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Marbaniang I, Borse R, Sangle S, Kinikar A, Chavan A, Nimkar S, Suryavanshi N, Mave V. Development of shortened HIV-related stigma scales for young people living with HIV and young people affected by HIV in India. Health Qual Life Outcomes 2022; 20:119. [PMID: 35909172 PMCID: PMC9340676 DOI: 10.1186/s12955-022-02030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND HIV-related stigma is associated with poor quality of life and poor healthcare-seeking behaviours in young people living with HIV (YPLHIV) and young people affected by HIV (YPAHIV). India has an estimated 120,000 YPLHIV and 4 million YPAHIV, but efforts to measure HIV-related stigma in them are sparse, impeded by the lack of measuring instruments. Here, we describe the development of the Pune HIV-Stigma Scale (PHSS) and modified-PHSS to measure HIV-related stigma among YPLHIV and YPAHIV, respectively, in India. METHODS We used data from a mental health study for YPLHIV and YPAHIV aged 15-25 years, conducted at Byramjee Jeejeebhoy Government Medical College & Sassoon General Hospitals, Pune, India, between August 2018 and June 2021. Findings from multiple confirmatory factor analyses and cognitive interviews guided the development of the 12-item PHSS. The modified-PHSS was developed by confirming the structure of the PHSS for YPAHIV. Convergent validity with Center for Epidemiological Studies Depression (CES-D) and UCLA Loneliness scales was assessed using Spearman's correlation coefficients. RESULTS Model fit indices were good for both the PHSS (χ2 = 65.0, df = 48, p value: 0.052; root mean square error of approximation (RMSEA): 0.054; comparative fit index (CLI): 0.980; Tucker-Lewis index (TLI): 0.972; and standardized root mean square residual (SRMR): 0.067), and the modified-PHSS (χ2 = 56.9, df = 48, p value: 0.176; RMSEA: 0.045; CLI: 0.983; TFI: 0.976, and SRMR: 0.078). Spearman's correlation coefficients indicated low to moderate convergent validity (ρ: 0.03-0.52) across different subscales of the PHSS and modified-PHSS. Cronbach's alpha for the PHSS was 0.82 and for the modified-PHSS 0.81. CONCLUSION We developed the first scales to measure HIV-related stigma among YPLHIV and YPAHIV in India. These concise scales can facilitate measurement of HIV-related stigma more frequently in research studies. We recommend that they be tested in different Indian languages.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, 2001 McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada
| | - Rohidas Borse
- Department of Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Shashikala Sangle
- Department of Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Paediatrics, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Nishi Suryavanshi
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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Penner J, Ferrand RA, Richards C, Ward KA, Burns JE, Gregson CL. The impact of vitamin D supplementation on musculoskeletal health outcomes in children, adolescents, and young adults living with HIV: A systematic review. PLoS One 2018; 13:e0207022. [PMID: 30439968 PMCID: PMC6237309 DOI: 10.1371/journal.pone.0207022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE HIV-positive children, adolescents, and young adults are at increased risk poor musculoskeletal outcomes. Increased incidence of vitamin D deficiency in youth living with HIV may further adversely affect musculoskeletal health. We investigated the impact of vitamin D supplementation on a range of musculoskeletal outcomes among individuals aged 0-25 years living with HIV. METHODS A systematic review was conducted using databases: PubMed/Medline, CINAHL, Web of Knowledge, and EMBASE. Interventional randomised control trials, quasi-experimental trials, and previous systematic reviews/meta-analyses were included. Outcomes included: BMD, BMC, fracture incidence, muscle strength, linear growth (height-for-age Z-score [HAZ]), and biochemical/endocrine biomarkers including bone turnover markers. RESULTS Of 497 records, 20 studies met inclusion criteria. Thirteen studies were conducted in North America, one in Asia, two in Europe, and four in Sub-Saharan Africa. High-dose vitamin D supplementation regimens (1,000-7,000 IU/day) were successful in achieving serum 25-hydroxyvitamin-D (25OHD) concentrations above study-defined thresholds. No improvements were observed in BMD, BMC, or in muscle power, force and strength; however, improvements in neuromuscular motor skills were demonstrated. HAZ was unaffected by low-dose (200-400 IU/day) supplementation. A single study found positive effects on HAZ with high-dose supplementation (7,000 vs 4,000IU/day). CONCLUSIONS Measured bone outcomes were unaffected by high-dose vitamin D supplementation, even when target 25OHD measurements were achieved. This may be due to: insufficient sample size, follow-up, intermittent dosing, non-standardised definitions of vitamin D deficiency, or heterogeneity of enrolment criteria pertaining to baseline vitamin D concentration. High-dose vitamin D may improve HAZ and neuromuscular motor skills. Adequately powered trials are needed in settings where HIV burden is greatest. PROSPERO Number: CRD42016042938.
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Affiliation(s)
- Justin Penner
- University of Manitoba, Winnipeg, Canada
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Rashida A. Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Kate A. Ward
- MRC Lifecourse Epidemiology, University of Southampton, Southampton, United Kingdom
| | - James E. Burns
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Queen Elizabeth University Hospital, Greater Glasgow & Clyde NHS Trust, Glasgow, United Kingdom
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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DeSilva MB, Penwill N, Sabin L, Gifford AL, Li Z, Fujie Z, Weiwei M, Yongzhen L, Hongyan L, Xuemei Z, Barnoon Y, Gill CJ, Bonawitz R. We don't dare to tell her … we don't know where to begin: Disclosure experiences and challenges among adolescents living with HIV and their caregivers in China. Int J Pediatr Adolesc Med 2018; 5:5-12. [PMID: 30805525 PMCID: PMC6363272 DOI: 10.1016/j.ijpam.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China. To help address this gap, we explored practices for disclosure to adolescents living with HIV (ALHIV) among Chinese caregivers and clinicians, and the disclosure experiences of the adolescents themselves using qualitative methods. DESIGN AND SETTING The study was conducted in 2014 at the Guangxi Center for Disease Control and Prevention ART (CDC-ART) clinic in Nanning, China. We used a qualitative design, incorporating in-depth interviews (IDIs) and focus group discussions (FGDs). PATIENTS AND METHODS We conducted IDIs with 19 adolescent/caregiver dyads and five FGDs with adolescents and clinicians. Adolescent participants were aged 10-15 years, and had contracted HIV perinatally. Using NVivoTM software, we summarized major themes. RESULTS Only 6/19 caregivers reported disclosing to their child; matched adolescents' statements indicate that 9/19 children knew their HIV status. Caregivers planned to disclose when children were 14 years or older. Concerns about stigma toward children and families were associated with reluctance to disclose. CONCLUSION Disclosure to adolescents living with HIV in China was delayed compared with recommended guidelines. Culturally appropriate disclosure strategies should be developed, focused on supporting caregivers and de-stigmatizing HIV.
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Affiliation(s)
- Mary Bachman DeSilva
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
- Westbrook College of Health Professions, University of New England, Portland, ME, United States
| | - Nicole Penwill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
| | - Lora Sabin
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Allen L. Gifford
- Departments of Health Policy and Management, Boston University Schools of Public Health and Medicine, Boston University, Boston, MA, United States
- Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | | | - Zhang Fujie
- Division of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mu Weiwei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, Beijing, China
| | - Li Yongzhen
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Lu Hongyan
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Zeng Xuemei
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Yiyao Barnoon
- Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
| | - Christopher J. Gill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Rachael Bonawitz
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
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Mothi SN, Lala MM, Tappuni AR. HIV/AIDS in women and children in India. Oral Dis 2017; 22 Suppl 1:19-24. [PMID: 27109269 DOI: 10.1111/odi.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/20/2016] [Accepted: 01/24/2016] [Indexed: 12/18/2022]
Abstract
Management of HIV in India has significantly improved with many international and local programmes supporting prevention and treatment. However, there are areas in India where women and children living with HIV endure a myriad of medical, psychological and social challenges. Women in rural poor areas in India have little control over important aspects of their life. Often, they have little decision-making powers within their families on matters that affect them personally. They find themselves unable to negotiate to protect themselves from harm or risk of infection. Those who are known to have contracted HIV are reluctant to access health care for fear of discrimination and marginalization, leading to a disproportionate death rate in HIV women. India is arguably home to the largest number of orphans of the HIV epidemic. These children face an impenetrable barrier in many Indian societies and endure stigmatization. This situation encourages concealment of the disease and discourages children and their guardians from accessing available essential services. This article provides an overview of the relevant literature and presents an insight into a complex mix of issues that arise directly out of the HIV diagnosis, including the role of social attitudes in the spread of HIV, and in creating barriers to accessing care. The review identifies international programmes and local initiatives that have ensured better access to antiretroviral therapy and have led to prolonged survival and reduction in the vertical transmission of HIV in India.
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Affiliation(s)
| | - M M Lala
- LTMMC & LTMGH, Wadia Group of Hospitals, CCDT, Mumbai, India
| | - A R Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
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Das A, Detels R, Javanbakht M, Panda S. Issues around childhood disclosure of HIV status - findings from a qualitative study in West Bengal, India. Child Care Health Dev 2016; 42:553-64. [PMID: 27116937 PMCID: PMC4913886 DOI: 10.1111/cch.12338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 02/04/2016] [Accepted: 02/22/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Informing the children living with HIV (CLH) about their disease (disclosure) is important from the perspective of disease treatment and overall psychosocial development. There are no published studies that qualitatively explored HIV disclosure-related issues among CLH in India. Our aim was to provide insights into the perceptions of informal caregivers of CLH regarding childhood disclosure. METHODS Children were defined as those aged <16 years. In-depth interviews were conducted with 34 primary caregivers of CLH aged 8 to 15 years old who were residing in West Bengal, India. The participants were recruited with the help of a community-based organization that provides need-based services to people living with HIV. RESULTS We obtained caregivers' perspectives on the motivators and barriers of childhood disclosure. Health benefits such as medication adherence emerged as an important motivator, while distress caused by disclosure and potential for stigma were identified as barriers. Health care providers were the preferred disclosers for most caregivers, followed by the caregivers themselves. Some caregivers wanted their child to learn about his/her HIV status by him/herself. There was no consensus among the caregivers about the ideal age for disclosure. Many preferred to wait until the child attained maturity or was of marriageable age. DISCUSSION Disclosure of HIV status to children is an emotional issue, both for the caregiver and the child. Like most low-or middle-income countries, no standardized, age-appropriate disclosure guidelines exist in India. Our findings advocate adoption of a multi-faceted approach, including increased availability of social and familial support, for childhood HIV disclosure.
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Affiliation(s)
- A Das
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - S Panda
- National Institute of Cholera and Enteric Diseases (NICED/ICMR), Kolkata, West Bengal, India
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Singh P, Hemal A, Agarwal S, Kumar D. Cardiac manifestations in HIV infected children. Indian J Pediatr 2015; 82:230-4. [PMID: 24859474 DOI: 10.1007/s12098-014-1481-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the occurrence of cardiac involvement in HIV infected children and describe its spectrum using non-invasive tests like ECG and 2-Dimensional Echocardiography (2-D ECHO). METHODS A cross sectional observational study was carried out on 100 HIV infected children between 1 and 18 y of age. The various cardiac manifestations were determined clinically, by electrocardiogram (ECG) and 2-D echocardiography. RESULTS Seventy four percent of the patients were males with a mean age of 9.62 ± 3.62 y. Seventy seven percent children were in WHO stage I. Sixty five percent did not have significant immune suppression. Eighty six percent children were on HAART (mean duration- 35.12 ± 29.48 mo). Fifty nine percent of children were symptomatic and only nine patients were clinically suspected to have cardiac involvement. ECG abnormalities were found in 14 % cases. The most common abnormal echocardiographic finding was left ventricular diastolic dysfunction by tissue Doppler (E/E') observed in 64 % cases followed by systolic dysfunction (37 %), abnormal left ventricular mass (29 %), pericardial effusion (2 %) and dilated cardiomyopathy (2 %); 64.2 % cases with left ventricular systolic dysfunction (LVSD) were in WHO stage III. CONCLUSIONS Involvement of heart in HIV/AIDS is mostly subclinical. HIV myocarditis produces systolic as well as diastolic dysfunction. At present, echocardiography remains the only tool for identifying heart involvement in HIV-infected children. Early diagnosis and intervention may halt the progression of the disease, thereby preventing morbidity and mortality.
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Affiliation(s)
- Pradeep Singh
- Department of Pediatrics and Neonatology, PGIMER and Ram Manohar Lohia Hospital, Delhi, 110001, India
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George MS, Lambert H. 'I am doing fine only because I have not told anyone': the necessity of concealment in the lives of people living with HIV in India. CULTURE, HEALTH & SEXUALITY 2015; 17:933-46. [PMID: 25706959 PMCID: PMC4772686 DOI: 10.1080/13691058.2015.1009947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/16/2015] [Indexed: 06/04/2023]
Abstract
In HIV prevention and care programmes, disclosure of status by HIV-positive individuals is generally encouraged to contain the infection and provide adequate support to the person concerned. Lack of disclosure is generally framed as a barrier to preventive behaviours and accessing support. The assumption that disclosure is beneficial is also reflected in studies that aim to identify determinants of disclosure and recommend individual-level measures to promote disclosure. However, in contexts where HIV infection is stigmatised and there is fear of rejection and discrimination among those living with HIV, concealment of status becomes a way to try and regain as much as possible the life that was disrupted by the discovery of HIV infection. In this study of HIV-positive women and children in India, concealment was considered essential by individuals and families of those living with HIV to re-establish and maintain their normal lives in an environment where stigma and discrimination were prevalent. This paper describes why women and care givers of children felt the need to conceal HIV status, the various ways in which people tried to do so and the implications for treatment of people living with HIV. We found that while women were generally willing to disclose their status to their husband or partner, they were very keen to conceal their status from all others, including family members. Parents and carers with an HIV-positive child were not willing to disclose this status to the child or to others. Understanding the different rationales for concealment would help policy makers and programme managers to develop more appropriate care management strategies and train care providers to assist clients in accessing care and support without disrupting their lives.
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Affiliation(s)
| | - Helen Lambert
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Gautam N, Dayal R, Agarwal D, Kumar R, Singh TP, Hussain T, Singh SP. Role of multivitamins, micronutrients and probiotics supplementation in management of HIV infected children. Indian J Pediatr 2014; 81:1315-20. [PMID: 24760382 DOI: 10.1007/s12098-014-1407-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy. METHODS This was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enrolled children were randomized to receive micronutrients for 6 mo or probiotics for 3 mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6 mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients. RESULTS In micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (p = 0.049) when compared to controls after 6 mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (p = 0.0022) in children >5 y. Control group showed significant decline in CD4 count in children ≤5 y (-65.3 cells/mm(3), p=0.005) and in children >5 y (-87.9 cells/mm(3), p=0.05) after 12 wk of supplementation. CONCLUSIONS Probiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.
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Affiliation(s)
- Neetu Gautam
- Department of Pediatrics, S.N. Medical College, Agra, India
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Editorial: recent advances in HIV infection. Indian J Pediatr 2012. [PMID: 23180412 DOI: 10.1007/s12098-012-0920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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