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Farmer HF, Byrne JEM, Mussap AJ. The Role of Gender and Sexuality in the Experience, Internalization, and Mental Health Correlates of Sexual Victimization Stigma. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241246798. [PMID: 38624136 DOI: 10.1177/08862605241246798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The stigma associated with sexual victimization (SV) can add to the psychological burden on survivors. We compared experiences of SV and SV stigma by survivor gender and sexuality and evaluated the relevance of public and internalized sources of this stigma to their psychological functioning. An online survey containing measures of SV type (sexual harassment and assault), public SV stigma, internalized SV stigma (self-blame, self-shame, anticipated-shame), and psychological functioning (depression, anxiety, stress, and post-traumatic stress disorder [PTSD] symptomatology) was completed by 877 women and 211 men aged 18 to 66 years (M = 30.2, SD = 8.06), of whom 73.9% were heterosexual and 26.1% identified as a sexual minority (same-sex-attracted, bisexual, pansexual, or asexual). Sexual harassment and assault were more prevalent in women and sexual minority men. Analysis of Covariance (ANCOVA) with age and SV frequency as covariates also revealed poorer psychological functioning in sexual minority men, and higher levels of SV stigma in sexual minority women and men. Multigroup path analyses further showed that exposure to public stigma was associated with poorer psychological functioning, that internalized stigma partly mediated these associations, and that the magnitude of the associations (particularly those involving self-shame and anticipated shame) was often greater in men and sexual minorities. The results add to our understanding of the role of gender and sexuality in the experience, internalization, and psychological impact of SV-related stigma on survivors. The results also highlight the need for societal shifts toward acknowledging and validating experiences of SV in men and sexual minorities, alongside women, and the development of intersectionality-informed interventions for SV stigma in survivors.
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Affiliation(s)
| | - Jamie E M Byrne
- School of Psychology, Deakin University, Melbourne, VIC, Australia
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Zhang Y, Liu M, Han J, Tian X, Xin Y. Beyond the Burden: A Qualitative Inquiry into the Experiences of Chinese Informal Caregivers for People Living with HIV or AIDS. Patient Prefer Adherence 2024; 18:677-685. [PMID: 38505188 PMCID: PMC10949991 DOI: 10.2147/ppa.s454590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose Informal caregivers are defined as families or close friends of patients, which take considerable responsibilities for providing care to people living with HIV/AIDS (PLWHA). Although there have been a number of studies in caregiver of PLWHA, research studies that sought to quantify the effects of informal caregiving for the caregivers failed to successfully provide empirical understanding of the nature of caregiving experience. Therefore, this study adopted a qualitative approach to explore the experiences and feelings of caregivers of PLWHA during the long-term care process. Methods The qualitative study was conducted in August 2023 in Beijing, China. Data were collected through individual in-depth semi-structured interviews with informal caregivers of PLWHA. Theme analysis was used to identify themes from the interview transcripts. Results A total of 21 participants were recruited into our study, 16 were family members of PLWAHA, and 5 were homosexual lover or close friend of PLWHA. Three major themes and ten sub themes were identified by thematic analysis: (1) care burden experience (including 5 sub-themes: negative emotional experience, psychological burden, economic burden, physical health loss and limitation of social interaction); (2) benefit findings from care (including 3 sub-theme: positive emotional experience, perceived social support, health promotion); (3) Demands for caregiving capacity (including 2 sub-theme: inadequate caregiving capacity and inadequate psychological comfort capacity). Conclusion This qualitative study provides a comprehensive exploration of the experiences faced by informal caregivers of PLWHA in China, uncovering the complex spectrum of psychological, physical, social, and economic challenges inherent in their caregiving roles, while predominantly challenging, caregivers also reported personal growth, increased social support, and emotional fulfillment. The research results could help in developing effective interventions to reduce the caregiver burden and improve their mental health.
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Affiliation(s)
- Ying Zhang
- School of Public Health, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Mingyuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Jing Han
- Department of Beijing Home of Red Ribbon, Beijing Ditan Hospital, Capital Medical University, Beijing, 100102, People’s Republic of China
| | - Xin Tian
- Administrative office of hospital, Beijing Ditan Hospital, Capital Medical University, Beijing, 100102, People’s Republic of China
| | - Youqing Xin
- Administrative Office of Hospital, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
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O'Doherty L, Whelan M, Carter GJ, Brown K, Tarzia L, Hegarty K, Feder G, Brown SJ. Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood. Cochrane Database Syst Rev 2023; 10:CD013456. [PMID: 37795783 PMCID: PMC10552071 DOI: 10.1002/14651858.cd013456.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults. OBJECTIVES To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood. SEARCH METHODS In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches. SELECTION CRITERIA Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD). AUTHORS' CONCLUSIONS Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.
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Affiliation(s)
- Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Maxine Whelan
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Brown
- Faculty of Arts, Business and Law, Law School, USC: University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Sherr L, Macedo A, Tomlinson M, Skeen S, Hensels IS, Steventon Roberts KJ. Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities. J Cross Cult Gerontol 2023:10.1007/s10823-023-09482-6. [PMID: 37243786 DOI: 10.1007/s10823-023-09482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/29/2023]
Abstract
Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ana Macedo
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Imca S Hensels
- Department of Psychology, University of Manchester, Manchester, UK
| | - Kathryn J Steventon Roberts
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
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Nabunya P, Namuwonge F, Sensoy Bahar O, Ssentumbwe V, Migadde H, Mugisha J, Ssewamala FM. Stigma by Association, Parenting Stress, and the Mental Health of Caregivers of Adolescents Living With HIV in Uganda. J Adolesc Health 2023; 72:S18-S23. [PMID: 37062579 PMCID: PMC10151126 DOI: 10.1016/j.jadohealth.2022.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE This study examined the relationship between stigma by association-defined as prejudice and discrimination against individuals who are associated with stigmatized individuals, parenting stress, and the mental health of caregivers of adolescents living with HIV. METHODS Multivariate regression analyses were conducted using baseline data from the Suubi4Stigma study (2020-2022), a pilot study addressing HIV-related stigma among adolescents and their caregivers in southern Uganda. RESULTS The average age was 47 years, 77.5% were female, and 49% identified as the child's biological parent. Stigma by association was associated with poor caregiver mental health (b = 1.346, 95% confidence interval = 0.49, 2.21) and parenting stress (b = 1.431, 95% confidence interval = 0.79, 2.08). Caregiver's gender, biological relatedness, household composition, and family cohesion were uniquely associated with caregiver mental health and parenting stress. DISCUSSION Findings point to the need to incorporate stigma reduction components, not only for adolescents living with HIV, but also their caregivers, to counteract the effects of stigma on their mental health.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
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Mitchell M, Hansen E, Tseng TY, Shen M, Catanzarite Z, Cruz-Oliver D, Parker L, Knowlton A. Caregiver role strain in caring for vulnerable persons living with HIV: correlates of caregiver and care recipient reports. AIDS Care 2022; 34:1314-1320. [PMID: 34445898 PMCID: PMC8881545 DOI: 10.1080/09540121.2021.1968997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/09/2021] [Indexed: 01/26/2023]
Abstract
Informal care of family and friends is important for the health and well-being of disadvantaged persons living with HIV (PLWH). Caregiver role strain may threaten the function and continuity of their main relationships and their health impacts. Data were from a disadvantaged, primarily African American, sample of PLWH care recipients. Caregiver role strain was operationalized as a latent factor measured by variables including PLWH's perceptions of their caregiver not wanting or complaining about helping them or wanting a break. We found that greater caregiver role strain was associated with higher levels of HIV-related stigma and depressive symptoms. Lower role strain was associated with more collaborative problem solving and shared medical treatment decision-making. Caregiver role strain was linked to disadvantaged PLWHs' worse stigma and mental health; collaborative engagement in care and coping assistance were protective of role strain. Caregiving relationship-focused research and interventions are needed for resourcing and sustaining disadvantaged African American communities' caregiving and health.
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Affiliation(s)
| | - Eric Hansen
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Tuo-Yen Tseng
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Mary Shen
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Zachary Catanzarite
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | | | - Lauren Parker
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Amy Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
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Song Y, Wang H, Yin Y, Nie A, Yang H, Liu Y, Tao L, Zhong H, Zhang L, Chen H. Caregiver Burden Among Informal Caregivers of Persons Living with HIV/AIDS in Liangshan Prefecture, China. Patient Prefer Adherence 2022; 16:1027-1035. [PMID: 35444411 PMCID: PMC9013673 DOI: 10.2147/ppa.s357580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/27/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous studies revealed that informal caregivers for persons living with HIV/AIDS (PLWHA) experience perceived caregiver burden. Although Liangshan prefecture is one of the areas with the fastest growing HIV/AIDS epidemics in China, little is known about burden of informal caregivers for PLWHA. This study aimed to evaluate caregiver burden and these predictors among informal caregivers of PLWHA in Liangshan prefecture, China. METHODS This was a cross-sectional study conducted from August to December 2017. We used convenience sampling to recruit informal caregivers of PLWHA. A total of 222 participants completed questionnaires including demographic information, caregiving-related information, and caregiver burden (measured by Zarit Burden Interview, ZBI). SPSS software was used to analyze the data. Independent student's t-test, one-way analysis of variance (one-way ANOVA), Spearman rank correlation, and multiple linear regression analysis were performed. RESULTS The mean ZBI score was 40.61 (SD = 14.47), and 199 (89.6%) informal caregivers had a mild or above caregiver burden. Multiple linear regression analysis revealed that older age (P=0.003), caregivers with poor health (P=0.002), parent-caregivers (P=0.001), poorer ability in 'balancing caregiving needs and their own needs' (P<0.001), and 'managing emotional needs' (P=0.014) were significantly associated with higher level of caregiver burden. CONCLUSION The majority of informal caregivers had perceived caregiver burden in Liangshan prefecture of China. Findings emphasize that health-care providers, medical institutions and government should develop educational programs and policy to improve caregiver's ability to cope with caregiving for PLWHA, and take more attention to caregivers with health problem, at older age, parent-caregivers. These may contribute to reducing caregiver burden among informal caregivers of PLWHA.
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Affiliation(s)
- Yuqing Song
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Huan Wang
- Department of Nursing, the Third Hospital of Mianyang, Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Yao Yin
- Department of Neurology/Evidence-Based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Anliu Nie
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Hui Yang
- Nursing Department, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, People's Republic of China
| | - Ying Liu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Lin Tao
- Department of Breast Surgery, West China Hospital /West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Hua Zhong
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Liao Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Hong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
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Jewkes R, Mhlongo S, Chirwa E, Seedat S, Myers B, Peer N, Garcia-Moreno C, Dunkle K, Abrahams N. Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort. Clin Psychol Psychother 2021; 29:328-338. [PMID: 34170058 PMCID: PMC9544891 DOI: 10.1002/cpp.2637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
Rape stigma, both external and self‐stigmatization (self‐blame), is associated with adverse health outcomes. Understanding its origins and resilience factors is critical for reducing and preventing it. We describe the prevalence of rape stigma, the characteristics of women experiencing it and the pathways to experiencing greater stigma. The Rape Impact Cohort Evaluation study enrolled 852 women aged 16–40 years who had been raped from post‐rape care centres in Durban, South Africa. We present a descriptive analysis of the baseline data, a multinomial logistic regression model of factors associated with different levels of stigma and a structural equation model (SEM). Most women reported stigmatizing thoughts or experiences, with self‐stigmatizing thoughts being more prevalent than external stigmatization. The multinomial model showed that experiences of childhood or other trauma, emotional intimate partner violence (IPV), having less gender equitable attitudes and food insecurity were significantly associated with medium or high versus low levels of stigma. Internal and external stigma were significantly associated with each other. Women who had been previously raped reported less stigma. The SEM showed a direct path between food insecurity and rape stigma, with poorer women experiencing more stigma. Indirect paths were mediated by more traditional gender attitudes and childhood trauma experience and other trauma exposure. Our findings confirm the intersectionality of rape stigma, with its structural drivers of food insecurity and gender inequality, as well as its strong association with prior trauma exposure. Rape survivors may benefit from gender‐empowering psychological support that addresses blame and shame.
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Affiliation(s)
- Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa.,Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, Stellenbosch University, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nasheeta Peer
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Moshidi ML, Malema RN, Muthelo L, Mothiba TM. Provision of Care to the People with HIV: Voices of Professional Nurses in the Public Hospitals of Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063112. [PMID: 33803507 PMCID: PMC8002935 DOI: 10.3390/ijerph18063112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
The battle against the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) epidemic are still raging in South Africa (SA) despite all the preventive strategies implemented via the five-year strategic plan (2011-2015). The intensity of the AIDS pandemic in SA creates additional challenges for the health workers as they have to deal with an increasing number of people who suffer from this disease. Professional nurses are a critical part of the workforce. The qualitative, explorative, descriptive, and contextual study design was conducted in five public hospitals from each district of Limpopo Province. The purpose of the study was to explore and describe experiences regarding support received by professional nurses while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province. Purposive sampling was employed to select the participants who provided care to HIV and AIDS patients for 24 months or more. The recruitment of participants continued until data saturation was reached at participant number 20. Data were collected through face-to-face individual interviews using a semi-structured guide. Data were analyzed using Tech's qualitative data analysis method. Trustworthiness was measured through credibility, dependability, confirmability, and transferability. Findings: Emotional and physical strain due to a shortage of staff, heavy workload, staff turnover, and high absenteeism were experienced by the nurses fulfilling these tasks. Exhaustion, fatigue, increased levels of stress, and lack of training, counselling, debriefing sessions, recognitions, and reward systems were also experienced. Recommendations: A program for support of all professional nurses providing care to HIV and AIDS patients should be conceptualized and implemented.
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Affiliation(s)
- Maria Lebeko Moshidi
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
| | - Rambelani Nancy Malema
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
| | - Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga 0727, South Africa; (M.L.M.); (R.N.M.)
- Correspondence: ; Tel.: +27-526-839-73
| | - Tebogo Maria Mothiba
- Faculty of Health Sciences Executive Dean’s Office, University of Limpopo, Sovenga 0727, South Africa;
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Abstract
OBJECTIVE The negative effects of HIV stigma may extend beyond those who are HIV-positive, to people who are perceived to be at risk of HIV. This article examines HIV stigma by association among Australian gay and bisexual men (GBM). DESIGN Cross-sectional, online survey of 1280 Australian gay and bisexual men. This article focuses on HIV stigma from within a larger study that investigated stigma related to sexual identity. METHODS Bivariate and multivariable comparisons were made between men who experienced HIV stigma by association and those who did not. A serial mediation model was tested to investigate relationships between GBM community attachment, sexual identity stigma, HIV testing frequency, HIV stigma by association, psychological distress, and rejection of sex partners. RESULTS Results found that 5% of participants were HIV-positive, yet over 70% reported that they had been stigmatized by others for their perceived risk of acquiring HIV. Multivariable analysis indicated that HIV stigma by association was associated with more frequent HIV testing, greater GBM community attachment, experiencing stigma related to sexual identity and psychological distress. Our results suggest flow-on effects of HIV stigma by association, such as being more likely to reject other GBM on the basis of their HIV status or not testing for HIV. CONCLUSION Our results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations. There is a need to address HIV stigma within GBM communities and society more broadly in order to encourage HIV testing and prevention among GBM.
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Maddocks S, Chetty V. Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 32633994 PMCID: PMC8377773 DOI: 10.4102/safp.v62i1.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Stacy Maddocks
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Brown SJ, Khasteganan N, Brown K, Hegarty K, Carter GJ, Tarzia L, Feder G, O'Doherty L. Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood. Cochrane Database Syst Rev 2019. [DOI: 10.1002/14651858.cd013456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sarah J Brown
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry UK CV1 5FB
- University of the Sunshine Coast; School of Law and Criminology; 90 Sippy Downs Drive Sippy Downs Queensland Australia 4556
| | - Nazanin Khasteganan
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry UK CV1 5FB
| | - Katherine Brown
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry UK CV1 5FB
| | - Kelsey Hegarty
- The University of Melbourne; Department of General Practice; 200 Berkeley Street Parkville Melbourne Australia 3010
- The Royal Women's Hospital; Victoria Australia
| | - Grace J Carter
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry UK CV1 5FB
| | - Laura Tarzia
- The University of Melbourne; Department of General Practice; 200 Berkeley Street Parkville Melbourne Australia 3010
- The Royal Women's Hospital; Victoria Australia
| | - Gene Feder
- University of Bristol; Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Lorna O'Doherty
- Coventry University; Faculty of Health and Life Sciences; Priory Street Coventry UK CV1 5FB
- The University of Melbourne; Department of General Practice; 200 Berkeley Street Parkville Melbourne Australia 3010
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Wang W, Yang N, Li X, Xiao H, Gao M, Yan H, Li S. A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China. PSYCHOL HEALTH MED 2019; 24:1100-1110. [PMID: 30892925 DOI: 10.1080/13548506.2019.1595677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.
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Affiliation(s)
- Wei Wang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china.,b Department of Epidemiology , University of Florida , Gainesville , FL , USA
| | - Ningxi Yang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Xiaoyan Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Han Xiao
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Mengting Gao
- c Information Center , Renmin Hospital of Wuhan University , Wuhan , P.R. China
| | - Hong Yan
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Shiyue Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
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Roomaney R, Kagee A, Knoll N. Received and perceived support subscales of the Berlin Social Support Scales in women diagnosed with breast cancer attending the breast clinic at Tygerberg hospital: structure and correlates. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319831819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research in the field of psycho-oncology in South Africa is increasing, and there is a need for validated measures that assess factors associated with cancer, such as social support. The Berlin Social Support Scales are a battery of instruments that measure various types and functions of social support. The measure was originally developed for use among adult cancer patients, and their partners but has also been used among other clinical populations and healthy adults. We investigated the psychometric properties of the English version of the perceived and received sub-scales, Berlin Social Support Scales. Our sample included South African women ( N = 201) who were diagnosed with breast cancer and receiving treatment at a public health care facility. We administered several measures, including a demographic questionnaire, the Berlin Social Support subscales, the Duke-UNC Functional Social Support Questionnaire, and The Functional Assessment of Cancer Therapy to participants. Validity and reliability analyses were conducted. Factor analysis resulted in the retention of 17 items that clustered on two factors, namely received support and perceived support. The 17-item version of the Berlin Social Support Scale demonstrated strong reliability and validity in the sample. The two subscales are quick to administer, easy to interpret, and are a reliable measure of social support among breast cancer patients in South Africa.
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Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Nina Knoll
- Department of Psychology, Freie Universität Berlin, Germany
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Zikhathile T, Atagana H. Challenges Facing Home-Based Caregivers in the Management of Health Care Risk Waste. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2700. [PMID: 30513572 PMCID: PMC6313601 DOI: 10.3390/ijerph15122700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
Abstract
The quadruple burden of diseases, early discharge from hospital and hospital at home have resulted in home-based care services becoming a requirement in South Africa. These home-based care services generate a significant amount of health care risk waste that is mismanaged. More attention is given to the health care risk waste generated in hospitals and clinics than to health care risk waste generated by home-based caregivers. Therefore, this study investigates the health care risk waste management practices by home-based caregivers. The study adopted a mixed research approach, qualitative and quantitative methods, using a literature review, interviews, and questionnaires as means of data collection. Results show that there are different types of health care risk waste generated as a result of different activities performed by home-based caregivers, but that the waste was found to be managed in an unsafe manner. The majority of households receiving home-based care did not have basic sanitation facilities such as toilets, running water and waste removal services, aggravating the issue of health care risk waste mismanagement. The study recommends a new policy framework that will lead to safe management practices of generated health care risk waste to be adopted by home-based caregivers.
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Affiliation(s)
- Thobile Zikhathile
- Mangosuthu University of Technology, Faculty of Natural Sciences, 511 Griffiths Mxenge Highway, Umlazi, KwaZulu-Natal 4031, South Africa.
| | - Harrison Atagana
- Institute for Science and Technology Education, University of South Africa, Pretoria 0003, South Africa.
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16
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Seo MH, Jeong SH. [Life Experiences of Uninfected Women Living with HIV-Infected Husbands: A Phenomenological Study]. J Korean Acad Nurs 2018; 47:781-793. [PMID: 29326409 DOI: 10.4040/jkan.2017.47.6.781] [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: 08/07/2017] [Revised: 11/19/2017] [Accepted: 11/19/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to understand the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. METHODS This qualitative study adopted van Manen's hermeneutic phenomenological method. Study participants were 8 females whose husband had been diagnosed with HIV for longer than 6 months, who had known about their husband's infection for more than 6 months, who were in a legal or common-law marriage and were living with their husbands at the time of interview for this study, and whose HIV antibody test results were negative. Data were collected from in-depth individual interviews with the participants from May to August 2016, and from related idiomatic expressions, literature, artwork, and phenomenological references. RESULTS The following essential themes were identified regarding the life experiences of uninfected women living with HIV-infected husbands: 'experiencing an abrupt change that came out of the blue and caused confusion', 'accepting one's fate and making desperate efforts to maintain one's family', 'dealing with a heavy burden alone', 'experiencing the harsh reality and fearful future', and 'finding consolation in the ordeal'. CONCLUSION This study provided a holistic and in-depth understanding of the meaning and essence of the life experiences of uninfected women living with HIV-infected husbands. Thus, this study recognizes these unnoticed women as new nursing subjects. Further, the present findings can be used as important basic data for the development of nursing interventions and national policy guidelines for uninfected women living with HIV-infected husbands.
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Affiliation(s)
- Myoung Hee Seo
- Department of Nursing, Kunsan College of Nursing, Kunsan, Korea
| | - Seok Hee Jeong
- College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea.
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Khan R, Pai K, Kulkarni V, Ramapuram J. Depression, anxiety, stress and stigma in informal caregivers of People Living with HIV (PLHIV). AIDS Care 2017; 30:722-726. [PMID: 29278924 DOI: 10.1080/09540121.2017.1418831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Informal caregivers are unpaid individuals who help friends or family members who cannot fully care for themselves. However fulfilling the act of helping debilitated individuals, exposure to another person's traumatic experiences often results in psychological distress. Caregiver's stigma towards HIV worsens this. Hence, this study aims to assess the effect of stigma on the mental health of caregivers so that their needs for support can be determined. A cross sectional hospital based study was carried out in Mangalore, India on 150 informal caregivers of PLHIV. The HIV Stigma Scale was used to assess stigma and DASS-21 was used to assess depression, anxiety and stress. Of the 150 caregivers, 20% marked one or more items on the stigma scale. Frequency of depression, anxiety and stress was 46%, 27% and 8% respectively. Most caregivers who had stigma and anxiety were of those patients diagnosed for a shorter duration of time (≤5 years) n = 20, p = 0.05 and n = 26, p = 0.03 respectively. Spouses of PLHIV (n = 31, p = 0.005), sero-positive caregivers (n = 25, p = 0.03) and those living with patients (n = 39, p = 0.01) suffered most from anxiety. Stress was significantly associated with depression (83%, p = 0.007) and anxiety (66.6%, p = 0.001) in caregivers. In conclusion, more of depression and anxiety was observed among the participants than stress. Stigma was seen in 20% of the participants. Stigma was not significantly associated with depression anxiety and stress.
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Affiliation(s)
- Rumana Khan
- a Kasturba Medical College , Manipal University , Mangalore , Karnataka
| | - Keshava Pai
- b Department of Psychiatry, Kasturba Medical College , Manipal University , Mangalore , Karnataka
| | - Vaman Kulkarni
- c Department of Community Medicine, Kasturba Medical College , Manipal University , Mangalore , Karnataka
| | - John Ramapuram
- d Department of Medicine, Kasturba Medical College , Manipal University , Mangalore , Karnataka
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Abrahams N, Seedat S, Lombard C, Kengne AP, Myers B, Sewnath A, Mhlongo S, Ramjee G, Peer N, Garcia-Moreno C, Jewkes R. Study protocol for a longitudinal study evaluating the impact of rape on women's health and their use of health services in South Africa. BMJ Open 2017; 7:e017296. [PMID: 28965098 PMCID: PMC5640088 DOI: 10.1136/bmjopen-2017-017296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care. METHODS AND ANALYSIS This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied. ETHICS AND DISSEMINATION The South African Medical Research Council's Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.
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Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, University of Stellenbosch, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alesha Sewnath
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nasheeta Peer
- Non-Communicable Disease Research Unit, South African Medical Research Council, Durban, South Africa
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Asadullah M, Kamath R, Pattanshetty S, Andrews T, Nair NS. Psychological impact on caregivers of HIV-infected children in Udupi district, Karnataka. AIDS Care 2016; 29:787-792. [PMID: 27915488 DOI: 10.1080/09540121.2016.1263720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Caregivers of children living with HIV/AIDS (CLWHA) face unique challenges due to disease-related stigma and discrimination, isolation from society, financial constraints, grief and mortality of loved one. A descriptive cross-sectional study was conducted at Udupi ART centre to assess the caregiver burden, psychological distress and their associated factors among the caregivers of CLWHA in Udupi District. The convenience sampling technique was used to collect the data from 171 caregivers and analysed with the help of SPSS version 15.0. Majority of caregivers were female (64.9%) with mean age of 38.1 ± 9.6 years. About 64.3% caregivers were HIV-positive and 63.2% were biological parents of CLWHA. Mild-to-severe caregiver burden on Zarit Burden Inventory (ZBI) was reported among 84.8% of caregivers, and mild-to-severe psychological distress on General Health Questionnaire (GHQ-12) was reported among 49.7% caregivers. Relationship with child was found to be a significant predictor of caregiver burden as compared to other relatives/foster (P < 0.001). Relationship with child (P 0.004), Alcohol use (P 0.008) and Schooling of children (P 0.049) were reported as significant predictors of psychological distress. Study concludes that caregiver burden and psychological distress were high among caregivers of CLWHA. Psychological problems of caregivers need to be addressed and integrated along with the clinical care of HIV-infected children at ART centres.
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Affiliation(s)
- Md Asadullah
- a Department of Public Health , Manipal University , Manipal , India
| | | | | | - Teddy Andrews
- a Department of Public Health , Manipal University , Manipal , India
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20
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Knight L, Hosegood V, Timæus IM. Obligation to family during times of transition: care, support and the response to HIV and AIDS in rural South Africa. AIDS Care 2016; 28 Suppl 4:18-29. [PMID: 27283212 DOI: 10.1080/09540121.2016.1195486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In rural South Africa, high HIV prevalence has the potential to affect the care and support that kin are able to provide to those living with HIV. Despite this, families seem to be largely resilient and a key source of care and support to family affected by HIV. In this article, we explore the motivations for the provision of care and support by kin. We use the results of a small-scale in-depth qualitative study conducted in 10 households over 6 months in rural KwaZulu-Natal, South Africa, to show that family obligation and conditional reciprocity operate in varying degrees and build social capital. We highlight the complexity of kin relations where obligation is not guaranteed or is limited, requiring the consideration of policy measures that provide means of social support that are not reliant on the family.
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Affiliation(s)
- Lucia Knight
- a School of Public Health , University of the Western Cape , Bellville , South Africa
| | - Victoria Hosegood
- b Division of Social Statistics and Demography , University of Southampton , Southampton , UK.,c Africa Centre for Health and Population Studies , Mtubatuba , South Africa
| | - Ian M Timæus
- d Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.,e Centre for Actuarial Research , University of Cape Town , Cape Town , South Africa
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Chandran V, Madi D, Chowta N, Ramapuram J, Bhaskaran U, Achappa B, Jose H. Caregiver Burden among Adults Caring for People Living with HIV/AIDS (PLWHA) in Southern India. J Clin Diagn Res 2016; 10:OC41-3. [PMID: 27437270 DOI: 10.7860/jcdr/2016/20076.7865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In India, family caregivers provide bulk of care to People Living With HIV/AIDS (PLWHA). Caregiver burden refers to the physical, emotional and financial hardships associated with providing care to a diseased individual. Attending to the needs of PLWHA can place a significant burden on family members. This may adversely affect their Quality of Life (QOL). AIM The main aim of our study was to assess the caregiver burden and QOL among the family members of PLWHA in Southern India. We also determined the impact of caregiver burden on QOL. MATERIALS AND METHODS This facility based cross-sectional study was carried out at Kasturba Medical College (KMC) Mangalore. The study was conducted over a period of 18 months starting from October 2013. A total of 360 caregivers participated in our study. The data were collected by face-to-face interview. Caregiver burden was assessed using the Zarit Burden scale & WHOQOL-BREF scale was used to assess the QOL of caregivers. The collected data was entered and analysed using SPSS version 11.5. A p-value of less than 0.05 was considered statistically significant. RESULTS The mean age of caregivers was 36.09± 10.18 years. Most of the caregivers were females 279 (77.5%). Majority of caregivers 184 (51.1%) belonged to Middle/Lower Middle socioeconomic class (Kuppuswamy class III). Majority of PLWHA 155 (43.1%) had Stage 2 disease. Mean CD4 count of the patients was 405.2± 240 cells/μL. In our study 88(24.4%) caregivers had moderate to severe burden and 36(10%) had very severe burden. Physical domain of QOL showed maximum score of 60.28±13.08, while a minimum score of 51.88 ± 14.20 was seen in social domain. With increase in caregiver burden, the mean QOL scores decreased which was statistically significant. CONCLUSION Our study highlights the need to counsel the caregivers on how to deal with PLWHA in the family. Family care plays a major role in the general wellbeing of PLWHA. Majority of national HIV programmes all over the world focus mainly on PLWHA. National programmes should immediately address the mental health issues of caregivers thereby reducing caregiver burden. More studies on this topic have to be conducted in developing countries.
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Affiliation(s)
- Vishnu Chandran
- Junior Resident, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Deepak Madi
- Associate Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Nithyananda Chowta
- Additional Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - John Ramapuram
- Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Unnikrishnan Bhaskaran
- Professor, Department of Community Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Basavaprabhu Achappa
- Associate Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Hyma Jose
- Junior Resident, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
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Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk. Food Secur 2016. [DOI: 10.1007/s12571-016-0561-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wada K, Smith DR, Ishimaru T. Reluctance to care for patients with HIV or hepatitis B / C in Japan. BMC Pregnancy Childbirth 2016; 16:31. [PMID: 26850002 PMCID: PMC4744415 DOI: 10.1186/s12884-016-0822-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/31/2016] [Indexed: 12/12/2022] Open
Abstract
Background Healthcare workers are faced with various professional dilemmas in the workplace, including at times, a reluctance to care for particular patients. This study investigated personal attitudes and factors influencing Japanese nurses’ reluctance to care for patients infected with HIV, Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV). Methods Participants completed an anonymous online survey focusing on potential attitudes towards hypothetical patients, awareness of infection risk and their confidence in using precautions to prevent infection. Statistical associations were analyzed using Poisson regression models. Results Regarding personal attitudes, 41 % and 18 % of nurses agreed or somewhat agreed that they would be reluctant to care for a hypothetical patient infected with HIV or HBV / HCV, respectively. Reluctance to care for patients with HIV or HBV / HCV was positively associated with prejudicial attitudes and negatively associated with confidence in personal safety precautions. Hypothetical reluctance to care for patients with HBV / HCV was negatively associated with actual previous experience caring for HBV / HCV patients. Older age among nurses (≥50 years) was positively associated with an increased reluctance to care for hypothetical patients with HIV. Conclusions Overall, this study suggests that anxiety arising from perceived infection risk and having a prejudicial attitude might affect the acceptance of infected patients, while personal confidence in universal precautions probably mitigates this situation. Improving nurses’ confidence in using universal precautions therefore represents a positive measure that can help reduce prejudice and improve the quality of healthcare services in Japan, as elsewhere. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0822-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koji Wada
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Derek R Smith
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia.
| | - Tomohiro Ishimaru
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand. .,Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Morton D, Mayekiso T, Cunningham P. Support for volunteer caregivers and its influence on the quality of community home-based care in the Eastern Cape, South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2015. [DOI: 10.1080/14330237.2015.1021509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- David Morton
- Department of Nursing Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Thoko Mayekiso
- Vice Chancellor's Office, University of Mpumalanga, Mbombela, South Africa
| | - Peter Cunningham
- Department of Sociology and Anthropology, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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Wu F, He X, Guida J, Xu Y, Liu H. Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study. Glob Public Health 2015; 10:1032-45. [PMID: 25642919 DOI: 10.1080/17441692.2014.1003572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.
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Affiliation(s)
- Fei Wu
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Xin He
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Jennifer Guida
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Yongfang Xu
- b Department of HIV/AIDS Control and Prevention , Nanning Center for Disease Control and Prevention , Nanning , China
| | - Hongjie Liu
- a Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
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Stigma in HIV-infected health care workers in Kenya: a mixed-method approach. J Assoc Nurses AIDS Care 2014; 26:639-51. [PMID: 25769752 DOI: 10.1016/j.jana.2014.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 12/22/2014] [Indexed: 11/23/2022]
Abstract
HIV-related stigma decreases access to HIV testing, prevention, and treatment services. Our mixed methods study explored stigma as perceived, experienced, and managed in a sample of 76 HIV-infected health care workers in Kisumu, Kenya. Stigma was quantitatively measured using the HIV/AIDS Stigma Instrument for People Living with AIDS (HASI-P). Overall, subjects experienced low stigma levels (mean = 7.88, SD = 12.90; range = 0-61), and none of the sociodemographic variables were predictive of stigma. Transcript analysis of 20 qualitative interviews revealed two negative themes (blame, lack of knowledge) and five positive themes (living positively, optimism, empathy, support, changes over time). Three themes emerged on reducing stigma (normalizing, empowerment, leading by example). Disclosure, access to treatment, stigma reduction training, workplace support groups, and awareness of an HIV workplace policy may have contributed to low stigma scores. Qualitative findings corroborated quantitative findings and corresponded to the six domains of the HASI-P.
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Kidman R, Thurman TR. Caregiver burden among adults caring for orphaned children in rural South Africa. VULNERABLE CHILDREN AND YOUTH STUDIES 2014; 9:234-246. [PMID: 24999368 PMCID: PMC4066884 DOI: 10.1080/17450128.2013.871379] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/28/2013] [Indexed: 06/01/2023]
Abstract
The AIDS epidemic has created an unprecedented number of orphans. While largely absorbed by extended family, this additional responsibility can weigh heavily on their caregivers. The concept of caregiver burden captures multiple dimensions of well-being (e.g., physical, social and psychological). Measuring the extent and determinants of caregiving burden can inform the design of programmes to ease the negative consequences of caregiving. This study uses the baseline data from a study assessing interventions for orphans and vulnerable adolescents in the Eastern Cape, South Africa. Orphan caregivers (n = 726) completed an adapted version of the 12-item Zarit Burden Interview. In addition to basic caregiver and household demographics, the survey also collected information on AIDS-related illness and recent deaths. Descriptive data are presented, followed by multivariate Poisson regression models to explore factors associated with caregiver burden. Approximately 40% of caregivers reported high levels of orphan caregiving burden. Feelings of stress and inadequacy concerning their care responsibilities as well as anger towards the child were common. Household food insecurity was the most important predictor of orphan caregiving burden (marginal effect = 7.82; p < 0.001 for those reporting severe hunger); income was also a significant determinant. When other AIDS impacts were added to the model, only the AIDS-related illness of the caregiver was significantly associated with burden (marginal effect = 3.77; p < 0.001). This study suggests that caregivers with economic vulnerability and those struggling with their own AIDS-related illness feel most overburdened. These findings are particularly relevant to service providers who must identify caregivers in need of immediate assistance and allocate limited resources effectively. To alleviate caregiver burden, programmes must foster greater economic security (e.g., by facilitating access to social grants or directly providing cash transfers) and coordinate services with home-based care programmes serving the chronically ill.
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Affiliation(s)
- Rachel Kidman
- Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Bam NE, Naidoo JR. Nurses experiences in palliative care of terminally-ill HIV patients in a level 1 district hospital. Curationis 2014; 37:1238. [PMID: 25685894 DOI: 10.4102/curationis.v37i1.1238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/24/2014] [Accepted: 05/22/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Whilst the discourse of palliative care in HIV management is largely documented and regarded as being an essential component, various authors have further argued that within the context of HIV care in sub-Saharan Africa, palliative care and exploration of the dimensions thereof is largely lacking. This article presents the lived experiences of nurses involved in palliative care, thus providing the perspective of nurses and the multi-faceted dimensions of the nature of caring inherent. OBJECTIVES This study explored the respondents' understanding of the concepts 'caring' and 'terminal patient' and described the experiences of nurses caring for terminally-ill patients with HIV and how these experiences influence the nature of care rendered. METHODS Qualitative research using Husserl's approach of phenomenology design underpinned the study and Giorgi's steps of analysis were used to make meaning of the data. RESULTS The concept 'caring' was experienced by the nurses as transforming the patients' quality of life through supportive care and hope for life. Palliative care made the nurses conscious of their own mortality, enabling them to be more sensitive, compassionate and dedicated to caring for their patients. The findings described the social networking that enabled nurses to collaborate with colleagues in the interdisciplinary teams and shared knowledge, skills and support within the palliative care team in order to optimise patient outcomes. CONCLUSION Nurses with prolonged involvement in caring for terminally-ill patients with HIV experienced helplessness and emotional stress. Recommendations based on the results are that training in psychological and holistic care of the patient, professional counselling and stress management services are needed to support the nurse in this context.
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Affiliation(s)
| | - Joanne R Naidoo
- School of Nursing and Public Health, University of KwaZulu-Natal.
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Kanamori M, Carter-Pokras O, Madhavan S, Feldman R, He X, Lee S. Orphan/vulnerable child caregiving moderates the association between women's autonomy and their BMI in three African countries. AIDS Care 2014; 26:1336-45. [PMID: 24888977 DOI: 10.1080/09540121.2014.921277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Enhancement of women's autonomy is a key factor for improving women's health and nutrition. With nearly 12 million orphan and vulnerable children (OVC) in Africa due to HIV/AIDS, the study of OVC primary caregivers' nutrition is fundamental. We investigated the association between married women's autonomy and their nutritional status; explored whether this relationship was modified by OVC primary caregiving; and analyzed whether decision-making autonomy mediated the association between household wealth and body mass index (BMI). This cross-sectional study used the data from Demographic Health Surveys collected during 2006-2007 from 20- to 49-year-old women in Namibia (n = 2633), Swaziland (n = 1395), and Zambia (n = 2920). Analyses included logistic regression, Sobel, and Goodman tests. Our results indicated that women's educational attainment increased the odds for being overweight (Swaziland and Zambia) and decreased the odds for being underweight (Namibia). In Zambia, having at least primary education increased the odds for being overweight only among child primary caregivers regardless of the OVC status of the child, and having autonomy for buying everyday household items increased the odds for being overweight only among OVC primary caregivers. Decision-making autonomy mediated the association between household wealth and OVC primary caregivers' BMI in Zambia (Z = 2.13, p value = 0.03). We concluded that depending on each country's contextual characteristics, having education can decrease the odds for being an underweight woman or increase the odds for being an overweight woman. Further studies should explore why in Namibia education has an effect on women's overweight status only among women who are caring for a child.
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Affiliation(s)
- Mariano Kanamori
- a Center for Research on U.S. Latino HIV/AIDS and Drug Abuse , Florida International University , Miami , FL , USA
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Liu H, Xu Y, Sun Y, Dumenci L. Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs). PLoS One 2014; 9:e92855. [PMID: 24658364 PMCID: PMC3962465 DOI: 10.1371/journal.pone.0092855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
| | - Yongfang Xu
- Department of HIV/AIDS Control, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yehuan Sun
- Department of Epidemiology, Anhui Medical University, Hefei, Anhui, China
| | - Levent Dumenci
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Models of delivering palliative and end-of-life care in sub-Saharan Africa: a narrative review of the evidence. Curr Opin Support Palliat Care 2014; 7:223-8. [PMID: 23572158 DOI: 10.1097/spc.0b013e328360f835] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This narrative review examines evidence for models of palliative and end-of-life (eol) care delivery in sub-Saharan Africa (SSA) since 2010. It highlights recent developments, on-going challenges and innovative approaches used to address obstacles to increased access to care. RECENT FINDINGS Electronic databases were searched for the literature published in English during the period 2010-2012 around broad thematic areas of palliative and eol care delivery models in SSA. Literature showed increased palliative and eol care service development, underpinned by advocacy work undertaken by regional and national palliative care associations. Despite this increase, care provision remains inadequately integrated in national public health agendas and systems. Consequently, it continues to be heavily reliant upon nongovernmental, community-based and home-based care (HBC) models. Efforts are, however, underway to integrate palliative care into national health systems, which should increase access to care. National policies and government financing will be important to sustain this integration. SUMMARY Although community and HBC programs remain primary models of palliative and eol care delivery in SSA, there is an urgent need to develop a public health approach that integrates care into national health systems to increase accessibility.
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Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. J Int AIDS Soc 2013; 16:18717. [PMID: 24242265 PMCID: PMC3833193 DOI: 10.7448/ias.16.3.18717] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/23/2013] [Accepted: 08/29/2013] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. METHODS This cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure. RESULTS High levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs "got what they deserved" (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions. CONCLUSIONS Stigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught.
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Akintola O, Hlengwa WM, Dageid W. Perceived stress and burnout among volunteer caregivers working in AIDS care in South Africa. J Adv Nurs 2013; 69:2738-49. [PMID: 23683176 DOI: 10.1111/jan.12166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Abstract
AIMS To conduct a quantitative investigation of stress and the relationship with burnout among AIDS care volunteers. BACKGROUND Volunteer caregivers experience stress that could lead to burnout. Yet, very few studies quantify stress and its relationship with burnout among AIDS care volunteers. DESIGN This study uses a cross-sectional, exploratory survey design. METHODS Face-to-face interviews were conducted with 126 volunteer caregivers working in 13 semi-rural communities (townships) in Durban, South Africa in April 2009. All participants were women, Christian and with low levels of education. A 22-item instrument was drawn from Pearlin et al.'s role overload and role captivity scales, Van Dyk's stress factor scale and the Maslach Burnout Inventory. RESULTS Most of the volunteers had moderate-to-high levels of stress. 'Role/work overload' 'lack of support' and 'overwhelming nature of the disease' explained most of the variance in stress. Volunteers' age and number of patients in their care were predictors of stress. Caring for only AIDS patients, lack of support, stress emanating from perceived stigma and lack of training; and the overwhelming nature of AIDS were predictors of burnout. CONCLUSION High levels of stress could negatively impact volunteers' health and well-being and on-the-job performance. Policy makers must develop and fund home-based care models that take into account the stressors associated with AIDS care, by reducing the work load, providing ongoing psychosocial support and recruiting nurses to assist volunteers. The small non-probability sample used in this study highlights the need to treat the findings with caution.
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Affiliation(s)
- Olagoke Akintola
- School of Applied Human Sciences, University of KwaZuluNatal, Durban, South Africa; Program in Policy Decision-making, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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Asuquo EF, Adejumo P, Etowa J, Adejumo A. Fear of HIV Susceptibility Influencing Burden of Care among Nurses in South-East Nigeria. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.33031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Managing and resisting stigma: a qualitative study among people living with HIV in South Africa. J Int AIDS Soc 2012; 15:17330. [PMID: 22905361 PMCID: PMC3494166 DOI: 10.7448/ias.15.2.17330] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Living with HIV is of daily concern for many South Africans and poses challenges including adapting to a chronic illness and continuing to achieve and meet social expectations. This study explored experiences of being HIV-positive and how people manage stigma in their daily social interactions. METHODS Using qualitative methods we did repeat interviewed with 42 HIV-positive men and women in Cape Town and Mthatha resulting in 71 interviews. RESULTS HIV was ubiquitous in our informants' lives, and almost all participants reported fear of stigma (perceived stigma), but this fear did not disrupt them completely. The most common stigma experiences were gossips and insults where HIV status was used as a tool, but these were often resisted. Many feared the possibility of stigma, but very few had experiences that resulted in discrimination or loss of social status. Stigma experiences were intertwined with other daily conflicts and together created tensions, particularly in gender relations, which interfered with attempts to regain normality. Evidence of support and resistance to stigma was common, and most encouraging was the evidence of how structural interventions such as de-stigmatizing policies impacted on experiences and transference into active resistance. CONCLUSIONS The study showed the complex and shifting nature of stigma experiences. These differences must be considered when we intensify stigma reduction with context- and gender-specific strategies focussing on those not yet on ARV programmes.
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