Quality of life and coping styles of HIV-positive women with children

Gender-related differences in quality of life domains of persons living with HIV/AIDS in South India in the era prior to greater access to antiretroviral therapy

This study sought to examine gender-based differences in the quality of life of men and women living with HIV in South India in the era prior to greater access to antiretroviral therapy. The participants in this prospective longitudinal study consisted of 215 men and 141 women who were administered a quality of life (QOL) instrument comprising five scales: physical well-being, psychosocial well-being, sexual well-being, satisfaction with health care, and strength of partner relationship. Interviews were conducted at enrollment and at 6 months in clinical care. Men and women reported similar scores in physical well-being, satisfaction with health care, and relationship with partner from the period prior to care, at enrollment, and at 6 months. Women scored significantly lower than men in psychosocial well-being from the period prior to care, at enrollment, and at 6 months (p < 0.05); women reported significantly higher levels of partner satisfaction at 6 months (p < 0.05). In light of the increasing feminization of the HIV epidemic in India, greater emphasis should be placed on examining the long-term experiences of Indian women living with HIV/AIDS, particularly their psychosocial well-being.

Life story of and depression in an HIV-positive pregnant Thai woman who was a former sex worker: case study

We describe the life story of an HIV-positive pregnant Thai woman--part of a larger action research study--with a case study methodology. The participant was chosen because of her unique and complex life story involving HIV infection, pregnancy, and former sex work. Bua (pseudonym), interviewed five times during 2001-2002, was a former sex worker who got married and later became infected with HIV through a sexual relationship with a man other than her husband. The significant events in Bua's life are outlined chronologically, and the social and cultural dimensions contributing to her depression are described.

Psychosocial problems and coping patterns of HIV seropositive wives of men with HIV/AIDS

The sociocultural milieu provides HIV positive women with fewer resources and more role responsibilities. The present research aimed at studying the psychosocial problems encountered in living, post HIV infection, and the coping patterns adopted by HIV seropositive wives of men with HIV/AIDS. In the background of an exploratory research design, thirty (n = 30) HIV positive women, attending Counseling Clinics in Bangalore (South India), selected through purposive sampling, were assessed using an interview schedule and a standardized coping scale. Majority of the respondents were the primary caregivers for their infected spouse and/or children. Content analysis of the problems revealed increased financial difficulties; problems in child care and support; compromised help-seeking due to stigma; problems in sexual interactions and communication in their marital relationship; role strain in caregiving; gender discriminatory and inadequate care; and increased concerns about parenting efficacy, post HIV infection. Escape avoidance was the most preferred coping strategy adopted by them. Situating the illness in a socio-familial context is indicated, and implications for social work and mental health practice follow from the findings.

Child-rearing practices of primary caregivers of HIV-infected children: An integrative review of the literature

The number of human immunodeficiency virus (HIV)-infected children has increased because of the HIV and acquired immunodeficiency syndrome epidemic. Yet little is known about the child-rearing practices of these children's primary caregivers. The purpose of this article is to describe what is known about the child-rearing practices of primary caregivers of HIV-infected children. The review covers a 10-year period from 1990 to 2000. Three electronic bibliographic databases (MEDLINE, CINAHL, and AIDSLINE) were explored. Key words used were HIV-positive children, caregivers, and child-rearing. A total of 50 papers were examined. Using the Matrix Method, each paper was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to identity salient themes. Themes that emerged were: caregiver, child, and interactions or child-rearing practices. These findings affirm the parent-child interaction model generated by Kathryn E. Barnard and support this framework as a tool for investigating the relationships between these children and their caregivers.

Mastery over stress among women with HIV/AIDS

To better understand how women with HIV infection deal with the stress of their disease, the authors explored the relationships between stressors, resources for managing stress, and mastery over stress in 80 HIV-positive women. Nurses and other professionals recruited participants in a variety of settings in 10 states. Participants completed a packet of research instruments that measured the stressors of perceived stress intensity, interpersonal conflict, and severity of illness; the resources of social support, support networks, and spiritual perspective; and the outcome of mastery over stress. Participants reported high levels of social support, spiritual perspective, interpersonal conflict, and perceived stress intensity. Twenty-nine women (36%) had achieved mastery over stress. Mastery over stress was significantly and positively correlated with social support, spiritual perspective, and physical functioning, a measure of severity of illness. Mastery over stress was significantly and negatively correlated with interpersonal conflict. An exploratory stepwise multiple regression analysis yielded two predictors of mastery over stress: social support and spiritual perspective. Although a comparison of these results with those reported in the literature for men suggests that men and women differ in how they respond to stressors, further research will be needed to enhance our understanding of these gender differences. Stress management training, especially related to interpersonal conflict, may be an effective intervention to facilitate mastery. Other potential interventions include assessing social support and spiritual perspective, discussing the potential benefit of these resources, and making referrals for psychosocial services as needed.

Mothers who silence themselves: a concept with clinical implications for women living with HIV/AIDS and their children

The number of women newly infected with the human immunodeficiency virus (HIV) continues to rise. Women living with HIV or the acquired immunodeficiency syndrome (AIDS) are often mothers who deal with the unenviable task of balancing the stigma and physical needs of illness with the needs of their families and, in particular, their children (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). This article addresses both the communication style and subsequent concept identified in women living with HIV/AIDS called "silencing the self," and the clinical implications for pediatric nurses who support and offer family-centered care to their patients. Mothers living with HIV/AIDS, often view the needs of the children primary as they deal with the trajectory of their own illness. In doing this, they effectively "silence" their own needs and may actually put their own psychosocial and physical needs in abeyance. It is critical that nurses in pediatric practice consider how to tangibly assess, refer, and educate mothers who silence their own needs in the process of providing care for their children.

Quality of life and risk perception among predominantly heterosexual, minority individuals with HIV/AIDS

The objective of this study was to examine the quality-of-life concerns of human immunodeficiency virus (HIV)-infected individuals and to assess their perceptions of acquired immune deficiency syndrome (AIDS) and the need for safer sex, in light of treatment advances. Respondents were recruited from seven AIDS service organizations in New York City, and the total sample consisted of 196 HIV-infected individuals. The sample consisted largely of heterosexual, African Americans, and Latinos. Respondents completed a self-administered questionnaire that was made available in English or Spanish. Three-quarters of the sample were receiving protease inhibitor combination therapies. Overall, respondents reported a high level of life satisfaction as well as trust in their medical providers. Health worries and financial worries were the main areas of concern. A significant minority of respondents indicated reduced concern about AIDS and the need for continued safer sex practices, because of the latest treatments. Respondents with greater quality-of-life concerns were more likely to believe that AIDS was less severe now and that safer sex was less important.

The effectiveness of self-management training for individuals with HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned to the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Content validity of a Scale to measure silencing and affectivity among women living with HIV/AIDS

This study measured quantitatively and explored qualitatively silencing behaviors and affectivity (mood) in women living with HIV/AIDS and confirmed the validity of the Silencing the Self Scale and the Positive and Negative Affect Scale. Silencing behaviors are interpersonal communication styles that suppress personal needs and feelings to preserve relationships with others. Silencing behaviors serve as protective strategies that allow one to divorce oneself from an overbearing culture. Affectivity is a way of measuring one's personal mood state by a positive to negative continuum. The results indicate that the women silenced themselves profoundly, especially when it came to putting the needs of their children or dependents before their own. The women also had high levels of negative affectivity. The research findings from this study extend nursing knowledge by addressing the unique social processes of women living with HIV/AIDS within health care service structures and significant social groups. Further exploration of "silencing" as a phenomenon of this group through measurement and experience will help define specific interventions that are meaningful to and for women living with HIV/AIDS.

The effectiveness of self-management training for individuals with HIV/AIDS

This study tested the effects of a 7-week individual self-management and coping skills training program on various measures of health and well-being of persons with HIV/AIDS. Forty men and women were randomly assigned the treatment or wait-list control group. Treated participants showed significant posttreatment changes on all four major measures of mood, coping, and health attitudes. Treatment significantly improved coping strategies as measured by the use and effective measures of the Jalowiec Coping Scale and several of its subscales, including decreases in use of emotive, fatalistic, and palliative coping styles. Psychological mood was improved, as measured by the Profile of Moods Total Mood Disturbance (POMS TMD) score and specific subscales of the POMS, which were targeted in the intervention (e.g., Anger). Treated participants also showed significant increases on the Internal subscale of the Health Attribution Test.

Predictors of quality of life in AIDS patients

BACKGROUND

While much work has been completed in relation to measuring and defining the varying dimensions of quality of life in HIV/AIDS, very little research attention has been directed toward identifying factors that influence or enhance quality of life.

OBJECTIVE

This study examined whether variables relating to demographic characteristics, severity of illness, psychological status, or level of engagement in nursing care would predict quality of life in persons with advanced or late stage HIV/AIDS.

METHODS

A convenience sample of 162 hospitalized male and female patients with AIDS participated in this study. The participants completed the HIV Symptom Checklist, the Beck Depression Inventory, the HIV-QAM (a measure of changes in the status of hospitalized AIDS patients due to nursing care), and two measures of engagement in nursing care. The Living With HIV Scale was used as the measure of quality of life. The two components of this scale were analyzed independently.

RESULTS

The strongest predictor of decreased quality of life scores was depression (accounting for 23% of the variance), with symptoms accounting for 9.75% and female gender accounting for an additional 8%. Two measures of patient engagement with nursing care providers contributed a total of 13.44% of the variance in quality of life scores.

CONCLUSIONS

The findings emphasize the importance of recognizing and treating depression in persons with HIV/AIDS. The number of symptoms and their frequency also has a profound effect on quality of life. Although modest, study findings suggest that quality of life for an acutely ill, hospitalized patient with AIDS is enhanced through more active involvement or engagement in the process of nursing care.

Clinical care issues for women living with HIV and AIDS in the United States

As the number of women infected with HIV in the United States continues to increase, the medical community is faced with the challenge of providing adequate and appropriate care to them. This paper reviews key questions concerning the state of knowledge on the epidemiology, biology, and clinical care of women living with HIV and AIDS in the United States. Because heterosexual transmission accounts for a growing number of cases among women, biological factors and cofactors that may enhance women's susceptibility to HIV infection are also reviewed. HIV-related gynecological issues are presented separately to evaluate whether gynecological complications are distinct in HIV-uninfected and HIV-infected women. Questions of whether there are sex-specific differences in the efficacy and adverse effects of new antiviral agents are discussed. In addition, significant gaps are highlighted that still exist in our understanding of both the effects of HIV and HIV-related drugs upon pregnancy. Finally, the psychiatric stresses and complications that affect women living with HIV and AIDS are also discussed. In each section of this review, gaps in our knowledge of these issues are identified. To properly address these disparities in knowledge, not only do efforts to gather sex-specific biomedical data need to be more exacting, but there is a distinct need to conduct more sex-specific research concerning HIV.

A holistic life view of human immunodeficiency virus-infected African American women

Minority women represent the fastest growing segment of the population to acquire HIV/AIDS in the United States. Although African American women are a large proportion of this group, no published study has concentrated solely on a holistic view of the experiences of HIV-infected African American women. The primary purpose of this phenomenological pilot study was to describe the lives of five HIV-infected African American women. Audiotaped interviews were conducted and subsequently were examined, using Giorgi's steps of analysis. Twelve themes emerged from the data: violence, addiction, it couldn't happen to me, shock and denial, education, time, uncertainty, cycles, secretive nature of their lives, someone, survival, and children. It is clear, even from this small pilot study, that these women have complex experiences that must be better understood before effective health care interventions can be designed and implemented.

Determinants of depression and HIV-related worry among HIV-positive women who have recently given birth, Bangkok, Thailand

HIV-infected pregnant women have been the focus of considerable research related to biomedical issues of mother-to-child transmission worldwide. However, there have been few reports on the psychological well-being of new mothers with HIV, either in developed or developing countries. As part of a perinatal HIV transmission and family impact study in Bangkok, predictors of psychological scales were evaluated from interview data (N = 129) collected 18-24 months postpartum. Standardised questionnaires were used to assess depressive symptoms and HIV-related worry. Depressive symptomatology and HIV-related worry were common amongst these women. Multivariate logistic regression analysis identified several factors that predicted these psychological outcomes. High depression scores were associated with women who were no longer in a relationship with their partner (odds ratio (OR) 5.72, confidence interval (CI) 2.18-14.97) and who used venting coping strategies (OR 2.15, CI 1.44-3.21). Higher levels of HIV-related worry were associated with women whose babies were HIV-infected (OR 3.51, CI 1.28-10.69), who had not disclosed their HIV status to others (OR 3.05, CI 1.29-7.24) and who reported that their HIV-infection was something about which their family would be ashamed (OR 3.44, CI 1.34-9.77). Based on the current findings, intervention strategies we propose are psychological interventions which address disclosure issues, feelings of shame and coping strategies as well as financial assistance for single mothers. Interventions that require few resources such as group counselling or support merit special consideration.

Poor women living with HIV: self-identified needs

Women with HIV are a growing at-risk population in our communities. They are often poor members of minority groups who have responsibilities for dependent children and other family members. They may experience physiological, psychological, and social symptoms and have needs that are unique to them as women. The purpose of this study was to give women with HIV the opportunity to identify their needs. Using the Objects Content Test, 48 women attending HIV clinics in a midsouth city listed 349 needs: 32% psychosocial, 14% physical, 13% service and maintenance, and 11% financial and legal. It is important for nurses working with these women in the community to know how they perceive their own needs and issues to plan and provide effective health care programs for this growing group of clients.

Quality of life and self-care management strategies of PLWAs with chronic diarrhea

A case control design was used to examine quality of life and self-care management strategies in persons living with AIDS (PLWAs) with chronic diarrhea. PLWAs without chronic diarrhea (n = 20) as compared to those with chronic diarrhea (n = 20) reported significantly higher general health perceptions (p = .028). In contrast, comparisons on symptom status scores revealed that PLWAs without chronic diarrhea reported greater fatigue (p = .05), greater psychological distress (p = .005), and greater gastrointestinal discomfort (p = .01). Although the intensity of chronic diarrhea was reported as moderate to severe by 85% of the sample, no single category of self-care management strategies was used by more than 65% of respondents. The number of categories of self-care management activities was significantly correlated with general health perceptions. The study findings support the need to test nursing interventions aimed at improving symptom management in chronic diarrhea and facilitating self-care behaviors including those focused on increasing adherence to prescribed therapeutic regimens.

Defensive mothering in HIV-positive mothers

The grounded theory study discussed in this article provides an explanatory schema that illuminates the mothering experiences of women living with HIV infection. Eighteen HIV-positive mothers provided 24 in-depth interviews. The grounded theory method was used for data analysis. Defensive mothering was the basic social psychological process that these HIV-positive mothers used in response to their diagnosis and the inherent stigma. Their defensive posture afforded these mothers and their children some degree of psychological protection. Defensive mothering involved much mental work and included three subprocesses: preventing the spread of HIV, preparing the children for a motherless future, and protecting themselves through thought control.

Caregivers of children with HIV/AIDS: quality of life and coping styles

The purpose of this study was to explore the quality of life and coping styles of caregivers of children with HIV/AIDS and to identify if there were differences between mothers and alternative caregivers in these areas. There were 54 mother-caregivers and 25 alternative caregivers in the study. The alternative caregivers scored significantly higher in each area of quality of life than the mothers, except for physical health. The mothers used passive and emotive coping significantly more than the alternative caregivers. The study concluded that caregivers provide support to children with HIV/AIDS, but they also need physical and emotional support themselves. Nurses must be aware of the importance of providing interventions for these caregivers to improve coping mechanisms, decrease stress, and thereby improve their quality of life.

Coping and mood in HIV-positive women

To date, little empirical research on the association of coping style with mood in HIV-positive women has been carried out. The extant literature on HIV-positive men suggests that active coping is related to diminished distress while avoidant coping is associated with elevated distress. Previous research with HIV-positive women has not consistently confirmed these relationships. To add to this literature, scores from a sample of 145 HIV-positive women who completed the Ways of Coping Questionnaire and the Mental Health Inventory were analyzed. Correlations indicated that an escape-avoidance strategy was associated with more negative emotions. Other strategies related to negative emotions included accepting responsibility and a self-controlling approach. These findings are consistent with those previously reported for HIV-positive men, suggesting that similar kinds of coping strategies may be associated with positive and negative moods among HIV-positive men and women.

Applying a feminist analysis model to selected nursing studies of women with HIV

Women's mental health has been linked to oppression and to oppressive practices in health care. Feminist approaches to health care delivery and research have been suggested as a remedy for the subtle and overt oppression faced by women, and many nurses have used feminist principles to conduct and report their research and to critique existing studies. Though nursing authors have identified useful feminist guides for conducting and reporting research, few examples of the practice of feminist critiques of research are available in the nursing literature. This analysis synthesizes and adapts feminist principles from nursing literature and presents a feminist model to review selected nursing research reports of women with human immunodeficiency virus (HIV). A convenience sample of eight articles from nursing journals was examined for statements or implications that the author(s) (a) perceived the purposes of the study as benefiting women, (b) demonstrated an awareness of the structures and policies that oppress women, (c) were sensitive to issues of diversity, (d) were committed to social change, and (e) recognized the female participants' strengths. The selected articles were found to meet many of the feminist criteria, although these principles were not always explicitly addressed in the articles.