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Barrett BW, Meanley S, Brennan-Ing M, Haberlen SA, Ware D, Detels R, Friedman MR, Plankey MW. The Relationship Between Posttraumatic Stress Disorder and Alcohol Misuse and Smoking Among Aging Men Who Have Sex With Men: No Evidence of Exercise or Volunteering Impact. J Aging Health 2023:8982643231215475. [PMID: 37976419 PMCID: PMC11288306 DOI: 10.1177/08982643231215475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To determine if the association between posttraumatic stress disorder (PTSD) and substance use (alcohol misuse or smoking tobacco) is mediated/moderated by exercise or volunteering among aging (≥40 years) men who have sex with men (MSM), and if this mediation/moderation differs by HIV serostatus. METHODS Multicenter AIDS Cohort Study data were used. Three datasets with PTSD measured during different time periods (10/1/2017-3/31/2018, 898 men; 4/1/2018-9/30/2018, 890 men; 10/1/2018-3/31/2019, 895 men) were analyzed. Longitudinal mediation analyses estimated the mediation effect of exercise and volunteering on the outcomes. RESULTS Nine percent of MSM had evidence of PTSD. There was no statistically significant mediation effect of exercise or volunteering regardless of substance use outcome. The odds of smoking at a future visit among MSM with PTSD were approximately double those of MSM without PTSD. Results did not differ by HIV serostatus. DISCUSSION There is a particular need for effective smoking cessation interventions for aging MSM with PTSD.
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Affiliation(s)
- Benjamin W. Barrett
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Meanley
- Department of Family and Community Health, University of
Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The
City University of New York, New York, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical
Center, Washington, District of Columbia, USA
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public
Health, University of California, Los Angeles, Los Angeles, California, USA
| | - M. Reuel Friedman
- Department of Urban-Global Public Health, School of Public
Health, Rutgers University, Newark, New Jersey, USA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical
Center, Washington, District of Columbia, USA
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Symptom Profile and Technology Use of Persons Living With HIV Who Access Services at a Community-Based Organization in the Deep South. J Assoc Nurses AIDS Care 2020; 31:42-50. [PMID: 30908348 DOI: 10.1097/jnc.0000000000000078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Currently, the Southern United States has the highest rates of new HIV diagnoses with the largest percentage of people living with HIV (PLWH), and the most Americans dying from the disease. Given the increase of the HIV epidemic in the Deep South and the availability of evidence-based self-management tools for PLWH, we conducted an in-person survey in Birmingham, Alabama, to understand the symptom profile and the use of technology by PLWH. Muscle aches or joint pain was the most frequently (67%) reported symptom followed by fatigue, sleep difficulties, neuropathy, and depressive symptoms. We also assessed mobile technology use and ownership and found that 83.7% of persons own a smartphone, with most of these (79.9%) being Android users. Given these findings, there is strong scientific premise to support the feasibility of a mobile-delivered symptom self-management tool in the Deep South for improving health outcomes for PLWH.
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Transcultural Adaptation and Psychometric Properties of Portuguese Version of the Spiritual Needs Questionnaire (SpNQ) Among HIV Positive Patients in Brazil. RELIGIONS 2018. [DOI: 10.3390/rel9040135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Reychler G, Caty G, Arcq A, Lebrun L, Belkhir L, Yombi JC, Marot JC. Effects of massage therapy on anxiety, depression, hyperventilation and quality of life in HIV infected patients: A randomized controlled trial. Complement Ther Med 2017; 32:109-114. [PMID: 28619295 DOI: 10.1016/j.ctim.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/08/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION HIV infection is often preceded or accompanied by psychiatric comorbidities. These disorders improve with complementary therapies. The aim of this study was to measure the effect of massage therapy on anxiety, depression, hyperventilation and quality of life in HIV infected patients. METHOD Adult HIV-infected patients were randomized (n=29) in massage therapy group (one hour a week during four weeks) and control group. Anxiety and depression (HADS-A and HADS-D), hyperventilation (Nijmegen questionnaire) and quality of life (WHOQOL-HIV) were evaluated at inclusion and after 4 weeks. RESULTS At inclusion, 51% and 17% of the patients had a positive HADS-A and HADS-D score respectively. Two facets from WHOQOL-HIV ("Home environment" and "Death and dying" (p=0.04)) were different between groups. After the four week massage therapy, a significant improvement was observed only for Nijmegen questionnaire (p=0.01) and HADS-A (p=0.04) contrarily to WHOQOL-HIV and HADS-D. Domains of the WHOQOL-HIV did not improve following the massage therapy. Only "Pain and discomfort" facet improved after massage therapy (p=0.04). CONCLUSION This study highlights the positive impact of a four week massage therapy on anxiety and hyperventilation in HIV infected patients. However, neither benefit of this program was observed on depression and quality of life.
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Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Bruxelles, Belgium; Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
| | - Gilles Caty
- Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
| | - Aude Arcq
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
| | - Laurie Lebrun
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
| | - Leïla Belkhir
- AIDS Reference Centre, Service de Médecine Interne, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
| | - Jean-Cyr Yombi
- AIDS Reference Centre, Service de Médecine Interne, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
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O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Cattaneo J, Chegwidden W, Gahagan J, Baxter L, Worthington C, Gayle P, Merritt B, Baltzer-Turje R, Iku N, Zack E. Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation. BMC Infect Dis 2014; 14:724. [PMID: 25551619 PMCID: PMC4304172 DOI: 10.1186/s12879-014-0724-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/17/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed 'disability'. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation. METHODS We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques. RESULTS Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy. CONCLUSIONS These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada.
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Affiliation(s)
- Kelly K O’Brien
- />Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON Canada
- />School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | | | - Patricia Solomon
- />School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- />Cicely Saunders Institute, School of Medicine, King’s College London, Bessemer Road, London, United Kingdom
| | - Jessica Cattaneo
- />AIDS Committee of Toronto, 399 Church Street, 4th Floor, Toronto, ON Canada
| | - William Chegwidden
- />Barts and the London NHS Trust, London, United Kingdom
- />University College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jacqueline Gahagan
- />School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, Halifax, NS Canada
| | - Larry Baxter
- />Canadian Working Group on HIV and Rehabilitation, 600 Bay Street, Suite 600, Toronto, ON Canada
| | - Catherine Worthington
- />School of Public Health and Social Policy, University of Victoria, Human and Social Development Building, 3800 Finnerty Road, Victoria, BC Canada
| | | | - Brenda Merritt
- />School of Occupational Therapy, Dalhousie University, Forrest Building, Room 215, 5869 University Avenue, Halifax, NS Canada
| | | | - Nkem Iku
- />Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | - Elisse Zack
- />Canadian Working Group on HIV and Rehabilitation, 600 Bay Street, Suite 600, Toronto, ON Canada
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Aantjes CJ, Ramerman L, Bunders JFG. A systematic review of the literature on self-management interventions and discussion of their potential relevance for people living with HIV in sub-Saharan Africa. PATIENT EDUCATION AND COUNSELING 2014; 95:185-200. [PMID: 24560067 DOI: 10.1016/j.pec.2014.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/16/2014] [Accepted: 01/18/2014] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study systematically reviews the literature on self-management interventions provided by health care teams, community partners, patients and families and discusses the potential relevance of these interventions for people living with HIV in sub-Saharan Africa. METHODS We searched major databases for literature published between 1995 and 2012. 52 studies were included in this review. RESULTS The review found very few studies covering people living with HIV and generally inconclusive evidence to inform the development of chronic care policy and practice in sub-Saharan Africa. CONCLUSION Chronic care models and self-management interventions for sub-Saharan Africa has not been a research priority. Furthermore, the results question the applicability of these models and interventions in sub-Saharan Africa. There is a need for studies to fill this gap in view of the rapidly increasing number of people needing chronic care services in Africa. PRACTICE IMPLICATIONS The established practices for long-term support for HIV patients are still the most valid basis for promoting self-management. This will be the case until there are more studies which assess those practices and their effect on self-management outcomes and other studies which assess the utility and feasibility of applying chronic care models that have been developed in high-income countries.
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Affiliation(s)
- Carolien J Aantjes
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands; ETC Foundation, The Netherlands.
| | - Lotte Ramerman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
| | - Joske F G Bunders
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
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Marie Modeste RR, Majeke SJ. Sources and types of information on self-care symptom management strategies for HIV and AIDS. Curationis 2014; 37:127. [PMID: 24833168 DOI: 10.4102/curationis.v37i1.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/22/2013] [Accepted: 11/23/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND It has been reported that South Africa has the highest number of people living with HIV worldwide, with more women being infected than men. Women living with HIV have been documented as experiencing various symptoms related to HIV and use various strategies to manage these symptoms. OBJECTIVE The objective of this study was to explore the sources and types of information regarding self-care symptom management strategies received by women living with HIV. METHOD The study was conducted at an HIV clinic in an urban area of KwaZulu-Natal. Individual in-depth interviews were completed with 11 women who were living with HIV,exploring the sources of information received on how they manage the HIV- (and/or AIDS-) related symptoms they experienced as well as the types of information received. The collecteddata were analysed using qualitative content analysis. RESULTS The participants identified various sources, which mainly included groups of people who provided them with information on how to manage their HIV-related symptoms, namely healthcare providers, their personal networks and the community. The different sources offered different types of information, including the use of medication, complementary treatments and self-comforting activities. CONCLUSION The study highlights that participants used multiple sources to get information about how to manage the experienced symptoms related to HIV, namely, healthcare providers, family and friends as well as themselves. It is to be noted that each source provided a preferred type of information.
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Affiliation(s)
- Regis R Marie Modeste
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape.
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8
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Schnall R, Wantland D, Velez O, Cato K, Jia H. Feasibility testing of a web-based symptom self-management system for persons living with HIV. J Assoc Nurses AIDS Care 2014; 25:364-71. [PMID: 24434198 DOI: 10.1016/j.jana.2013.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 09/10/2013] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to explore the feasibility of using a Web-based tool to provide tailored symptom management strategies for persons living with HIV (PLWH) and to estimate the effect size of the tool for future studies. Testing the components of the Web-based system was done by incorporating a repeated-measures design measuring the outcomes of symptom frequency and intensity, use of symptom management strategies, and engagement with health care providers. We recruited 42 PLWH; participants were enrolled in the study for 12 weeks and were asked to use the system and complete the questionnaires every 2 weeks. Our results showed that participants who used the strategies were more likely to have a decrease in symptom frequency and intensity. Findings from this feasibility study provide preliminary evidence for the use of a Web-based HIV symptom management tool with self-management strategies for individuals living with HIV infection.
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9
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Kemppainen J, Johnson MO, Phillips JC, Sullivan KM, Corless IB, Reid P, Iipinge S, Chaiphibalsarisdi P, Sefcik E, Chen WT, Kirksey K, Voss J, Rivero-Méndez M, Tyer-Viola L, Dawson Rose C, Webel A, Nokes K, Portillo C, Holzemer WL, Eller L, Nicholas P, Wantland D, Brion J, Beamon ER. A multinational study of self-compassion and human immunodeficiency virus-related anxiety. Int Nurs Rev 2013; 60:477-86. [PMID: 24251940 DOI: 10.1111/inr.12056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease. BACKGROUND Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. METHODS Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. FINDINGS Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries. CONCLUSIONS Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.
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Affiliation(s)
- J Kemppainen
- University of North Carolina Wilmington, Wilmington
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10
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Kemppainen JK, Brion JM, Leary M, Wantland D, Sullivan K, Nokes K, Bain CA, Chaiphibalsarisdi P, Chen WT, Holzemer WL, Eller LS, Iipinge S, Johnson MO, Portillo C, Voss J, Tyer-Viola L, Corless IB, Nicholas PK, Rose CD, Phillips JC, Sefcik E, Mendez MR, Kirksey KM. Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS. AIDS Care 2013; 25:1513-9. [PMID: 23527887 DOI: 10.1080/09540121.2013.780119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to extend the psychometric evaluation of a brief version of the Self-Compassion Scale (SCS). A secondary analysis of data from an international sample of 1967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self-Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with 0.714 for the total scale and 0.822 for Factor I and 0.774 for Factor II. Factor I (lower self-compassion) demonstrated strongly positive correlations with measures of anxiety and depression, while Factor II (high self-compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.
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Affiliation(s)
- Jeanne K Kemppainen
- a School of Nursing , University of North Carolina Wilmington , Wilmington , NC , USA
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Corless IB, Wantland D, Kirksey KM, Nicholas PK, Human S, Arudo J, Rosa M, Cuca Y, Willard S, Hamilton MJ, Portillo C, Sefcik E, Robinson L, Bain C, Moezzi S, Maryland M, Huang E, Holzemer WL. Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection. AIDS Patient Care STDS 2012; 26:335-43. [PMID: 22612448 DOI: 10.1089/apc.2011.0404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n=569) of an international 12 site longitudinal randomized controlled trial (RCT) (n=775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, nausea, and neuropathy. Symptom burden, engagement with the provider, and antiretroviral adherence were analyzed with regard to GSE. Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE. Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group. There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group. The low GSE group was also significantly (p= < 0.001) less engaged with their healthcare providers. Given the difference in substance use by perceived GSE, and the importance of engagement with the healthcare provider, more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted.
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Affiliation(s)
- Inge B. Corless
- School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts
| | - Dean Wantland
- School of Nursing, Rutgers University, Newark, New Jersey
| | - Kenn M. Kirksey
- Clinical Education Center at Brakenridge, Seton Family of Hospitals, Austin, Texas
| | - Patrice K. Nicholas
- School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts
| | - Sarie Human
- Department of Health Sciences, University of South Africa, Pretoria, South Africa
| | - John Arudo
- Advanced Nursing Programme, Aga Khan University, Nairobi, Kenya
| | - Maria Rosa
- School of Health Sciences, Universidad del Turabo, Gurabo, Puerto Rico
| | - Yvette Cuca
- School of Nursing, University of California–San Francisco, San Francisco, California
| | - Sue Willard
- School of Nursing, Rutgers University, Newark, New Jersey
| | - Mary Jane Hamilton
- School of Nursing, Texas A & M University–Corpus Christi, Corpus Christi, Texas
| | - Carmen Portillo
- School of Nursing, University of California–San Francisco, San Francisco, California
| | - Elizabeth Sefcik
- School of Nursing, Texas A & M University–Corpus Christi, Corpus Christi, Texas
| | - Linda Robinson
- School of Nursing, University of San Diego, San Diego, California
| | - Cathy Bain
- School of Nursing, University of California–San Francisco, San Francisco, California
| | - Shanaz Moezzi
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Mary Maryland
- Department of Nursing, Chicago State University, Chicago, Illinois
| | - Emily Huang
- School of Nursing, University of California–San Francisco, San Francisco, California
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12
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Kemppainen JK, Wantland D, Voss J, Nicholas P, Kirksey KM, Corless IB, Willard S, Holzemer WL, Robinson L, Hamilton MJ, Sefcik E, Eller LS, Huang E, Arudo J, Moezzi S, Rivero-Mendez M, Rosa M, Human S, Cuca Y, Lindgren T, Portillo CJ, Maryland M. Self-care behaviors and activities for managing HIV-related anxiety. J Assoc Nurses AIDS Care 2011; 23:111-23. [PMID: 21839652 DOI: 10.1016/j.jana.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/13/2011] [Indexed: 11/25/2022]
Abstract
The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.
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13
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Tufts KA, Wessell J, Kearney T. Self-care behaviors of African American women living with HIV: a qualitative perspective. J Assoc Nurses AIDS Care 2009; 21:36-52. [PMID: 19819168 DOI: 10.1016/j.jana.2009.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 07/08/2009] [Indexed: 11/24/2022]
Abstract
Significant numbers of African American (AA) women have been diagnosed with HIV over the past decade. HIV may be viewed as a chronic condition that can be actively managed through the use of self-care behaviors, yet little is known about how these women define self-care (SC) for themselves, and still less is known about what facilitates and hinders SC behaviors among these women. This article highlights the results of a qualitative research study undertaken with AA women living with HIV in a metropolitan city in the southeastern United States. The objective of this study was to systematically collect data about the SC experiences of these women. Focus group methodology was used. Content analysis of the data was conducted. Two primary domains emerged: do what the doctor says and living healthy. SC activities included seeking social support, managing disclosure, engaging in pampering, taking part in religious customs, and maintaining recovery.
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Swendeman D, Ingram BL, Rotheram-Borus MJ. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care 2009; 21:1321-34. [PMID: 20024709 PMCID: PMC2881847 DOI: 10.1080/09540120902803158] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV/AIDS is widely recognized as a chronic illness within HIV care, but is often excluded from chronic disease lists outside the field. Similar to other chronic diseases, HIV requires lifetime changes in physical health, psychological functioning, social relations, and adoption of disease-specific regimens. The shift from acute to chronic illness requires a self-management model in which patients assume an active and informed role in healthcare decision making to change behaviors and social relations to optimize health and proactively address predictable challenges of chronic diseases generally and HIV specifically. This article reviews literature on chronic disease self-management to identify factors common across chronic diseases, highlight HIV-specific challenges, and review recent developments in self-management interventions for people living with HIV (PLH) and other chronic diseases. An integrated framework of common elements or tasks in chronic disease self-management is presented that outlines 14 elements in three broad categories: physical health; psychological functioning; and social relationships. Common elements for physical health include: a framework for understanding illness and wellness; health promoting behaviors; treatment adherence; self-monitoring of physical status; accessing appropriate treatment and services; and preventing transmission. Elements related to psychological functioning include: self-efficacy and empowerment; cognitive skills; reducing negative emotional states; and managing identity shifts. Social relationship elements include: collaborative relationships with healthcare providers; social support; disclosure and stigma management; and positive social and family relationships. There is a global need to scale up chronic disease self-management services, including for HIV, but there are significant challenges related to healthcare system and provider capacities, and stigma is a significant barrier to HIV-identified service utilization. Recognizing that self-management of HIV has more in common with all chronic diseases than differences suggests that the design and delivery of HIV support services can be incorporated into combined or integrated prevention and wellness services.
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Affiliation(s)
- Dallas Swendeman
- Global Center for Children and Families, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
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Mohammadpour A, Yekta ZP, Nikbakht Nasrabadi AR, Mohraz M. Coming to terms with a diagnosis of HIV in Iran: a phenomenological study. J Assoc Nurses AIDS Care 2009; 20:249-59. [PMID: 19576542 DOI: 10.1016/j.jana.2009.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 03/03/2009] [Indexed: 11/24/2022]
Abstract
The number of people living with HIV (PLWH) has increased in all Asian regions, including Iran. Discovering that one has any serious illness can be a traumatic experience, but coming to terms with an HIV diagnosis is made more difficult by social constructs and negative reactions to the infection. This interpretative phenomenological study was carried out to understand and describe the lived experience of HIV-infected Iranians during the period immediately following an HIV diagnosis. Audiotaped in-depth semistructured interviews with 13 participants were used to collect data, which were analyzed with critical hermeneutics. Two main themes emerged: (a) doubt and delay in coming to terms with the diagnosis and (b) testing and its associated impacts. Nine subthemes were also found. Many challenges face people who need to determine their HIV status, and these are compounded by the sociocultural context found in Iran. Iran needs more education, counseling, testing facilities, and support programs to encourage people to get tested for HIV and to help them deal with a positive test result.
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Affiliation(s)
- Ali Mohammadpour
- Tehran University of Medical Sciences, School of Nursingand Midwifery, Tehran, Iran
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16
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Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa. Appl Nurs Res 2009; 24:1-9. [PMID: 20974052 DOI: 10.1016/j.apnr.2009.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/15/2008] [Accepted: 01/03/2009] [Indexed: 10/20/2022]
Abstract
Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.
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17
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Willard S, Holzemer WL, Wantland DJ, Cuca YP, Kirksey KM, Portillo CJ, Corless IB, Rivero-Méndez M, Rosa ME, Nicholas PK, Hamilton MJ, Sefcik E, Kemppainen J, Canaval G, Robinson L, Moezzi S, Human S, Arudo J, Eller LS, Bunch E, Dole PJ, Coleman C, Nokes K, Reynolds NR, Tsai YF, Maryland M, Voss J, Lindgren T. Does "asymptomatic" mean without symptoms for those living with HIV infection? AIDS Care 2009; 21:322-8. [PMID: 19280409 PMCID: PMC3630501 DOI: 10.1080/09540120802183511] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.
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Affiliation(s)
- Suzanne Willard
- Assistant Professor, Drexel University, College of Nursing and Health Professions, Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Avenue, NW, Suite 200, Washington, DC 20036, T: 202 448-8491
| | - William L. Holzemer
- Professor and Associate Dean, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-476-2763, F: 415-476-6042
| | - Dean J. Wantland
- Assistant Adjunct Professor, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-613-4107, F: 415-476-6042
| | - Yvette P. Cuca
- Project Director, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-502-8081, F: 415-476-6042
| | - Kenn M. Kirksey
- Director of Nursing Research, SETON Family of Hospitals, 1601 Rio Grande, Suite 300, Austin, Texas 78701, T: 512-324-8988
| | - Carmen J. Portillo
- Professor, UCSF School of Nursing, 2 Koret Way, Box 0608, San Francisco, CA 94143-0608, T: 415-476-1630, F: 415-476-6042
| | - Inge B. Corless
- MGH Institute of Health Professions, CNY 36 1 Ave, Boston, MA 02129, T: 617-726-8018, F: 617-724-6321
| | - Marta Rivero-Méndez
- Professor, University of Puerto Rico, Medical Sciences Campus, School of Nursing, P.O. Box 365067, San Juan, Puerto Rico 00936-5067, T: 787-758-2525, x2114, F: 787-281-0721
| | - María E. Rosa
- Dean and Professor, Universidad del Turabo, School of Health Sciences, PO Box 3030, Gurabo, PR 00778, T: 787-743-7979 x 4017/4462, F: 787-704-2703
| | - Patrice K. Nicholas
- Director of Global Health and Academic Partnerships, Professor, MGH Institute of Health Professions, Brigham and Women’s Hospital, One Brigham Circle 4th Floor, Boston, MA 02115, T: 617-525-7790
| | - Mary Jane Hamilton
- Dean & Professor, Texas A&M University - Corpus Christi, College of Nursing & Health Science, 6300 Ocean Drive, Corpus Christi, TX 78412, T: 361-825-2649, F: 361-825-2484
| | - Elizabeth Sefcik
- Professor, Texas A&M University - Corpus Christi, 6300 Ocean Drive, Corpus Christi, TX 78412, T: 361-825-5857
| | - Jeanne Kemppainen
- Associate Professor, School of Nursing, The University of North Carolina at Wilmington, 1080 St. Joseph St., 3B, Carolina Beach, NC 28428, T: 910-962-3202, H: 910-458-3788
| | - Gladys Canaval
- Universidad del Valle, A.A. 25360 Cali, Valle, Colombia, T: 57-2-3391437 ext 110, F: 57-2-5581938
| | - Linda Robinson
- Associate Professor, University of San Diego, Hahn School of Nursing, 5998 Alcala Park, San Diego, CA, T: 619-260-4571, F: 619-260-6814
| | - Shahnaz Moezzi
- Assistant Professor, University of Utah, College of Nursing, 1340 Michigan Ave., Salt Lake City, UT 84105, T: 801-587-9128, F: 801-581-4642
| | - Sarie Human
- University of South Africa, Department of Health Studies, PO Box 392, Unisarand, UNISA, Pretoria, 0003, South Africa, T: 27-12-429-6290, F: 27-12-429-6688
| | - John Arudo
- Regional Research Co-ordinator, Aga Khan University Advanced Nursing Programme, PO Box 39340-00623, Nairobi, Kenya, T: 254-20-374-74-83, F: 254-20-374-7004
| | - Lucille Sanzero Eller
- Associate Professor, Rutgers, the State University of New Jersey, 180 University Ave., Suite 102, Newark, NJ 07102, T: 973-353-5326 x503, F: 973-353-1277
| | - Eli Bunch
- Professor, University of Oslo, Institute of Nursing Science, POB 1153, Blindern, 0318, Oslo Norway, T: 47-22-85-05-60, F: 47-22-85-05-70
| | - Pamela J. Dole
- Village Diagnostic and Treatment Center, 121A W 20 Street, New York, NY 10011, T: 212-337-9290, F: 212-337-9254
| | - Christopher Coleman
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-6096, T: 215-898-0760, F: 215-573-7496
| | - Kathleen Nokes
- Professor, Hunter College, CUNY, Hunter-Bellevue School of Nursing, 425 East 25 St., Box 874, New York, NY 10010, T: 212-481-7594, F: 212-481-4427
| | - Nancy R. Reynolds
- Yale University, School of Nursing, P.O. Box 9740, 100 Church Street South, Suite 200, New Haven, CT 06536-0740, T: 203-737-2313, F: 203-785-6455
| | - Yun-Fang Tsai
- Professor, School of Nursing, Chang Gung University, 259 Wen Hua 1 Road, Kwei-Shan, Tao-Yuan 333, Taiwan, ROC, T: 011-886-3-3283016 ext 5958, F: 011-886-3-211868
| | - Mary Maryland
- University of Illinois at Chicago, College of Medicine, Hematology Oncology, 820 S. Wood St., Suite 172 (M/C 712), Chicago, Illinois 60612, T: 312-413-2042, F: 312-996-5984
| | - Joachim Voss
- Assistant Professor, University of Washington, School of Nursing, Dept. of Biobehavioral Nursing and Health Systems, UW Box 357266, Room T 624B, Seattle, WA 98195, T: 206-616-7819, F: 206-543-4771
| | - Teri Lindgren
- Project Director, UCSF School of Nursing, 2 Koret Way, Box 0606, San Francisco, CA 94143-0606, T: 415-504-7892
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18
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Fillipas S, Bowtell-Harris CA, Oldmeadow LB, Cicuttini F, Holland AE, Cherry CL. Physical activity uptake in patients with HIV: who does how much? Int J STD AIDS 2008; 19:514-8. [PMID: 18663035 DOI: 10.1258/ijsa.2007.007237] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Regular physical activity is recommended for patients with human immunodeficiency virus (HIV) to help manage their disease. However, to date, little is known about levels of uptake of this advice. This study describes daily physical activity in HIV antibody-positive patients attending a public hospital infectious diseases clinic, compares them with those of patients attending the clinic for general infectious diseases and investigates compliance with the recommendations of the Centres for Disease Control and Prevention and American College of Sports Medicine physical activity guidelines. During April 2006, 261 patients completed the International Physical Activity Questionnaire short form. One hundred and ninety-one reported being HIV antibody-positive. Results showed that 1:4 HIV antibody-positive and 1:3 HIV antibody-negative respondents failed to meet the recommended guidelines. These findings are of concern, given the evidence-based benefits of regular physical activity. Further work is needed to identify barriers to participation and interventions that can improve uptake.
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Affiliation(s)
- S Fillipas
- Physiotherapy Department, The Alfred, Prahran, Vic, Australia.
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19
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Wantland DJ, Holzemer WL, Moezzi S, Willard SS, Arudo J, Kirksey KM, Portillo CJ, Corless IB, Rosa ME, Robinson LL, Nicholas PK, Hamilton MJ, Sefcik EF, Human S, Rivero MM, Maryland M, Huang E. A randomized controlled trial testing the efficacy of an HIV/AIDS symptom management manual. J Pain Symptom Manage 2008; 36:235-46. [PMID: 18400461 DOI: 10.1016/j.jpainsymman.2007.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 10/18/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
Abstract
This study investigates whether using an HIV/AIDS symptom management manual with self-care strategies for 21 common symptoms, compared to a basic nutrition manual, had an effect on reducing symptom frequency and intensity. A 775-person, repeated measures, randomized controlled trial was conducted over three months in 12 sites from the United States, Puerto Rico, and Africa to assess the relationship between symptom intensity with predictors for differences in initial symptom status and change over time. A mixed model growth analysis showed a significantly greater decline in symptom frequency and intensity for the group using the symptom management manual (intervention) compared to those using the nutrition manual (control) (t=2.36, P=0.018). The models identified three significant predictors for increased initial symptom intensities and in intensity change over time: (1) protease inhibitor-based therapy (increased mean intensity by 28%); (2) having comorbid illness (nearly twice the mean intensity); and (3) being Hispanic receiving care in the United States (increased the mean intensity by 2.5 times). In addition, the symptom manual showed a significantly higher helpfulness rating and was used more often compared to the nutrition manual. The reduction in symptom intensity scores provides evidence of the need for palliation of symptoms in individuals with HIV/AIDS, as well as symptoms and treatment side effects associated with other illnesses. The information from this study may help health care providers become more aware of self-management strategies that are useful to persons with HIV/AIDS and help them to assist patients in making informed choices.
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Affiliation(s)
- Dean J Wantland
- School of Nursing, University of California, San Francisco, California 94143-0608, USA.
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20
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Nicholas PK, Voss JG, Corless IB, Lindgren TG, Wantland DJ, Kemppainen JK, Canaval GE, Sefcik EF, Nokes KM, Bain CA, Kirksey KM, Eller LS, Dole PJ, Hamilton MJ, Coleman CL, Holzemer WL, Reynolds NR, Portillo CJ, Bunch EH, Tsai YF, Mendez MR, Davis SM, Gallagher DM. Unhealthy behaviours for self-management of HIV-related peripheral neuropathy. AIDS Care 2008; 19:1266-73. [PMID: 18071970 DOI: 10.1080/09540120701408928] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.
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21
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The Lived Experience of a Mind-Body Intervention for People Living With HIV. J Assoc Nurses AIDS Care 2008; 19:192-9. [DOI: 10.1016/j.jana.2008.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 02/12/2008] [Indexed: 11/30/2022]
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22
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Ridge D, Williams I, Anderson J, Elford J. Like a prayer: the role of spirituality and religion for people living with HIV in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2008; 30:413-428. [PMID: 18419695 DOI: 10.1111/j.1467-9566.2007.01062.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Over 40,000 people are now living with diagnosed HIV in the UK. There is, however, uncertainty about how people with HIV use religion or spirituality to cope with their infection. Adopting a modified grounded theory approach, we analysed individual and group interviews with the people most affected by HIV in the UK: black African heterosexual men and women and gay men (mostly white). For the majority of black African heterosexual men and women in our study, religion was extremely important. We found that gay men in the study were less religious than black Africans, although many were spiritual in some way. Black African individuals constructed their spiritual narratives as largely Christian or collective, while gay men described more individualistic or 'New Age' approaches. We developed a six-level heuristic device to examine the ways in which prayer and meditation were deployed in narratives to modulate subjective wellbeing. These were: (i) creating a dialogue with an absent counsellor; (ii) constructing a compassionate 'life scheme'; (iii) interrupting rumination; (iv) establishing mindfulness; (v) promoting positive thinking, and (vi) getting results. That people with HIV report specific subjective benefits from prayer or meditation presents a challenge to secular healthcare professionals and sociologists.
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Affiliation(s)
- Damien Ridge
- Institute of Health Sciences, City University London, UK.
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