Is HIV/AIDS a consequence or divine judgment? Implications for faith-based social services. A Nigerian faith-based university's study

Blueprint for Future Research Advancing the Study of Sexuality, Gender, and Equity in Later Life: Lessons Learned From Aging With Pride, The National Health, Aging, and Sexuality/Gender Study (NHAS)

While interest in sexuality\research is growing, in the past, it has been largely invisible in gerontology. By exploring the full range and dimensions of sexuality and their interrelationships with multiple factors, this article presents conceptual, substantive, and methodological advances for the field of sexuality in later life. Based on the Sexual Equity Framework, an extension of the Health Equity Promotion Model, this article highlights the heterogeneity and intersectionality of sexuality across the life course, examining how historical and contemporary contexts frame key dimensions of sexuality at multiple levels (intrapersonal, interpersonal, sociocultural, and structural) and their relationship with sexual quality of life. Utilizing findings from Aging with Pride: National Health, Aging and Sexuality/Gender Study, the heterogeneity and intersectionality of age, gender, race, and ethnicity are critical to understanding sexuality and its dimensions in later life. Many adults experience changes in sexual and gender identities over time. Affirming sexual and gender identities, social connections, and health-promoting behaviors are positively associated with sexual quality of life, while sexual stigma and marginalization have adverse consequences. The study of sexuality needs to be fully integrated into gerontology. The Sexual Equity Framework explicates the potential deleterious effect of historical and contemporary structures on sexuality as well the important roles of affirmation, agency, and resilience among older adults, and recognizes the important role of human rights to advance sexual quality of life. Important directions for future research, practices, and policies are outlined.

Exploring Spiritual and Religious Coping Among PLHIV in a Malaysian Muslim Community: A Qualitative Study

Purpose

Increase in life expectancy of PLHIV has brought new challenges especially for young Malay Muslim men who have sex with men (MSM) in Malaysia. This country has strong religious and cultural roots that may pose as additional stigma and discrimination in the lives of PLHIV. Therefore, coping skills among PLHIV is important. Theories on coping strategies has shown that spiritual and religion are one aspect of emotional focused coping. The aim of this study is to explore the views on spiritual and religious (S/R) coping among Malay Muslim MSMs.

Patients and Methods

This was a qualitative study using in-depth interview. Eligible participants were recruited using purposive and snowballing sampling techniques via NGOs and online flyers. The narrative inquiry approach was used to understand the lived experiences of PLHIV and their coping strategies, particularly using S/R coping. The interviews were transcribed verbatim and analysed using Qualitative Data Analysis (QDA) Miner. The data was analysed using thematic analysis.

Results

Interviews with seven participants yielded four themes. Ambivalence towards religion was experienced by participants at some point following their diagnosis. Using S/R as a form of self-reflection was identified. Having positive religious support from family or NGOs helped some participants to embrace religious coping rather than to avoid it, and relationship with God was an important aspect of religious coping.

Conclusion

Spirituality and religiosity can be a form of positive coping for PLHIV. This study suggests the need for S/R guidance as well as positive support from healthcare professionals and religious-based organizations for PLHIV. This can have positive effects towards handling of the condition, adherence to treatment and health outcomes.

Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM (N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate (OR = 1.63, p < .01), vicarious HIV stigma (OR = 2.73, p < .01), and age (OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC (OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

Models of Disability as Models of First Contact

Because humanity is a young technological species, any extraterrestrials we meet will inevitably be more advanced than we are. The realization that we are no longer dominant in our sphere of influence will inevitably cause spiritual cultural and even economic trauma as we come to terms with the new reality. The question we should endeavor to answer before this happens is: what direction will this trauma take and how can we prepare in advance to minimize harm as we adjust to this? Disability studies offer several models of how one advantaged group understands and interacts with a less advantaged group. These include the medical, social, moral/religious, economic, charity, and limits models, and each lays out a unique way of understanding situations where one group has a strong perceived or real advantage over another. Exploring these models can give us a sense of the possible variation that might occur upon first contact. Such an exploration is relevant both to how ET might perceive us and how we might begin to conceptualize ourselves in that new situation. As with most seemingly theoretical forays into astrobiology, this work has implications for the present as it interrogates how disabled and abled humans interact and negotiate power and how we understand one another.

Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania

INTRODUCTION

Mental health disorders in pregnant women living with HIV are associated with poor maternal and child outcomes, and undermine the global goals of prevention of mother-to-child transmission of HIV (PMTCT). This study aimed to determine prevalence of depression and anxiety and identify factors associated with these common mental health disorders among HIV-infeced pregnant women in Tanzania.

METHODS

We enrolled 200 pregnant women living with HIV from antenatal care clinics in the Kilimanjaro region. Women were eligible if they were in the second or third trimester of pregnancy and had been in PMTCT care for a minimum of one month. Data were collected via interviewer administered surveys. Participants self reported depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and anxiety symptoms (Brief Symptom Index, BSI). Multivariate logistic regression models examined factors associated with depression, anxiety, and comorbid depression and anxiety.

RESULTS

25.0% of women met screening criteria for depression (EPDS ≥10). Depression was significantly associated with being single (aOR = 4.2, 95% CI = 1.1-15.5), food insecurity (aOR = 2.4, 95% CI = 1.0-6.4), and HIV shame (aOR = 1.2, 95% CI = 1.1-1.3). 23.5% of participants met screening criteria for anxiety (BSI ≥1.01). Anxiety was associated with being single (aOR = 3.6, 95%CI = 1.1-11.1), HIV shame (aOR = 1.1, 95% CI = 1.1-1.2) and lifetime experience of violence (aOR = 2.3, 95% CI = 1.0-5.1). 17.8% of the sample met screening criteria for both depression and anxiety. Comorbid depression and anxiety was associated with being single (aOR = 4.5, 95%CI = 1.0-19.1), HIV shame (aOR = 1.2, 95%CI = 1.1-1.3) and lifetime experience of violence (aOR = 3.4, 95% CI = 1.2-9.6).

CONCLUSION

Depression and anxiety symptomatology was common in this sample of pregnant women living with HIV, with a sizable number screening positive for comorbid depression and anxiety. In order to successfully engage women in PMTCT care and support their well-being, strategies to screen for mental health disorders and support women with mental illnesses are needed.

Towards an integrated approach to health and medicine in Africa

This article frames the intersections of medicine and humanities as intrinsic to understanding the practice of health care in Africa. Central to this manuscript, which draws on empirical findings on the interplay between HIV and AIDS and alternative medicine in Zimbabwe is the realisation that very limited research has been undertaken to examine ‘HIV/AIDS patient behaviour’ with respect to choice of therapy on the continent [Bene, M. & Darkoh, M. B. K. (2014). The Constraints of Antiretroviral Uptake in Rural Areas: The Case of Thamaga and Surrounding Villages, Botswana. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 11(1), 167–177. doi:10.1080/17290376.2014.972057; Chavunduka, G. (1998). Professionalisation of Traditional Medicine in Zimbabwe, Harare, Jongwe Printers; O’Brien, S. & Broom, A. (2014). HIV in (and out of) the Clinic: Biomedicine, Traditional Medicine and Spiritual Healing in Harare. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 11(1), 94–104. doi:10.1080/17290376.2014.938102]. As such, a social approach to health-seeking behaviour questions how decisions about alternative therapies including herbal remedies, traditional healing and faith healing are made. The paper unpacks the realities around how people living with HIV and AIDS – who span different age groups and profess various religious backgrounds, faced with an insurmountable health challenge against a background of limited resources and no cure for the virus – often experience shifts in health-seeking behaviour. Grappling with seemingly simple questions about ‘when, where and how to seek medical attention’, the paper provides pointers to therapy choices and health-seeking behaviour; and it serves as a route into deeper and intense healthcare practice explorations. In conclusion, the paper proposes that medicine and the humanities should engage seriously with those social aspects of HIV and AIDS which call for an integrated approach to healthcare practice in Africa. If combined, medicine and the humanities might achieve what neither would alone.

Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study

BACKGROUND

Zimbabwe's Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known.

METHODS

A qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10.

RESULTS

Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART.

CONCLUSIONS

This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the importance of male partner and community support in satisfactory adherence to ART and enhancing counseling techniques. Strengthening community sensitization and male knowledge is critical to encourage women to disclose their HIV status and ensure successful adherence to ART. Targeting and engaging partners of women will remain key determinants to women's acceptance and adherence on ART under Option B+.