Support groups for people living with HIV/AIDS: a review of literature

Pozitively Me: HIV Support Groups, Culture and Individualism in Toronto

In Toronto, numerous support groups exist for people living with HIV (PLWH). Membership is based on HIV status and sometimes an additional demographic factor of ethnicity, age, sexuality or gender. Groups cover a range of topics including physical and psycho-social health, and everyday challenges of living with HIV. Based on participant observation in three support groups, this article examines how individualism and cultural difference structure 'positive living' therapeutic frameworks, and how the prioritization of the former over the latter contributes to the production of a depoliticized, neoliberal formation of multicultural therapeutic citizenship with differing effects for differentially positioned PLWH.

Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis

High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals' depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.

The Role of Emotional Avoidance, the Patient-Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals

Adherence to antiretroviral therapy (ART) is associated with positive health outcomes among HIV+ patients. However, non-adherence remains high. Though factors that account for non-adherence remain unclear, social support has been consistently associated with ART adherence. As such, identifying malleable factors that hinder patients' ability to form supportive relationships may have consequence for improving ART adherence. Emotional avoidance (EA) may be one such factor given that it has been linked to difficulties in social situations. The present study examined relations among EA, the patient-provider relationship, other sources of social support, and ART adherence within a sample of HIV+ ART-prescribed patients. High EA was related to poor adherence and patient-provider relationships. EA was indirectly related to poor adherence through poorer patient-provider interactions. The indirect relation of EA to ART adherence through other sources of social support was not significant. Implications for developing targeted behavioral interventions focused on improving ART adherence are discussed.

Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol

BACKGROUND

More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study.

METHODS/DESIGN

Study aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512).

DISCUSSION

This is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02801747 , Registered June 8, 2016.

Mixed-Methods Evaluation of a Novel, Structured, Community-Based Support and Education Intervention for Individuals with HIV/AIDS in KwaZulu-Natal, South Africa

People living with HIV in Sub-Saharan Africa face significant challenges accessing care. Community-based peer support groups can increase linkage to treatment, though the effectiveness of structured, scalable groups has not been demonstrated. This study aimed to measure the impact of the structured Integrated Access to Care and Treatment intervention on clients' knowledge, attitudes, and practice regarding HIV/AIDS, including their experiences of stigma, in KwaZulu-Natal, South Africa. Data collection involved pre-/post-tests and client interviews. Pre-/post-test data from 66 clients were collected. 17 participants were interviewed. Paired t-tests did not detect significant changes in the main outcomes. Qualitative results suggested a psychosocial benefit as participants connected with their peers, expressed themselves openly, and re-engaged with their communities. Unfortunately, this study did not quantitatively measure psychosocial changes, and the results have limited generalizability to men. I ACT may be an effective complement to clinic-based support services, though further study should quantify the psychosocial benefit.

Haemodialysis: the effects of using the empowerment concept during the development of a mutual-support group in Taiwan

AIMS AND OBJECTIVE

To determine the effectiveness of using the empowerment concept during the development of a mutual-help group for haemodialysis.

BACKGROUND

Haemodialysis has different impacts on patients' physical, psychological and social health. The effects of mutual-support group have been found in groups of chronic disease patients. However, none of them were for haemodialysis patients.

DESIGN

An intervention-evaluation design was used for this study. The intervention process was divided into four phases: (1) assessment, (2) planning, (3) action and (4) evaluation/feedback. As part of this study, a mutual-help group was formed that met eight times for group activities over a three-month study period.

RESULTS

There were three indicators of empowerment outcomes. Physical symptoms decreased significantly after the patients had participated in the mutual-help group (z = -2.893, p < 0.05), especially symptoms such as itchy skin, insomnia and spasms. In terms of the patients' social network and social functions, social support increased significantly (z = -3.412, p < 0.05). The total score for the patients' quality of life also showed a significant improvement (z = -3.408, p < 0.05) with the emotional and health dimensions improving the most.

CONCLUSION

This study provides evidence that supports the use of mutual-help groups as a means of aiding patients with chronic illness to cope with their illness. Mutual-help groups are a necessary future direction in nursing that will improve the quality of health care for patients' with chronic illness.

RELEVANCE TO CLINICAL PRACTICE

The study found that a mutual-help group not only can improve patient's illness adaptability, but also brought about a range of other empowerment outcomes. It also had many positive impacts for the hospital. Therefore, it will be beneficial for the patients with a chronic illness if health care professionals can be sensitive to relevant factors and construct mutual-support groups based on the empowerment concept.

Women living with HIV/AIDS (WLHA), battling stigma, discrimination and denial and the role of support groups as a coping strategy: a review of literature

BACKGROUND AND OBJECTIVES

Women living with HIV/AIDS, in particular, have been positioned as a latent source of infection, and have captivated culpability and blame leading to a highly stigmatised and discriminated life. Despite the situation, women and their particular concerns have largely been ignored in HIV/AIDS research literature. This review aims to examine and analyze the feelings, experiences and perceptions of Women living with HIV/AIDS (WLHA) and will also access the role of support group as a coping strategy on the basis of 7 primary researches conducted in or on different parts of the world.

METHODOLOGY

A systematic literature search was carried out on major data bases ASSIA, CINAHL, Science Direct, Web of Knowledge, Wiley Inter Science, AMED, Pub Med/Bio Med Central, MEDLINE and Cochrane Library. The articles included for review purpose were gauged against the pre-defined inclusion/exclusion criteria and quality assessment checklist resulting in a final 7 papers.

FINDINGS/RESULTS

The findings were compiled into five thematic areas: (1) Disclosure as a sensitive issue; (2) Stigma and Discrimination associated with HIV/AIDS and the multidimensional effects on women's health and wellbeing; (3) Internalised Stigma; (4) Women living with HIV/AIDS experiences of being rejected, shunned and treated differently by physicians, family and close friends; (5) Support Group as among the best available interventions for stigma and discrimination.

CONCLUSION

Support groups should be offered as a fundamental part of HIV/AIDS services and should be advocated as an effective and useful intervention. Further research is needed to examine the effect of support groups for women living with HIV/AIDS. A community based randomised controlled trial with support group as an intervention and a control group could provide further evidence of the value of support groups.

The struggle for recognition by people living with HIV/AIDS in Sudan

In settings with high HIV/AIDS-related stigma and where HIV is at low prevalence, the political space is often not conducive to making the epidemic more visible to public debate. In the Middle East and North Africa people living with HIV are only beginning to be prominent players in the policy planning in response to the epidemic. We conducted a qualitative case study analyzing an emerging nongovernmental support group association of people living with HIV/AIDS in Sudan. The study consisted of 16 interviews, with 15 HIV-positive members and the president of the association. We also conducted eight interviews with leaders of HIV-related institutions in Khartoum and reviewed relevant published and unpublished literature. We document the challenges faced by the association's members and illustrate the potential for community mobilization to counter HIV-related stigma. We also point out the need to create the political space for addressing the needs of people living with HIV.

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

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

Medical and support service utilization in a medical program targeting marginalized HIV-infected individuals

BACKGROUND

One strategy to facilitate HIV health care services utilization is to incorporate support services with medical services. We developed a program that delivers HIV medical care and support services to marginalized people, and evaluated the association between support and medical services utilization.

METHODS

We extracted data on 218 newly enrolled program participants 3 months prior to through 6 months after program enrollment, and analyzed associations between support and medical services.

RESULTS

Case management visits (AOR=1.95, 95% CI 1.04-3.67) and group visits (AOR=2.59, 95% CI 1.30-5.16) were associated with greater odds of quarterly medical visits. Outreach visits were associated with greater odds of having a medical visit in a traditional medical setting (AOR=2.31, 95% CI 1.15-4.67).

CONCLUSION

Case management, support groups, and outreach were associated with HIV medical visits. Further research exploring how integration of support services into HIV medical programs can improve health care delivery is crucial for health policy and program development.

Establishing support groups for HIV-infected women: using experiences to develop guiding principles for project implementation

HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences and interaction with clinic staff and clients were used as sources of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. The socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. The metaphor of building a bridge over a gorge was used to describe the different phases in and obstacles to the implementation of the intervention. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.

Support group participation among persons with HIV: Demographic characteristics and perceived barriers

Support groups are widely available for persons living with HIV and some evidence supports their efficacy. However, limited information exists regarding characteristics of those who utilize HIV support groups. The present study examined demographic characteristics and perceived barriers of attenders and non-attenders of HIV support groups via a mail survey. The 35 respondents were predominantly white (71.4%), male (65.7%), homosexual/bisexual (57.1%) and diagnosed with HIV within the last five years (62.8%). Results suggested that HIV support group attenders had higher educational attainment and a longer time since diagnosis than non-attenders. Respondents who expressed interest in HIV support group participation were diagnosed more recently than those who did not express interest. Respondents who had attended other types of support groups reported fewer perceived barriers to participation in HIV support groups. Overall, findings suggest that the perception of barriers may be related to interest and participation in support groups for HIV and other problems.

Development of structured support groups for HIV-positive women in South Africa

Women living with HIV in a stigmatising community need support to cope with their HIV status. In a process of action research, a structured support group programme was designed to meet the needs of women to cope with their diagnosis and interpersonal relationships. The emphasis was on identifying their needs and developing programme material to address those needs through group participation and interaction. The programme was pilot-tested at two sites located in two townships in Tshwane, South Africa. Feedback after each session made it possible to adjust the programme to the needs of the participants. In a formative evaluation, audio-taped sessions, process notes of facilitators, and experiences of the participants were used to identify therapeutic elements, the value of the groups and the problems in the implementation process. Women reported benefit from participation in the support groups. A 10-session structured programme to be used in support groups addressing the most important needs of HIV-positive women was developed.

Social support and the management of uncertainty for people living with HIV or AIDS

People with chronic and acute illnesses experience uncertainty about their prognoses, potential treatments, social relationships, and identity concerns. In a focus group study of people living with HIV or AIDS, we examined how social support may facilitate or interfere with the management of uncertainty about health, identity, and relationships. We found that support from others helps people with HIV or AIDS to manage uncertainty by (a) assisting with information seeking and avoiding, (b) providing instrumental support, (c) facilitating skill development, (d) giving acceptance or validation, (e) allowing ventilation, and (f) encouraging perspective shifts. Respondents also reported a variety of ways in which supportive others interfered with uncertainty management or in which seeking support imposed costs. Problems associated with social support and uncertainty management included a lack of coordination in uncertainty management assistance, the addition of relational uncertainty to illness uncertainty, and the burden of others' uncertainty management. Our study reveals strategies respondents used to manage costs and complications of receiving support, including developing an active or self-advocating orientation, reframing supportive interactions, withdrawing from nonproductive social situations, selectively allowing others to be support persons, and maintaining boundaries.

A behavioral-medicine program in HIV. Implications for quality of life

The purpose of this descriptive study is to examine quality of life issues in participants in a behavioral-medicine group (N = 24). Of the sample, 60% indicated current use of complementary therapies. Sexual functioning, a subscale of the quality-of-life measure, was positively correlated with length of time with HIV. CD4+ lymphocyte counts were not significantly correlated with quality of life (QOL). Viral load (VL) was positively correlated with the social-support subscale of the QOL scale. Use of body therapies (massage, acupuncture) was associated with social functioning and use of nutritional therapies was associated with mental health. Results of the study indicate that clinical interventions, including behavioral-medicine interventions and complementary therapies for persons with HIV/AIDS, can result in greater QOL.

'From victim to agent': the clinical and social significance of self-help group participation for people with life-threatening diseases

AIM

The main objective of the paper is to discuss the ways in which self-help groups can be useful to persons with life-threatening diseases like cancer or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The paper offers an outline of the central characteristics of self-help groups, highlighted by the participants themselves.

BACKGROUND

Self-help groups are a growing phenomenon across national borders. New empirical sociological studies show that nurses have become important agents in self-help groups, both within and outside the public health-care system. However, research on self-help groups is a relatively new area within nursing studies yet it serves an important function in shedding light on a rather unique form of social practice organized and managed partly by the participants themselves.

METHODS

Qualitative interviews designed to examine how participants evaluate their experiences with self-help groups. The study includes 53 self-help group participants suffering from cancer or HIV/AIDS.

FINDINGS

Contact with other people, forming of friendships, new networks and increased self-confidence are some of the effects indicated by the participants. Participation in a self-help group has a positive impact on the patients' ability to cope with the psychological and social consequences of living with a life-threatening disease.

CONCLUSIONS

It is evident that the positive effects of self-help groups are mainly because of their inherent capacity for universalizing personal problems, which, in itself, legitimizes the scientific relevance of self-help groups. There is no evidence to indicate that self-help groups have a positive influence on the life expectancy of participants who suffer from cancer or HIV/AIDS, but it should be noted that this is not the explicit concern when groups are formed. By their very existence self-help groups indicate the need for a reevaluation of the scope and focus of the individualized care and nursing. The clinical and social significance of self-help group participation has not been sufficiently accounted for.

A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease

Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.

Understanding the psychosocial needs of HIV-positive women: a qualitative study

The purpose of this study was to engage women with HIV disease in a qualitative needs assessment for psychological services. Focus groups/interviews were held to develop an understanding of these women's experiences and perceptions of services needed within a support group format. Results support women's interest in and perceived need for psychosocial group intervention and provide feedback on how to structure groups, including considerations for the facilitator, concrete barriers to address, and attention to group attributes and guidelines. These results support ongoing development of psychosocial support groups for women with HIV disease and further exploration of the efficacy of group models for the diverse subgroups of women with HIV/AIDS.