthen interventions that are aimed at controlling the spread of COVID-19.

Exploring Intimate Partner Relationships before and after HIV Diagnosis among Minority Older Women

OBJECTIVES

Literature shows that sexual activity remains important at older age and is a valued part of life. However, little is known about the intimate partner relationships (IPR) among minority older women living with Human Immunodeficiency Virus (HIV). The purpose of this study is to explore the effect HIV diagnosis had on the intimate partner relationships (IPR) among minority older women living with HIV (MOWH).

METHODS

Qualitative descriptive study. A total of 28 MOWH (Black and Latinas) aged 50 years and older participated in face to face semi-structured in-depth interviews. Interviews were analyzed using content analysis.

RESULTS

Three themes emerged from the analysis: (a)"Intimate partner relationships before HIV diagnosis" that revealed sexual practices increasing the risk for HIV in their intimate relationships; (b)"Facing relationship consequences of HIV disclosure after diagnosis" explored the consequences of HIV disclosure, and how disclosure determined the future of their intimate relationships; and (c) "Intimate partner relationships after HIV diagnosis" described the quality of intimate partner relationships and changes after HIV diagnosis.

CONCLUSIONS

Results from this study contribute to understanding and increasing awareness of the effect of HIV on the intimacy of MOWH.

CLINICAL IMPLICATIONS

Education provided by health care workers and interventions targeting MOWH should address the effect of HIV in IPR, address MOWH's concerns about it, and help them to improve their overall health.

Dynamic needs and challenges of people with drug-resistant tuberculosis and HIV in South Africa: a qualitative study

BACKGROUND

There is little evidence of patient acceptability for drug-resistant tuberculosis (DRTB) care in the context of new treatment regimens and HIV co-infection. We aim to describe experiences of DRTB-HIV care among patients in KwaZulu-Natal province, South Africa.

METHODS

In this qualitative study using Bury's framework for chronic illness, we conducted 13 focus groups at a tertiary hospital with 55 patients co-infected with DRTB and HIV (28 women, 27 men) who were receiving new bedaquiline-based treatment for DRTB, concurrent with antiretroviral therapy. Eligible patients were consenting adults (aged >18 years) with confirmed DRTB and HIV who were enrolled into the PRAXIS study within 2 weeks of initiating bedaquiline-based treatment for DRTB. Participants were recruited from the PRAXIS cohort to participate in a focus group based on their time in DRTB treatment: early (2-6 weeks after treatment initiation), middle (2-6 months after discharge or treatment initiation if never hospitalised), and late (>6 months after treatment initiation). Focus groups were carried out in isiZulu language, audio recorded, and translated to English within 4 weeks. Participants were asked about their experiences of DRTB and HIV care and treatment, and qualitative data were coded and thematically analysed.

FINDINGS

From March, 2017, to June, 2018, distinctive patient challenges were identified at four critical stages of DRTB care: diagnosis, marked by centralised hospitalisation, renunciation from routine life, systemic stigmatisation and, for patients with longstanding HIV, renewed destabilisation; treatment initiation, marked by side-effects, isolation, and social disconnectedness; discharge, marked by brief respite and resurgent therapeutic and social disruption; and continuity, marked by deepening socioeconomic challenges despite clinical recovery. The periods of diagnosis and discharge into the community were particularly difficult. Treatment information and agency in decision making was a persistent gap. Sources of stigmatisation shifted with movement between the hospital and community. Resilience was built by connecting to peers, self-isolating, financial and material security, and a focus on recovery.

INTERPRETATION

People with DRTB and HIV undergo disruptive, life-altering experiences. The lack of information, agency, and social protections in DRTB care and treatment causes wider-reaching challenges for patients compared with HIV. Decentralised, community, peer-support, and differentiated care models for DRTB might be ameliorative and help to maximise the promise of new regimens.

FUNDING

US National Institutes of Health.

TRANSLATION

For the isiZulu translation of the abstract see Supplementary Materials section.

Depressive symptoms among older adults with HIV in Namibia: the role of social support and spirituality

Background: More than 60% of older adults living with HIV reside in sub-Saharan Africa. Namibia has one of the highest HIV/AIDS prevalence rates. This study examined the association between social support, spirituality and depressive symptoms.Method and results: The sample consisted of 147 Oshiwambo-speaking older adults (mean age = 61 years, SD = 6.92 years) with HIV in Namibia. By utilising a hierarchical multivariate regression method, this study found that social support from friends and spirituality showed a significant negative relationship to depressive symptoms. In addition, self-rated health status and alcohol use were significant sociodemographic predicitive factors of depressive symptoms.Conclusion: This study suggests the need to develop interventions and support programmes that incorporate peer support and spiritual practice to promote health and well-being among older persons living with HIV in Namibia.

Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China

BACKGROUND

In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China.

METHOD

In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15).

RESULTS

Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75).

CONCLUSION

Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.

Test but not treat: Community members' experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural KwaZulu-Natal, South Africa

Introduction

Antiretroviral therapy (ART) has revolutionised the care of HIV-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. However, these benefits can only be realised if individuals are aware of their HIV-positive status, initiated and retained on suppressive lifelong ART. Framed using the socio-ecological model, the present study explores factors contributing to poor ART uptake among community members despite high acceptance of HIV-testing within a Treatment as Prevention (TasP) trial. In this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components.

Methods

This research was embedded within a cluster-randomised trial (ClinicalTrials.gov, number NCT01509508) of HIV treatment as Prevention in rural KwaZulu-Natal, South Africa. Data were collected between January 2013 and July 2014 from resident community members. Ten participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. Data from individual interviews and focus group discussions were triangulated using community walks to give insights into community members’ perception of the barriers and facilitators of ART uptake. We used thematic analysis guided by a socio-ecological framework to analyse participants’ narratives from both individual interviews and focus group discussions.

Results

Barriers and facilitators operating at the individual, community and health system levels influence ART uptake. Stigma was an over-arching barrier, across all three levels and expressed variably as fear of HIV disclosure, concerns about segregated HIV clinical services and negative community religious perceptions. Other barriers were individual (substance misuse, fear of ART side effects), community (alternative health beliefs). Facilitators cited by participants included individual (expectations of improved health and longer life expectancy following ART, single tablet regimens), community (availability of ART in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff).

Discussion

We identified multiple barriers to achieving universal ART uptake. To enhance uptake in HIV care services, and achieve the full benefits of ART requires interventions that tackle persistent HIV stigma, and offer people with HIV respectful, convenient and efficient services. These interventions require evaluation in appropriately designed studies.

Religiosity, Social Support, and Ethnic Identity: Exploring "Resilience Resources" for African-American Women Experiencing HIV-Related Stigma

INTRODUCTION

African-American women living with HIV report substantial HIV-related stigma and depression. Resilience resources are strength-based resources that may moderate the effects of HIV-related stigma on poor psychosocial outcomes such as depression.

OBJECTIVE

To evaluate whether religiosity, social support, and ethnic identity moderate the effects of HIV-related stigma on depression among African-American women living with HIV.

METHODS

We used baseline data (May 2013-October 2015) from a randomized controlled trial testing the efficacy of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago, IL, and Birmingham, AL, who were older than 18 years and currently receiving HIV services. To assess whether religiosity (7-item Religious Beliefs and Behaviors survey), social support (select subscales from the Medical Outcomes Study Social Support Survey), and ethnic identity (Commitment subscale from the Multigroup Ethnic Identity Measure) modified the relationship between HIV-related stigma (Stigma Scale for Chronic Illness) and depression (8-item Patient Health Questionnaire), we conducted 3 separate moderation analyses using linear regression with interactions between HIV-related stigma and each moderator of interest, adjusted for study site, age, time since diagnosis, and education.

RESULTS

Among 226 African-American women living with HIV, greater levels of HIV-related stigma were associated with greater depression in all 3 models (P < 0.05). Only religiosity modified this association (P = 0.04), with a weaker association among women reporting higher levels of religiosity.

CONCLUSIONS

The protective effects of religiosity may be leveraged in interventions for African-American women living with HIV struggling with HIV-related stigma.

The relationship between self-reported viral load suppression and quality of life among people living with HIV in South Carolina

Ensuring the wellbeing of people living with HIV (PLWH) has become a significant public health concern in the era of highly active antiretroviral therapy. This study was to assess the quality of life (QoL) among PLWH in South Carolina (SC) and to examine the relationship between self-reported viral load (VL) suppression and their perceived QoL. In 2018, a cross-sectional survey was conducted among 402 PLWH from a large immunology clinic in SC. The WHOQoL brief version (WHOQoL-HIV-BREF) instrument with six domains (physical health, psychological health, social relations, independence, environmental health, and spirituality) and two specific questions (overall rate of QoL and satisfaction with health) were used. On a five-point scale, the participants rated their overall rating of QoL as good (mean = 4.07). The participants reported their psychological health as the highest (mean = 3.88) followed by environmental health (mean = 3.82), social relations (mean = 3.69), and independence (mean = 3.47). 71% reported an undetected VL. In multivariable analyses, self-awareness of undetected VL was significantly associated with satisfaction with health, psychological health, social relations, environmental health, but negatively associated with spirituality. These findings suggest that self-awareness of undetected VL had a significant impact on their perceived QoL beyond sociodemographic factors among PLWH who were linked to care in SC.

Collective Coping Strategies for HIV-Related Challenges Among Men Who Have Sex With Men in Manila, Philippines

Contextual factors, such as cultures of collectivism versus individualism, shape HIV coping strategies; despite this, little research regarding collective coping strategies applied to HIV exists. This may be important for the growing HIV epidemic in the Philippines, which has a collectivistic culture and where men who have sex with men (MSM) account for a majority of the cases. Fifteen semistructured, in-depth interviews with HIV-positive MSM and 6 interviews with community-based organization workers were conducted between June and August 2017. Data were analyzed using thematic framework analysis. Three strategies were identified: peer support, spirituality, and support from existing relationships. Each form of collective coping had unique mechanisms and benefits for dealing with HIV. Overall, helping MSM with HIV find a collective identity after an HIV diagnosis enables management of HIV-related challenges. Policies and research interventions that improve access to collective identities for MSM with HIV may improve management of HIV-related challenges.

The Correlation between Stigma and Family Acceptance with Religiosity of PLWH MSM in Medan, Indonesia

There are several factors related to religiosity of PLWH MSM in Medan. This study aimed to identify the correlation between stigma and family acceptance with religiosity of PLWH MSM in Medan. This cross-sectional study applied purposive sampling technique and involved 175 samples from H. Adam Malik Public Central Hospital, Medan Pirngadi Hospital, Padang Bulan and Teladan Public Health Centers. The data was analyzed using the multiple logistic regression technique. Bivariate analysis showed a significant correlation between stigma along with family acceptance with religiosity of PLWH MSM in Medan (p = 0.005; α = 0.005).

Repercusiones de la espiritualidad en la vida de las mujeres que viven con el VIH

Introducción: La espiritualidad en pacientes que viven con el VIH ayuda a afrontar los pensamientos negativos provocados por la enfermedad. El objetivo del estudio fue conocer el impacto de la espiritualidad en la vida de las mujeres que viven con el VIH. Materiales y Métodos: Investigación cualitativa sobre historias de vida temáticas. La muestra está compuesta por siete mujeres que fueron diagnosticadas con VIH/SIDA hace más de un año. Para la recolección de datos se utilizó una entrevista semiestructurada con preguntas sobre el contexto social, situación sociodemográfica y clínica, religión y espiritualidad. Para el análisis de datos se empleó la técnica de análisis de contenidos. Los resultados se organizaron en dos categorías: la búsqueda de la fuerza en la espiritualidad y la esperanza de curación. Resultados: En momentos de angustia causados por el VIH/SIDA, todas las entrevistadas recurrieron a la espiritualidad a través de la oración e incluso a la materialización de la presencia de Dios como estrategias para afrontar la enfermedad. El anhelo de sanación mediante revelaciones divinas se expresa en los discursos de los entrevistados. Discusión: Según las historias de vida de las entrevistadas, la figura divina las ha fortalecido para hacer frente a los retos generados por el VIH/SIDA. Conclusiones: A través de esta investigación se pudo comprobar que la espiritualidad está presente en las vidas de las mujeres que viven con el VIH y que mitiga las adversidades producidas por la enfermedad. Cómo citar este artículo: Santos FDRP, Amaral LROG, Santos MA, Ferreira AGN, Moura JF, Brito LB. Repercussions of spirituality in the lives of women living with HIV. Rev Cuid. 2019; 10(3): e771. http://dx.doi.org/10.15649/cuidarte.v10i3.711

Religious Coping and Depressive Symptoms Among Black Americans Living with HIV: An Intersectional Approach

This exploratory quantitative study examined the association between religious coping and depressive symptoms among a sample of 216 Black Americans living with HIV (BALWH) in the Southeastern United States. Descriptive analyses and multiple linear regression were used to determine statistically significant associations between religious coping styles and depressive symptoms, and to investigate the potential of sexual orientation and gender to moderate the associations between religious coping styles and depressive symptoms. Negative religious coping, but not positive religious coping, significantly predicted depressive symptoms. Sexual orientation, but not gender, significantly moderated the association between positive religious coping and depressive symptoms so that the relationship was only significant for heterosexual BALWH. Implications of these findings for future research and clinical work with BALWH are discussed.

The relationship between stigma, religiosity, and the quality of life of HIV-positive MSM in Medan, Indonesia

OBJECTIVE

This study aims to determine the relationship between stigma, religiosity, and the quality of life of HIV-positive men who have sex with men (MSM) in Medan.

METHODS

This is an analytical observational study with a cross-sectional approach. Data in demographics, stigma, religiosity, and quality of life were obtained directly from the participants. Data were taken from April to May 2018. There were 175 subjects who met the criteria which; (i) HIV-positive MSM; (ii) aged≥18 y.o.; and (iii) able to read and write.

RESULTS

Bivariate analysis found that there is a negative relationship between stigma and quality of life (p-value=0.007), and there is a positive relationship between religiosity and quality of life (p-value=0.000).

CONCLUSION

These findings suggest that stigma is an indicator of poor quality of life, while higher religiosity is associated with better quality of life. An interdisciplinary approach is needed in health care planning and social services, to improve the quality of life of HIV-positive MSM.

Medical pluralism and rationalities for HIV care utilization among discordant couples in Siaya County, rural western Kenya

Understanding healthcare seeking and utilization of members of discordant couples can help in implementing effective HIV treatment, care, and support. We conducted a qualitative study comprised of in-depth interviews (n = 26) and ten focus group discussions (n = 73) with community members including opinion leaders, healthcare workers, and members of discordant couples. A portion of the latter group had been participants in the HIV Prevention Trials Network (HPTN) 052 study. Themes that emerged from the data were pragmatism and the realities of hospital care, quest for a cure through traditional medicine, and religious dogma. Medical pluralism is practiced by members of discordant couples seeking HIV care through intersections of hospital facility services and traditional and religious therapeutic options. It would be prudent for healthcare policy makers and conventional medical providers to recognize the importance of traditional medicine and religion in the lives of members of HIV discordant couples and make efforts to integrate the positive concepts of both into the couples’ overall health plan.

Religiosity and sexual abstinence among Nigerian youths: does parent religion matter?

BACKGROUND

Religion plays an important role in youth behaviours, making it a significant factor in the discourse on youth sexuality in sub-Saharan Africa. Several studies have found that religion and religiosity play an important role in the sexual behaviours of young people. However, little research in Nigeria has examined the mechanisms through which religiosity influences youth sexual behaviour and if parents' religion moderates this relationship. Guided by the social control theory, this paper contributes to the existing literature by examining the relationship between religiosity and youth sexual behaviour.

METHODS

Data for the study came from 2399 male and female youth aged 16-24 years in four states purposively selected from four regions in Nigeria. Abstinence was the sexual behaviour of interest. Logistic regression was used to examine this relationship.

RESULTS

Results showed that 68% of the youth had never had sex. Religiosity was a protective factor for youth sexual behaviour and this positive association was still evident even after controlling for other covariates. Youth who were highly religious (OR - 1.81, CI- 1.13-2.88) had significantly higher odds of abstaining compared to their counterparts who were not religious.

CONCLUSION

Religiosity is a protective factor for sexual abstinence among youth in Nigeria. Policy makers can work around using religious institutions for behavioural change among youth in Nigeria.

Religious Fundamentalism, Satisfaction with Life and Posttraumatic Stress Symptoms Intensity in a Polish Sample of People Living with HIV/AIDS

We investigated the relationship between religious fundamentalism, satisfaction with life and the intensity of posttraumatic stress symptoms in people living with HIV/AIDS. The study was conducted on 283 adults, including 242 HIV-positive patients and 41 individuals with AIDS, aged from 20 to 74. Religious fundamentalism was positively correlated with age and posttraumatic stress symptoms intensity. Negative correlation between satisfaction with life and posttraumatic stress intensity was also found. Religious fundamentalism and satisfaction with life accounted for 34% of the variance in posttraumatic stress symptoms intensity. The level of patients' education mediated the relationship between religious fundamentalism and the posttraumatic stress symptoms intensity.

Diagnósticos de enfermagem associados às necessidades humanas no enfrentamento do HIV

Resumo Objetivo: Identificar as implicações e mudanças na vida do indivíduo, considerando o momento da revelação do diagnóstico de HIV, e construir diagnósticos de enfermagem adequados às necessidades humanas relacionadas às implicações e mudanças. Métodos: Pesquisa descritiva retrospectiva, de abordagem qualitativa. Foram entrevistadas 20 pessoas que participam de uma organização não governamental. O corpus de análise foi organizado em três categorias: “influência do diagnóstico na empregabilidade”, “apoio religioso” e “piora da saúde”. A partir delas foram elaborados diagnósticos de enfermagem, de acordo com a CIPE®, versão 2015, e segundo as necessidades humanas. Resultados: Frente ao diagnóstico, foi relatado modificações no cotidiano como a influência na empregabilidade, apoio religioso e a piora da saúde. Foram identificados 35 diagnósticos de enfermagem relacionados às necessidades de autoestima, segurança e proteção e sociais, 26 relacionados à necessidade de autorreconhecimento, 7 à necessidade fisiológica e 18 à necessidade espiritual. Conclusão: com a identificação das categorias, dos DE e necessidades humanas, o enfermeiro se apropria de subsídios para a realização de uma prática pautada em uma linguagem padronizada auxiliando na melhoria da assistência de enfermagem.

The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study

Early and sustained antiretroviral therapy (ART) adherence can suppress the HIV virus in individuals and reduce onward transmission of HIV in the population. Religiosity has been associated with better HIV clinical outcomes. Data are from a longitudinal, observational study of 749 HIV-infected individuals from Brazil, Zambia, and Thailand (HPTN 063). Ordered logistic regression assessed whether religious service attendance was associated with ART adherence (self-reported and plasma HIV-RNA) and moderated the association between alcohol problems and ART adherence. In each country, > 80% of participants reported high self-reported ART adherence (good/very good/excellent). Religious service attendance exceeded 85% but was statistically unrelated to adherence. In combined-country models, (p = 0.03) as alcohol problems increased, the probability of high self-reported ART adherence, as well as viral-load, became weaker at higher compared to low service attendance frequency. Future studies should evaluate spirituality variables and replicate the moderation analyses between religious attendance and alcohol problems.

Predictors of willingness to accept pre-marital HIV testing and intention to sero-sort marital partners; risks and consequences: Findings from a population-based study in Cameroon

Introduction

The objectives of this study was to investigate and compare levels of acceptability of pre-marital HIV testing; and intention to sero-sort future marital and its associated factors among unmarried adults in two cities in Cameroon.

Methods

A population-based survey was conducted simultaneously in the cities of Kumba and Buea, located in the Southwest region of Cameroon. Data were collected from September to October 2016 by trained interviewers who administered questionnaires to eligible and consenting unmarried adults aged 21–35 years. Data were weighted and logistic regression analyses performed to identify significant predictors. The level of statistical significance was set at p< = 0.05.

Results

A total of 1,406 respondents (767 in Kumba and 639 in Buea) participated in the study. In the pooled sample, the median age of respondents was 26 years (IQR = 23–29) and over half (54.8%) were males. Over 90% of respondents in both cities indicated their willingness to accept pre-marital HIV testing. Respondents who had previously tested for HIV in Kumba (AOR = 7.87; 95%CI, 4.02–15.44) were significantly more likely to accept premarital HIV testing than those who had never tested for HIV. In Kumba, older age (AOR = 0.42; 95%CI, 0.18–0.96) and those unemployed (AOR = 0.22; 95% CI, 0.06–0.76) were significantly less likely to accept pre-marital HIV testing. In Buea males (AOR = 0.64 95% CI, 0.45–0.89) who would test HIV negative would be significantly less likely to accept to marry an HIV positive partner. In Buea, respondents who indicated a moderate risk of contracting HIV (AOR = 1.71; 95%CI, 1.09–2.66, p = 0.018) were significantly more likely to accept to marry an HIV positive partner. The major limitation of the study was that a hypothetical situation was used to ask respondents about their willingness to accept pre-marital HIV testing rather than actual HIV test acceptance.

Conclusions

Most respondents expressed their willingness to undergo pre-marital HIV testing. However, majority of respondents who would test HIV negative would refuse to marry their partner who tests HIV positive. These findings suggest that interventions to reduce HIV infection and fight against stigma and discrimination should be reinforced at community level.

The Influence of Religion and Spirituality on HIV Prevention Among Black and Latino Men Who Have Sex with Men, New York City

The influence of religion and spirituality (R/S) on HIV prevention has been understudied, especially for Black and/or Latino men who have sex with men (BLMSM), who bear a disproportionate burden of HIV, and who are part of racial/ethnic communities with high engagement in R/S. The specific aim of this study was to explore perspectives about R/S among BLMSM to inform HIV prevention strategies and reduce HIV-related health disparities. Data from 105 qualitative interviews with BLMSM were analyzed; 58 (55%) stated that R/S had no personal influence on HIV prevention. For those reporting any R/S influence, main themes were: (1) R/S positively influenced decision-making and self-respect, (2) perceived judgment and stigma by religious communities, (3) belief in a higher power, and (4) altruism. These findings can inform faith-based HIV prevention interventions for BLMSM.

Religious and spiritual coping in people living with HIV/Aids

OBJECTIVE

evaluate the religiosity and the religious/spiritual coping of people living with HIV/Aids.

METHOD

descriptive, cross-sectional study with quantitative approach, conducted in a reference HIV/Aids outpatient clinic in a university hospital of Recife-PE, Brazil, from June to November 2015. At total of 52 people living with HIV/Aids (PLWHA) participated in the research, which employed own questionnaire, the Duke University Religion Index (DUREL), and the Religious/Spiritual Coping Scale (RCOPE).

RESULTS

the sample presented high indices of organizational religiosity (4.23±1.66), non-organizational religiosity (4.63±1.50), and intrinsic religiosity (13.13±2.84). Positive RCOPE was used in high mean scores (3.66±0.88), and negative RCOPE had low use (2.12 ± 0.74). In total, use of RCOPE was high (3.77±0.74), having predominated the positive RCOPE (NegRCOPE/PosRCOPE ratio=0.65±0.46).

CONCLUSION

it is evident the importance of encouraging religious activity and RCOPE strategies, seen in the past as inappropriate interventions in clinical practice.

Analysis of resilience and sexual behavior in persons with HIV infection

The main objective of this study was to evaluate ex post facto resilience in persons with HIV infection and its relationship to socio-demographic and sexual behavior variables. Participants included 159 persons with HIV infection, of both sexes, aged between 19 and 55 years. Fifty-one percent of patients were infected through homosexual means. Sixty-seven percent were in the asymptomatic phase of infection. Assessment instruments used were the following: a questionnaire on socio-demographic data and sexual behavior and the Connor-Davidson Resilience Scale. The evaluation was individual, voluntary, and anonymous. The results showed that 49.05% of patients had average resilience, 27.68% had high resilience, and 23.37% had low resilience. They found that heterosexual patients infected with HIV, diagnosed between 1985 and 1990 (23 and 28 years of diagnosis) and those who had disclosed their HIV status to more than 30 people, had greater resilience than homosexual patients, diagnosed between 1996 and 2000 (13 and 17 years of diagnosis) and those who had disclosed their HIV status to 1–5 people. Finally, resilience was not a predictor of sexual risk factor. It is suggested that health interventions take into account the resilience and psychological variables that may be beneficial to improve coping with the disease.

A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

Impaired religiosity and spiritual distress in people living with HIV/AIDS

Objective

To verify the inference of Nursing Diagnoses, Impaired religiosity and Spiritual distress in people living with HIV/AIDS.

Methods

This is a cross-sectional study with a quantitative approach, performed in a specialized Service CenteR of Recife, Pernambuco, from June to November 2015. The results related to 52 people living with HIV/AIDS and that were interviewed were analyzed by three nurse judges.

Results

Spiritual distress was estimated at 73.1% (38), Impaired religiosity at 36.5% (19), with an average number of defining characteristics of 3.88 ± 2.05 and 2.55±0.69. The main defining characteristic for Impaired religiosity was: "reports a need to reconnect with previous beliefs" (92.3%); and for Spiritual distress, it was: "Expresses a lack of purpose in life/expresses lack of meaning in life" (86.5%).

Conclusions

The results point to the need to consider the religious-spiritual dimension in care protocols and research in nursing.

Psychosocial Aspects of ART Counseling: A Comparison of HIV Beliefs and Knowledge in PMTCT and ART-Naïve Women

Antiretroviral therapy (ART)-readiness counseling has been deemed critical to adherence, instilling knowledge, and promoting positive beliefs and attitudes. In the landscape of changing policy in South Africa, some ART initiators have had prior ART-readiness counseling (e.g., for prevention-of-mother-to-child-transmission [PMTCT] programs). The extent to which previous counseling resulted in retained knowledge and belief is unknown, which may be important to the promotion of women's ART adherence. We compared 320 women living with HIV and initiating ART, with and without prior PMTCT on HIV knowledge, treatment, beliefs, and attitudes. The PMTCT group held more accurate beliefs and more positive attitudes about ART. Both groups lacked understanding of basic HIV biology. Nondisclosure of HIV status was high. Thus, in individuals re-initiating therapy, some knowledge about HIV and its treatment was not well retained. Tailored education and counseling may be critical to adherence, with a focus on biological concepts that impact ART resistance.

Reported Church Attendance at the Time of Entry into HIV Care is Associated with Viral Load Suppression at 12 Months

The Southeast has high rates of church attendance and HIV infection rates. We evaluated the relationship between church attendance and HIV viremia in a Southeastern US, HIV-infected cohort. Viremia (viral load ≥200 copies/ml) was analyzed 12 months after initiation of care. Univariate and multivariable logistic regression models were fit for variables potentially related to viremia. Of 382 patients, 74 % were virally suppressed at 12 months. Protective variables included church attendance (AOR 0.5; 95 % CI 0.2, 0.9), being on antiretroviral therapy (AOR 0.01; 95 % CI 0.004, 0.04), CD4(+) T lymphocyte count 200-350 cells/mm(3) at care entry (AOR 0.3; 95 % 0.1, 0.9), and education (AOR 0.5; 95 % CI 0.2, 0.9). Variables predicting viremia included black race (AOR 3.2; 95 % CI 1.4, 7.4) and selective disclosure of HIV status (AOR 2.7; 95 % CI 1.2, 5.6). Church attendance may provide needed support for patients entering HIV care for the first time.

Spirituality/Religiosity: A Cultural and Psychological Resource among Sub-Saharan African Migrant Women with HIV/AIDS in Belgium

Spirituality/religion serves important roles in coping, survival and maintaining overall wellbeing within African cultures and communities, especially when diagnosed with a chronic disease like HIV/AIDS that can have a profound effect on physical and mental health. However, spirituality/religion can be problematic to some patients and cause caregiving difficulties. The objective of this paper was to examine the role of spirituality/religion as a source of strength, resilience and wellbeing among sub-Saharan African (SSA) migrant women with HIV/AIDS. A qualitative study of SSA migrant women was conducted between April 2013 and December 2014. Participants were recruited through purposive sampling and snowball techniques from AIDS Reference Centres and AIDS workshops in Belgium, if they were 18 years and older, French or English speaking, and diagnosed HIV positive more than 3 months beforehand. We conducted semi-structured interviews with patients and did observations during consultations and support groups attendances. Thematic analysis was used to analyse the data. 44 women were interviewed, of whom 42 were Christians and 2 Muslims. None reported religious/spiritual alienation, though at some point in time many had felt the need to question their relationship with God by asking "why me?" A majority reported being more spiritual/religious since being diagnosed HIV positive. Participants believed that prayer, meditation, regular church services and religious activities were the main spiritual/religious resources for achieving connectedness with God. They strongly believed in the power of God in their HIV/AIDS treatment and wellbeing. Spiritual/religious resources including prayer, meditation, church services, religious activities and believing in the power of God helped them cope with HIV/AIDS. These findings highlight the importance of spirituality in physical and mental health and wellbeing among SSA women with HIV/AIDS that should be taken into consideration in providing a caring and healthy environment.

Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature

Much attention has been given to the relationship between religion/spirituality (R/S) and HIV in recent years, but comparatively little has been explored in regard to R/S and HIV testing, retention in care, and adherence to medication. Religious views concerning HIV risk behavior pose challenges to communication and education about sexual health in religious communities and may serve as barriers to HIV treatment and care. Conversely, religious coping and spiritual well-being, as well as social support could serve as facilitators to HIV treatment and care. This study aims to fill a gap in the literature by addressing the following questions: (1) what dimensions of R/S have been found to be factors associated with HIV outcomes?; (2) which R/S factors function as barriers or facilitators to care among people living with HIV (PLWH)?; and (3) which R/S factors, if any, vary across socio-demographic groups? Thirty-three empirical articles were identified for systematic review. Of the 33 empirical studies included, 24 studies found that at least one measure of R/S was associated with better adherence and clinical health outcomes. Twelve studies found at least one measure of R/S to be associated with poorer adherence and clinical health outcomes. Seven of the studies found at least one R/S measure to have no significant association with outcomes. Though all of the studies included in this review focused on R/S experiences of PLWH, there was very little consistency in regard to measurement of R/S. Studies in this review included a wide range of R/S measures, including beliefs, religious/spiritual practices, R/S coping, organizational religion, and many more. Of the 33 studies reviewed, only 9 focused on unique populations such as women, people with histories of substance abuse, immigrants, etc. Findings from this review highlight opportunities for more studies in various populations using standardized R/S measures.

Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV

Psychological distress is common among adolescents living with HIV (ALHIV) worldwide, and has been associated with non-adherence to anti-retroviral therapy (ART), leading to poor virologic suppression, drug resistance, and increased risk for AIDS morbidity and mortality. However, only a few studies have explored the relationship between psychological distress and ART adherence among adolescents in sub-Saharan Africa. The paper examines the relationship between psychological distress and ART adherence, and effect of psychosocial resources on ART adherence. We conducted a cross-sectional survey of 464 ALHIV (aged 12-19; 53% female) seeking HIV care at a large HIV treatment center in Kampala, Uganda. ALHIV were recruited during routine clinic visits. Three self-reported binary adherence measures were utilized: missed pills in the past three days, non-adherence to the prescribed medical regimen, and self-rated adherence assessed using a visual analog scale. Psychological distress was measured as a continuous variable, and computed as the mean score on a locally developed and validated 25-item symptom checklist for Ugandan ALHIV. Psychosocial resources included spirituality, religiosity, optimism, social support, and coping strategies. After adjusting for respondents' socio-demographic characteristics and psychosocial resources, a unit increase in psychological distress was associated with increased odds of missing pills in past 3 days (Odds Ratio(OR) = 1.75; Confidence Interval (CI): 1.04-2.95), not following the prescribed regimen (OR = 1.63; CI: 1.08-2.46), and lower self-rated adherence (OR = 1.79; CI: 1.19-2.69). Psychosocial resources were associated with lower odds for non-adherence on all three self-report measures. There is a need to strengthen the psychosocial aspects of adolescent HIV care by developing interventions to identify and prevent psychological distress among Ugandan ALHIV.

Qualidade de vida e fatores associados em pessoas vivendo com HIV/AIDS

Resumo Objetivo Avaliar a qualidade de vida em pessoas vivendo com HIV/AIDS e os fatores associados. Métodos Estudo transversal, realizado com 146 pessoas com HIV em tratamento ambulatorial. Os instrumentos utilizados foram: questionário para avaliação socioeconômica, demográfica, epidemiológica e clínica e a escala WHOQOL HIV-bref para avaliação da qualidade de vida. Foi realizada análise descritiva e empregado o teste de Regressão linear múltipla com modelagem stepwise forward. Resultados Houve prevalência do sexo masculino, baixa escolaridade e assintomáticos. Os domínios Nível de independência e Meio ambiente tiveram os piores escores. Ter ocupação remunerada, renda per capita, possuir religião, maior tempo de diagnóstico e adesão ao tratamento associaram-se positivamente à qualidade de vida. Relação homoafetiva, ter sofrido estigma ou preconceito, presença de sintomas psicossociais e ter adquirido infecções oportunistas foram preditores associados à pior qualidade de vida. Conclusão A qualidade de vida apresentou preditores associados e comprometimento em dois domínios da escala.