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Azmach NN, Hamza TA, Husen AA. Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature. Curr HIV Res 2020; 17:161-172. [PMID: 31538899 DOI: 10.2174/1570162x17666190919130229] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. METHODS The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). FINDINGS From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). CONCLUSION The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.
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Affiliation(s)
- Nuredin Nassir Azmach
- Department of Statistics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temam Abrar Hamza
- Department of Biotechnology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Awel Abdella Husen
- Department of Physics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
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Lee N, Beeler Stücklin S, Lopez Rodriguez P, El Alaoui Faris M, Mukaka I. Financial education for HIV-vulnerable youth, orphans, and vulnerable children: A systematic review of outcome evidence. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1071. [PMID: 37131976 PMCID: PMC8356319 DOI: 10.1002/cl2.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Problem According to Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide. Global commitments to reverse the HIV epidemic will only be achieved if strategies prioritize children and youth. Relevant evidence reviews found mixed evidence that HIV prevention may be addressed through economic strengthening activities such as financial education for youth. There was some evidence related to the potential for plural interventions that include both financial and sexual, reproductive health education. However, there is limited quality evidence that focused on HIV vulnerable youth in low- and middle-income countries (LMICs). Aims This systematic review assessed the scope and strength of evidence for financial education and plural interventions aimed at reducing HIV vulnerability for youth, orphans and vulnerable children (OVC) in LMICs. Methods Standard methodological procedures expected of systematic reviews were used. Six scientific and 24 grey literature sites were searched for relevant studies in English, French, Spanish and Arabic published between 1990 and 2016. Experimental and quasi-experimental research methods were considered where data was gathered at baseline and at least 6 months after the end of the intervention. Mixed-methods studies were considered provided they demonstrated validity in terms of randomization, appropriate sampling and controls, and minimization of bias errors and attrition. Evidence was then analysed and mapped to show types of financial and plural interventions by outcome type, direction and strength of evidence through qualitative assessments by the team. In addition, meta-analysis of odds ratios was conducted to validate the strength of evidence. This analysis illustrated the relative effect or weight of interventions on HIV-related outcomes based on confidence levels and sample sizes. Results Of 5,216 records, 16 moderate to higher quality studies representing 10 interventions were identified, mostly focusing on HIV-vulnerable girls in Sub-Saharan Africa. More than half of the interventions were plural and included access to finance and counselling or supports to improve confidence, negotiating ability and social conditions. Most studies used an experimental design. Only 11 of the 16 studies had comparable enough measures to be validated with meta-analysis of odds ratios. Findings The strongest evidence showed plural education interventions with self-efficacy supports, with and without savings to have positive effects on HIV-related outcomes. These outcomes included improved knowledge, attitudes and reduced sexual risk-taking behaviour. Evidence also showed improved self-efficacy from plural interventions, the changes in confidence, negotiating ability and social conditions that enable people to act on knowledge. Self-efficacy seems important as both a set of conditions to support reduced vulnerabilities and a way to measure them in terms of outcomes. While positive effects were also observed related to increased savings and improved attitudes toward saving, generally interventions showed mixed effects on financial and economic outcomes. Conclusions This systematic review supports emerging evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMIC. Even so, as a body of evidence, it is not clear which components are effective at producing favourable outcomes. Therefore, asset theories linking financial education and asset building with favourable outcomes for vulnerable youth are not as clear as may be commonly assumed. Quality evidence is needed in more settings separating out economic, health and self-efficacy components to better understand pathways and effects on outcomes. Segmentation in quantitative studies will enhance our understanding of asset, capability and self-efficacy theories for greater impact. Mixed methods and qualitative studies will be important complements to enhance our understanding of contextual conditions and how to build assets and self-efficacy in HIV vulnerable youth and OVC.
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Mahapatra B, Bhattacharya R, Atmavilas Y, Saggurti N. Measuring vulnerability among female sex workers in India using a multidimensional framework. PLoS One 2018; 13:e0204055. [PMID: 30252879 PMCID: PMC6155505 DOI: 10.1371/journal.pone.0204055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/31/2018] [Indexed: 11/18/2022] Open
Abstract
Measuring vulnerability and identifying determinants of vulnerability are key to designing interventions for marginalized groups like sex workers. The current study introduces a new approach of measuring vulnerability among female sex workers (FSWs) by adopting a multidimensional poverty measurement framework. A multidimensional vulnerability index was created from four dimensions and 16 indicators using a dual cut-off approach. The study found that 55% of FSWs were multidimensionally vulnerable with 48% of intensity in vulnerability. The overall value of multidimensional vulnerability index was 0.265. FSWs in Maharashtra were most vulnerable (82%). Lack of financial security contributed mostly to FSWs’ vulnerability. Further, compared to less vulnerable FSWs, multidimensionally vulnerable ones were more to engage in behaviors that put them at risk such as inconsistent use of condoms with clients, alcohol consumption, engaging in anal sex with clients and experiencing sexually transmitted infections. Findings suggest that structural, social and financial vulnerabilities of FSWs need to be addressed concurrently.
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Affiliation(s)
| | - Ruchira Bhattacharya
- Population Council, Zone 5A, India Habitat Center, New Delhi, India
- National Institute of Rural Development and Panchayati Raj, Rajendranagar Mandal, Hyderabad, India
| | - Yamini Atmavilas
- Bill & Melinda Gates Foundation, The Capital Court, New Delhi, India
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Ngwenya N, Gumede D, Shahmanesh M, McGrath N, Grant A, Seeley J. Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:72-81. [PMID: 29504507 PMCID: PMC7308171 DOI: 10.2989/16085906.2017.1415214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Following calls for targeted HIV prevention interventions in so-called “hotspots”, we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities’ sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people’s perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
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Affiliation(s)
- Nothando Ngwenya
- a Africa Health Research Institute , KwaZulu-Natal , South Africa
| | - Dumile Gumede
- a Africa Health Research Institute , KwaZulu-Natal , South Africa
| | - Maryam Shahmanesh
- a Africa Health Research Institute , KwaZulu-Natal , South Africa.,c Institute of Global Health , University College London , London , UK
| | - Nuala McGrath
- b Africa Health Research Institute, School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa.,d Faculty of Medicine and Faculty of Social, Human and Mathematical Sciences , Southampton University , Southampton , UK.,g Research Department of Epidemiology & Public Health , University College London , London , UK
| | - Alison Grant
- b Africa Health Research Institute, School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa.,e London School of Hygiene & Tropical Medicine , London , UK.,f School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Janet Seeley
- b Africa Health Research Institute, School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa.,e London School of Hygiene & Tropical Medicine , London , UK
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Affiliation(s)
- Nena Foster
- Faculty of Health and Social Care, London South Bank
University,
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Chevrier C, Khan S, Reza-Paul S, Lorway R. 'No one was there to care for us': Ashodaya Samithi's community-led care and support for people living with HIV in Mysore, India. Glob Public Health 2015; 11:423-36. [PMID: 26548553 DOI: 10.1080/17441692.2015.1091488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Under the umbrella of the Bill and Melinda Gates-funded HIV initiative in India, the Mysore-based sex workers' (SWs) collective Ashodaya Samithi focused on improving its members' living and working conditions through community-led structural interventions, including community mobilisation, advocacy, peer-led support, and health promotional activities. Based on four months of ethnographic fieldwork, this article examines the care and support activities of one of its sub-wings, Ashraya, which specifically focuses on people living with HIV and AIDS (PLHIV). We first discuss the stigma-related perceptions and experiences of participants in relation to health-care settings and work environment, families and communities, and within varied HIV support networks. We then explore how Ashraya's community-led interventions attempt to challenge the structural forces feeding on and creating stigma. We argue that the current policy focus on the involvement of SWs' collectives in sexually transmitted infection (STI) prevention in India is rather limited and should be expanded along the continuum of care and support offered to PLHIV. As suggested in this paper, SWs' organisations may have greater potential to contribute to more than STI prevention work, both within and outside their communities, than currently recognised.
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Affiliation(s)
- Claudyne Chevrier
- a Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Shamshad Khan
- b Department of Communication , University of Texas , San Antonio , TX , USA
| | - Sushena Reza-Paul
- a Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Robert Lorway
- a Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Bailey TC, Sugarman J. Social justice and HIV vaccine research in the age of pre-exposure prophylaxis and treatment as prevention. Curr HIV Res 2013; 11:473-80. [PMID: 24033297 PMCID: PMC4084567 DOI: 10.2174/1570162x113116660054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/05/2013] [Accepted: 07/11/2013] [Indexed: 11/22/2022]
Abstract
The advent of pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) as means of HIV prevention raises issues of justice concerning how most fairly and equitably to apportion resources in support of the burgeoning variety of established HIV treatment and prevention measures and further HIV research, including HIV vaccine research. We apply contemporary approaches to social justice to assess the ethical justification for allocating resources in support of HIV vaccine research given competing priorities to support broad implementation of HIV treatment and prevention measures, including TasP and PrEP. We argue that there is prima facie reason to believe that a safe and effective preventive HIV vaccine would offer a distinct set of ethically significant benefits not provided by current HIV treatment or prevention methods. It is thereby possible to justify continued support for HIV vaccine research despite tension with priorities for treatment, prevention, and other research. We then consider a counter-argument to such a justification based on the uncertainty of successfully developing a safe and effective preventive HIV vaccine. Finally, we discuss how HIV vaccine research might now be ethically designed and conducted given the new preventive options of TasP and PrEP, focusing on the ethically appropriate standard of prevention for HIV vaccine trials.
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Affiliation(s)
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics and Division of Infectious Diseases, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
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Hanif H, Bastos FI, Malta M, Bertoni N, Surkan PJ, Winch PJ, Kerrigan D. Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil. BMC Public Health 2013; 13:574. [PMID: 23758780 PMCID: PMC3710472 DOI: 10.1186/1471-2458-13-574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors. METHODS A cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632). RESULTS Eighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs (AOR 0.58 CI [0.38-0.88]) while those with a high asset index (AOR 2.47 CI [1.79-3.40]) were positively associated with adherence to ARVs. CONCLUSIONS This research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support.
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Affiliation(s)
- Homaira Hanif
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
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Fawzi MCS, Lambert W, Boehm F, Finkelstein JL, Singler JM, Léandre F, Nevil P, Bertrand D, Claude MS, Bertrand J, Louissaint M, Jeannis L, Farmer PE, Yang AT, Mukherjee JS. Economic risk factors for HIV infection among women in rural Haiti: implications for HIV prevention policies and programs in resource-poor settings. J Womens Health (Larchmt) 2010; 19:885-92. [PMID: 20380576 PMCID: PMC2875958 DOI: 10.1089/jwh.2008.1334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The goals of this study were to (1) estimate the prevalence of HIV infection among women accessing services at a women's health center in rural Haiti and (2) to identify economic risk factors for HIV infection in this population. METHODS Women who accessed healthcare services at this center between June 1999 and December 2002 were recruited to participate. The analysis was based on data from a case-control study of sexually transmitted diseases (STDs) in rural Haiti. HIV prevalence in the study population was 4%. RESULTS In multivariate analyses, partner occupation was associated with HIV infection in women, with mechanic (OR 9.0, 95% CI 1.8-45) and market vendor (OR 4.2, 95% CI 1.6-11) reflecting the strongest partner occupational risk factors. Partner's occupation as a farmer reduced the risk of infection in women by 60% (95% CI 0.14-1.1). Factors indicating low socioeconomic status (SES), such as food insecurity (OR 2.0, 95% CI 0.75-5.6) and using charcoal for cooking (OR 1.7, 95% CI 0.72-3.8) suggested an association with HIV infection. CONCLUSIONS Given pervasive gender inequality in Haiti, women's economic security often relies on their partners' income earning activities. Our findings show that although factors reflecting poverty are associated with HIV-positive status, stronger associations are observed for women whose partners indicated a more secure occupation (e.g., mechanic or market vendor). Policies and programs that expand access to education and economic opportunities for women and girls may have long-term implications for HIV prevention in Haiti and other resource-poor settings.
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Affiliation(s)
- M C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Schatz EJ. Reframing vulnerability: Mozambican refugees' access to state-funded pensions in rural South Africa. J Cross Cult Gerontol 2009; 24:241-58. [PMID: 19142721 PMCID: PMC3475964 DOI: 10.1007/s10823-008-9089-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
Researchers at the South African Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit (Agincourt) fieldsite in rural South Africa consider Mozambican residents more vulnerable than others in the local population. These self-settled refugees, many of whom are still not South African citizens, primarily came to South Africa in the 1980s during the Mozambican Civil War. This perceived economic vulnerability is rooted in their difficulties in accessing social grants, until recently legally available only to those with South African citizenship documentation. This paper focuses on semi-structured interviews with 30 'older' women of Mozambican-descent living in the Agincourt area. These interviews highlight three important aspects of vulnerability; the respondents: (1) perceive a risk of deportation despite their having lived in the country for 20 years, (2) are unable to easily access social grants, namely the state-funded old-age pension, and (3) struggle to make ends meet when faced with daily needs and crisis situations. All three of these vulnerabilities were mediated to some extent by these women's resourcefulness. They generated ties to South Africa through obtaining identification-documents, used these documents to access pensions, and used the pensions to help them sustain their multigenerational households.
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Affiliation(s)
- Enid J Schatz
- University of Missouri, 420 Lewis Hall, Columbia, MO 65203, USA.
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Agbonyitor M. Home-based care for people living with HIV/AIDS in Plateau State, Nigeria: findings from qualitative study. Glob Public Health 2009; 4:303-12. [PMID: 19437217 DOI: 10.1080/17441690902783165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As health-care services in Nigeria and other African countries are becoming overstrained with patients, home-based care has increasingly been touted as a possible solution. The faith-based organisation, Gospel Health and Development Services, provides a home-based care programme for people living with HIV/AIDS (PLWHA) residing in Plateau State, Nigeria. This paper assesses the challenges that PLWHA in the programme faced while maintaining their health and livelihoods. The frustrations that volunteers endured in performing their work are also described, as well as the benefits and weaknesses of the programme from the perspective of PLWHA and their volunteer caregivers. Focus groups and interviews were done with 30 PLWHA and 22 volunteers to learn about their experiences with the home-based care programme and possible areas for its improvement. From these discussions three major challenges facing PLWHA emerged: discrimination towards PLWHA; the lack of money, food, and transport to health-care centres; and the desire for closer antiretroviral drug access.
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Affiliation(s)
- M Agbonyitor
- University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Orner P, Cooper D, Myer L, Zweigenthal V, Bekker LG, Moodley J. Clients’ perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa. AIDS Care 2008; 20:1217-23. [DOI: 10.1080/09540120701867008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Phyllis Orner
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Diane Cooper
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | | | - Linda-Gail Bekker
- c Desmond Tutu HIV Centre , University of Cape Town , Cape Town , South Africa
| | - Jennifer Moodley
- a School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
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Varga C, Brookes H. Preventing Mother-to-Child HIV Transmission Among South African Adolescents. JOURNAL OF ADOLESCENT RESEARCH 2008. [DOI: 10.1177/0743558407310771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting maternal—child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision making, and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed.
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Abstract
As a result of limited access to antiretroviral treatment, many South Africans die yearly of AIDS. It is important that the end-of-life needs of these people be met. This article examines the major challenges involved in providing quality end-of-life care to people with AIDS in South Africa. Published reports are reviewed, as is the author's experience living and working in KwaZulu-Natal, South Africa. The issues discussed include the nature of the South African health care system, with emphasis on the scarcity of palliative care resources for AIDS patients, ineffective control of pain, models of care such as the integrated community-based home care model that relies heavily on community caregivers to meet the needs of people dying of AIDS, the living conditions of AIDS patients and their families, and AIDS-related stigma. Broad recommendations are presented for improving palliative care services for people with AIDS in the South African context.
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Affiliation(s)
- Craig Demmer
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA.
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Thomas F. Stigma, fatigue and social breakdown: Exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia. Soc Sci Med 2006; 63:3174-87. [DOI: 10.1016/j.socscimed.2006.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Indexed: 12/01/2022]
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Abstract
The implications of orphanhood for AIDS-affected children in Thailand is a subject which has received little scholarly attention despite the intensity and longevity of the epidemic in that country. The present study presents preliminary findings from a longitudinal investigation of the circumstances and welfare of Thai youth who have lost one or both parents to AIDS-related causes and the families who care for them. Based on interviews and focus groups carried out in Chiang Mai province in 2001-2002, the study finds that most of the children left orphaned by AIDS were being cared for by members of their extended family, especially grandparents or maternal aunts, and that many caregiving households were experiencing significant financial hardship which might have implications for the children's long-term well-being and stability and for their opportunities for educational advancement. Concern were also expressed about the unavailability or inaccessibility of childcare for AIDS-affected children and the perceived instability of fostering arrangements which placed young children in the care of elderly relatives.
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Affiliation(s)
- R M Safman
- Department of Sociology National University of Singapore.
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Sliep Y, Weingarten K, Gilbert A. Narrative Theatre as an Interactive Community Approach to Mobilizing Collective Action in Northern Uganda. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/1091-7527.22.3.306] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Roca B, Suarez I, Gonzalez J, Garrido M, de la Fuente B, Teira R, Geijo P, Cosin J, Perez-Cortes S, Galindo MJ, Lozano F, Domingo P, Viciana P, Ribera E, Vergara A, Sánchez T. Hepatitis C virus and human immunodeficiency virus coinfection in Spain. J Infect 2003; 47:117-24. [PMID: 12860144 DOI: 10.1016/s0163-4453(03)00067-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND METHODS In a cross-sectional study, based on a cohort composed of HIV-infected patients of fifteen tertiary level institutions of Spain, the main data of the entire cohort are described, characteristics of patients with or without hepatitis C coinfection are compared, and the possible association of hepatitis C virus coinfection with socioeconomic, HIV-related, and hepatitis B-related variables is assessed. RESULTS A total of 4,709 patients are studied. Median of age is 37 years, 78.3% are male. HIV risk behaviours are: parenteral drug use in 63.8% of patients, heterosexual in 22.3%, and homosexual in 10.8%. Serology of hepatitis C is positive in 69.2% of participants. The following variables are associated with increased prevalence of hepatitis C coinfection, both in univariate and in multivariate analysis: HIV risk behaviour, positive anti-HBs, longer time elapsed since HIV infection diagnosis, younger age, lower social status, lower CD4 cell count increase between nadir and last available result, and lower educational level (all P<0.001). Patients with heterosexual behaviour are more frequently coinfected than patients with homosexual behaviour (P<0.001). CONCLUSION This study highlights that, in Spain, more than two thirds of patients with HIV infection are coinfected with hepatitis C virus.
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