1
|
Varshney K, Chu MG, Shet P, Hopkins J, Braga F, Ghosh P. Health and social consequences for survivors of genocidal rape: A systematic scoping review. J Trauma Stress 2023; 36:691-699. [PMID: 37246151 DOI: 10.1002/jts.22936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/30/2023]
Abstract
The unique forms of trauma experienced by survivors of genocidal rape are not well understood. Hence, we conducted a systematic scoping review regarding the consequences for survivors of rape during genocide. Searches conducted in PubMed, Global Health, Scopus, PyscInfo, and Embase produced a total of 783 articles. After completing the screening process, 34 articles were eligible for inclusion in the review. The included articles focus on survivors from six different genocides, with most focusing on either the genocide of the Tutsis in Rwanda or the Yazidis in Iraq. The study findings consistently show that survivors deal with stigmatization as well as a lack of both financial and psychological social support. This lack of support is partly due to social ostracization and shame but is also attributed to the fact that many survivors' families and other providers of social support were murdered during the violence. Many survivors, particularly young girls, reported dealing with intense forms of trauma both as a direct result of sexual violence and due to witnessing the death of their community members during the period of genocide. A notable proportion of survivors became pregnant from genocidal rape and contracted HIV. Group therapy was shown to improve mental health outcomes across numerous studies. These findings have important implications and can inform recovery process efforts. Psychosocial supports, stigma reduction campaigns, community reestablishment, and financial assistance are integral in facilitating recovery. These findings can also play an important role in shaping refugee support programs.
Collapse
Affiliation(s)
- Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Minh Giao Chu
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Pavan Shet
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | | | - Francesca Braga
- Permanent Mission of the Republic of San Marino, United Nations
| | - Prerana Ghosh
- School of Medicine, Deakin University, Waurn Ponds, Australia
| |
Collapse
|
2
|
Mukamana D, Gishoma D, Holt L, Kayiranga D, Na JJ, White R, Nyblade L, Knettel BA, Agasaro C, Relf MV. Dehumanizing language, motherhood in the context of HIV, and overcoming HIV stigma - the voices of Rwandan women with HIV: A focus group study. Int J Nurs Stud 2022; 135:104339. [PMID: 36088732 DOI: 10.1016/j.ijnurstu.2022.104339] [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: 10/21/2021] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stigma is an underlying cause of health inequities, and a major barrier to HIV prevention, care, and treatment. Experiences of HIV stigma have been shown to reduce engagement in care across the HIV care continuum, from testing and diagnosis to long-term retention in care and anti-retroviral therapy adherence. In Rwanda, approximately 130,000 women are living with HIV, representing a prevalence rate (3.7%) which is substantially higher than Rwandan men (2.2%). Both the national Rwanda and City of Kigali HIV and AIDS strategic plans identify stigma as a key concern for reducing the burden of HIV. OBJECTIVES The first objective of this study was to understand the sources of HIV-related stigma among women living with HIV in Rwanda. The second objective was to understand the cultural, linguistic, and contextual context of HIV-related stigma and the intersection of HIV-related stigma to the HIV care continuum (engagement in care, medication/treatment adherence) among women with HIV in Rwanda. DESIGN This study used a cross-sectional, qualitative design. SETTING AND PARTICIPANTS Three-three women from urban and rural settings in Rwanda were recruited from public HIV treatment and care centers to participate in this study. METHOD Focus groups discussions, guided by a structured interview guide, were used to collect qualitative data. Framework analysis was used to analyze the data, which was collected during July 2018. RESULTS The participants in this study highlighted that Rwandan women with HIV experience all forms of stigma - enacted, anticipated, perceived, and internalized - associated with HIV as well as structural stigma. Further, three major themes - dehumanizing language, importance of motherhood in the context of HIV, and overcoming HIV stigma - emerged from the data. CONCLUSION The results of this study are among the few to give voice and perspective to the stigma experiences of Rwandan women with HIV. The women with HIV participating in this study shed light on the pervasive and culturally constructed effects of stigma that continue to exist. Further, the findings from this study highlighted the significant intersection of the role dehumanizing language experienced by Rwandan women with HIV. Additionally, the intersectional identities of being a woman with HIV and a mother and their relationship to societal and cultural norms and expectations must be considered concurrently. Finally, the beneficial effects of support groups was identified as key in helping Rwandan women with HIV to accept self.
Collapse
Affiliation(s)
- Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda
| | - Darius Gishoma
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda; University Teaching Hospital of Kigali, KN 4 Ave, Kigali, Rwanda
| | - Lauren Holt
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA
| | - Dieudonne Kayiranga
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda
| | - Jieun Julia Na
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA
| | - Rebecca White
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda; University of Illinois Chicago, College of Nursing, 845 S. Damen Ave, Chicago 60612, IL, USA
| | - Laura Nyblade
- RTI International, 701 13th Street NW, Suite 750, Washington 20005-3967, DC, USA
| | - Brandon A Knettel
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA; Duke Global Health Institute, Duke University, 3110 Trent Drive, 27710, NC, USA
| | - Charity Agasaro
- Duke University, 2080 Duke University Road, Durham 27708, NC, USA
| | - Michael V Relf
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA; Duke Global Health Institute, Duke University, 3110 Trent Drive, 27710, NC, USA.
| |
Collapse
|
3
|
Examining the Linkage Between Social Support and Gender-Based Violence Among Women and Girls in Humanitarian Settings: a Systematic Review of the Evidence. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
4
|
Advancing and translating knowledge: a systematic inquiry into the 2010-2020 mental health and psychosocial support intervention research evidence base. Glob Ment Health (Camb) 2022; 9:133-145. [PMID: 36618729 PMCID: PMC9806978 DOI: 10.1017/gmh.2022.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND STUDY OBJECTIVES MHPSS is increasingly seen as a critical component to effective and responsible humanitarian programming. This review examines the extent to which MHPSS research generated since 2010 has contributed to the public health evidence base and how this has influenced and impacted programming and policy in humanitarian settings. METHODS This mixed-method study included a scoping literature review (n = 50) and a consultation process with qualitative key informant interviews (n = 19) and online survey responses (n = 52) to identify the facilitating and inhibiting factors for the two areas of inquiry and to understand the broader context in which knowledge is generated and taken up. The interviews were thematically analysed and the survey responses were descriptively analysed. RESULTS The review identified a rapidly growing evidence base that has evaluated a range of MHPSS interventions. However, few studies examined long-term impacts of interventions, there was limited direct evidence on outcomes for children and adolescents and whole family approaches, and there were minimal replications of the same approach that could test efficacy across settings and population groups. A general shift was identified in the consultation process away from a focus on disorder towards the more positive aspects of wellbeing. However, there remained a mismatch in many studies included in the literature review, whereby the interventions were broad, community-based but the outcome measures used still focused on changes in symptoms of mental disorders. CONCLUSION The evidence base for MHPSS has grown significantly over the last 10 years. However, several knowledge gaps remain, as does the divide between research and practice. Moving forward, MHPSS intervention research needs to be more responsive to the needs on the ground.
Collapse
|
5
|
Ireland H, Tran NT, Dawson A. The role of social capital in women's sexual and reproductive health and rights in humanitarian settings: a systematic review of qualitative studies. Confl Health 2021; 15:87. [PMID: 34819110 PMCID: PMC8611620 DOI: 10.1186/s13031-021-00421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Social capital is an important social determinant of women's sexual and reproductive health and rights. Little research has been conducted to understand the role of social capital in women's sexual and reproductive health and how this can be harnessed to improve health in humanitarian settings. We synthesised the evidence to examine the nexus of women's sexual and reproductive health and rights and social capital in humanitarian contexts. METHODS We undertook a systematic review of qualitative studies. The preferred reporting items for systematic review and meta-analysis guidelines were used to identify peer-reviewed, qualitative studies conducted in humanitarian settings published since 1999. We searched CINAHL, MEDLINE, ProQuest Health & Medicine, PubMed, Embase and Web of science core collection and assessed quality using the Critical Appraisal Skills Programme tool. We used a meta-ethnographic approach to synthesise and analyse the data. FINDINGS Of 6749 initially identified studies, we included 19 studies, of which 18 were in conflict-related humanitarian settings and one in a natural disaster setting. The analysis revealed that the main form of social capital available to women was bonding social capital or strong links between people within groups of similar characteristics. There was limited use of bridging social capital, consisting of weaker connections between people of approximately equal status and power but with different characteristics. The primary social capital mechanisms that played a role in women's sexual and reproductive health and rights were social support, informal social control and collective action. Depending on the nature of the values, norms and traditions shared by network members, these social capital mechanisms had the potential to both facilitate and hinder positive health outcomes for women. CONCLUSIONS These findings demonstrate the importance of understanding social capital in planning sexual and reproductive health responses in humanitarian settings. The analysis highlights the need to investigate social capital from an individual perspective to expose the intra-network dynamics that shape women's experiences. Insights could help inform community-based preparedness and response programs aimed at improving the demand for and access to quality sexual and reproductive health services in humanitarian settings.
Collapse
Affiliation(s)
- Hannah Ireland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| |
Collapse
|
6
|
Garcia M, Luecke E, Mayo AJ, Scheckter R, Ndase P, Kiweewa FM, Kemigisha D, Musara P, Mansoor LE, Singh N, Woeber K, Morar NS, Jeenarain N, Gaffoor Z, Gondwe DK, Makala Y, Fleurs L, Reddy K, Palanee-Phillips T, Baeten JM, van der Straten A, Soto-Torres L, Torjesen K. Impact and experience of participant engagement activities in supporting dapivirine ring use among participants enrolled in the phase III MTN-020/ASPIRE study. BMC Public Health 2021; 21:2041. [PMID: 34749675 PMCID: PMC8576984 DOI: 10.1186/s12889-021-11919-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low adherence to investigational products can negatively impact study outcomes, limiting the ability to demonstrate efficacy. To continue advancing potential new HIV prevention technologies, efforts are needed to improve adherence among study participants. In MTN-020/ASPIRE, a phase III randomized, double-blind, placebo-controlled study of the dapivirine vaginal ring carried out across 15 sites in sub-Saharan Africa, a multifaceted approach to adherence support was implemented, including a strong focus on participant engagement activities (PEAs). In this manuscript, we describe PEAs and participant attendance, and analyze the potential impact of PEAs on ring use. METHODS All sites implemented PEAs and submitted activity and attendance reports to the study management team throughout the study. Participant demographics were collected via case report forms. Residual dapivirine remaining in the last ring returned by each participant was used to estimate drug released from the ring, which was then adjusted for time participants had the ring to calculate probable use categorized into three levels (low/intermittent/high). Product use was connected to PEA attendance using participant identification numbers. We used multivariate Poisson regression with robust standard errors to explore differences in ring use between PEA attendance groups and reviewed qualitative reports for illustrative quotes highlighting participant experiences with PEAs. RESULTS 2312 of 2629 study participants attended at least one of 389 PEAs conducted across sites. Participant country and partner knowledge of study participation were most strongly associated with PEA attendance (p < 0.005) with age, education, and income status also associated with event attendance (p < 0.05). When controlling for these variables, participants who attended at least one event were more likely to return a last ring showing at least some use (RR = 1.40) than those who never attended an event. There was a stronger correlation between a last returned ring showing use and participant attendance at multiple events (RR = 1.52). CONCLUSIONS Our analysis supports the growing body of work illustrating the importance of meaningfully engaging research participants to achieve study success and aligns with other analyses of adherence support efforts during ASPIRE. While causation between PEA attendance and product use cannot be established, residual drug levels in returned rings strongly correlated with participant attendance at PEAs, and the benefits of incorporating PEAs should be considered when designing future studies of investigational products.
Collapse
Affiliation(s)
- Morgan Garcia
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA.
| | - Ellen Luecke
- Women's Global Health Imperative (WGHI) RTI International, Berkeley, CA, USA; ASTRA Consulting, Kensington, CA, USA
| | - Ashley J Mayo
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA
| | - Rachel Scheckter
- Global Health Population and Nutrition, FHI, Durham, NC, 360, USA
| | - Patrick Ndase
- Population Services International (PSI), 1120 19th St. NW, Washington, DC, USA
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Doreen Kemigisha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Petina Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre, Harare, Zimbabwe
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Nishanta Singh
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kubashni Woeber
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Neetha S Morar
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Nitesha Jeenarain
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Zakir Gaffoor
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Daniel K Gondwe
- College of Medicine - Johns Hopkins Bloomberg School of Public Health, Blantyre, Malawi
| | - Yvonne Makala
- University of North Carolina Project, Lilongwe, Malawi
| | - Llewellyn Fleurs
- Desmond Tutu HIV Foundation, Emavundleni Clinical Research Site, Cape Town, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared M Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Ariane van der Straten
- Women's Global Health Imperative (WGHI) RTI International, Berkeley, CA, USA; ASTRA Consulting, Kensington, CA, USA.,Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, CA, USA
| | - Lydia Soto-Torres
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | |
Collapse
|
7
|
Elias L, Singh A, Burgess RA. In search of 'community': a critical review of community mental health services for women in African settings. Health Policy Plan 2021; 36:205-217. [PMID: 33543248 DOI: 10.1093/heapol/czaa140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.
Collapse
Affiliation(s)
- Lauren Elias
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Aneeha Singh
- International Research and Exchanges Board (South & South East Asia Centre), 1275 K Street, NW, Suite 600 Washington, DC 20005, USA
| | - Rochelle A Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Research Associate, Department of Social Work, University of Johannesburg, South Africa
| |
Collapse
|
8
|
Enane LA, Apondi E, Omollo M, Toromo JJ, Bakari S, Aluoch J, Morris C, Kantor R, Braitstein P, Fortenberry JD, Nyandiko WM, Wools‐Kaloustian K, Elul B, Vreeman RC. "I just keep quiet about it and act as if everything is alright" - The cascade from trauma to disengagement among adolescents living with HIV in western Kenya. J Int AIDS Soc 2021; 24:e25695. [PMID: 33838007 PMCID: PMC8035676 DOI: 10.1002/jia2.25695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There are approximately 1.7 million adolescents living with HIV (ALHIV, ages 10 to 19) globally, including 110,000 in Kenya. While ALHIV experience poor retention in care, limited data exist on factors underlying disengagement. We investigated the burden of trauma among disengaged ALHIV in western Kenya, and its potential role in HIV care disengagement. METHODS We performed in-depth qualitative interviews with ALHIV who had disengaged from care at two sites, their caregivers and healthcare workers (HCW) at 10 sites, from 2018 to 2020. Disengagement was defined as not attending clinic ≥60 days past a missed scheduled visit. ALHIV and their caregivers were traced through phone calls and home visits. Interviews ascertained barriers and facilitators to adolescent retention in HIV care. Dedicated questions elicited narratives surrounding traumatic experiences, and the ways in which these did or did not impact retention in care. Through thematic analysis, a conceptual model emerged for a cascade from adolescent experience of trauma to disengagement from HIV care. RESULTS Interviews were conducted with 42 disengaged ALHIV, 34 caregivers and 28 HCW. ALHIV experienced a high burden of trauma from a range of stressors, including experiences at HIV disclosure or diagnosis, the loss of parents, enacted stigma and physical or sexual violence. A confluence of factors - trauma, stigma and isolation, and lack of social support - led to hopelessness and depression. These factors compounded each other, and resulted in complex mental health burdens, poor antiretroviral adherence and care disengagement. HCW approaches aligned with the factors in this model, suggesting that these areas represent targets for intervention and provision of trauma-informed care. CONCLUSIONS Trauma is a major factor underlying disengagement from HIV care among Kenyan adolescents. We describe a cascade of factors representing areas for intervention to support mental health and retention in HIV care. These include not only the provision of mental healthcare, but also preventing or addressing violence, trauma and stigma, and reinforcing social and familial support surrounding vulnerable adolescents. In this conceptualization, supporting retention in HIV care requires a trauma-informed approach, both in the individualized care of ALHIV and in the development of strategies and policies to support adolescent health outcomes.
Collapse
Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Moi Teaching and Referral HospitalEldoretKenya
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Clemette Morris
- Indiana University‐Purdue University‐IndianapolisIndiana UniversityIndianapolisINUSA
| | - Rami Kantor
- Division of Infectious DiseasesDepartment of MedicineBrown University Apert Medical SchoolProvidenceRIUSA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of EpidemiologyIndiana University Fairbanks School of Public HealthIndianapolisINUSA
- Dalla Lana School of Public HealthDivision of EpidemiologyUniversity of TorontoTorontoONCanada
- Department of MedicineCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - J Dennis Fortenberry
- Division of Adolescent MedicineDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of Child Health and PediatricsCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - Kara Wools‐Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Batya Elul
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
- Department of Health System Design and Global HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Arnhold Institute for Global HealthNew YorkNYUSA
| |
Collapse
|
9
|
A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study. Glob Ment Health (Camb) 2021; 8:e17. [PMID: 34104457 PMCID: PMC8157815 DOI: 10.1017/gmh.2021.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/05/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adolescents living with HIV (ALWH) are disproportionally impacted by depression, experiencing worse HIV outcomes. Integrated depression and HIV care may support antiretroviral adherence. This study pilot tested for proof of concept a basic depression care pathway for ALWH to inform depression care integration with HIV services in Peru. METHODS ALWH were screened for depression with the Patient Health Questionnaire-9 (PHQ-9). Participants with PHQ-9 scores of ⩾10 or suicidal ideation (SI) were eligible for Psychological First Aid (PFA) delivered by non-mental health specialists. Participants with PHQ-9 re-assessments of ⩾20 or SI were referred to specialized services. RESULTS Twenty-eight (11 female, 17 male) ALWH aged 15-21 years participated; n = 20 (71%) identified as heterosexual. Most (18/28) acquired HIV at birth. Baseline PHQ-9 scores were 0-4, n = 3 (11%); 5-9, n = 9 (32%); 10-14, n = 10 (36%); 15-19, n = 4 (14%); and 20-27, n = 2 (7%). Eleven participants (40%) reported SI. Among participants with PHQ-9 > 4, 92% (23/25) were not severe. Of the 21 (75%) of participants eligible for PFA, n = 9 (32%) accepted at least one session, of which n = 3 (33%) were linked to specialized care. CONCLUSIONS A simple care pathway operationalizing depression screening and non-specialist delivered emotional support is a first step toward integrated depression and HIV care for ALWH.
Collapse
|
10
|
Kiss L, Quinlan-Davidson M, Pasquero L, Tejero PO, Hogg C, Theis J, Park A, Zimmerman C, Hossain M. Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries. Confl Health 2020; 14:11. [PMID: 32127913 PMCID: PMC7045597 DOI: 10.1186/s13031-020-0254-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.
Collapse
Affiliation(s)
- Ligia Kiss
- 1Institute for Global Health, University College London, London, UK
| | | | | | - Patricia Ollé Tejero
- All Survivors Project, Vaduz, Liechtenstein.,3London School of Economics, London, UK
| | - Charu Hogg
- All Survivors Project, Vaduz, Liechtenstein
| | | | | | - Cathy Zimmerman
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- 6Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,7Centre for Women, Peace and Security, London School of Economics, London, UK
| |
Collapse
|
11
|
Kun KE, Couto A, Jobarteh K, Zulliger R, Pedro E, Malimane I, Auld A, Meldonian M. Mozambique's Community Antiretroviral Therapy Support Group Program: The Role of Social Relationships in Facilitating HIV/AIDS Treatment Retention. AIDS Behav 2019; 23:2477-2485. [PMID: 30771134 DOI: 10.1007/s10461-019-02419-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Community Antiretroviral (ARV) Therapy Support Group (CASG) program aims to address low retention rates in Mozambique's HIV treatment program and the absorptive capacity of the country's health facilities. CASG provides patients with the opportunity to form groups, whose members provide peer support and collect ARV medications on a rotating basis for one another. Based on the promising results in one province, a multi-site level evaluation followed. We report on qualitative findings from this evaluation from the patient perspective on the role of social relationships (as facilitated through CASG) in conferring time, financial, educational and psychosocial benefits that contribute to improved patient retention. These findings may be helpful in informing what aspects of social relationships are critical to foster as CASG is implemented within a greater number of Mozambican health facilities, and as other countries design and implement related models of care and treatment with a support group component.
Collapse
Affiliation(s)
- Karen E Kun
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E30, Atlanta, GA, 30333, USA.
| | - Aleny Couto
- HIV Program, Mozambique Ministry of Health, Maputo, Mozambique
| | | | - Rose Zulliger
- Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Inacio Malimane
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Andrew Auld
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | |
Collapse
|
12
|
Gailits N, Mathias K, Nouvet E, Pillai P, Schwartz L. Women's freedom of movement and participation in psychosocial support groups: qualitative study in northern India. BMC Public Health 2019; 19:725. [PMID: 31182064 PMCID: PMC6558745 DOI: 10.1186/s12889-019-7019-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. METHODS This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. RESULTS The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. CONCLUSIONS Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.
Collapse
Affiliation(s)
- Nicola Gailits
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada.
| | - Kaaren Mathias
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Elysée Nouvet
- School of Health Studies, Western University, Labatt Health Sciences Bldg, Rm 215. 1151 Richmond St., London, ON, N6A 5B9, Canada
| | - Pooja Pillai
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| |
Collapse
|
13
|
Indashyikirwa Women’s Safe Spaces: Informal Response for Survivors of IPV within a Rwandan Prevention Programme. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8030076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Within intimate partner violence (IPV) prevention programmes that raise awareness of women’s rights and the forms and consequences of IPV, there is a need to ensure response mechanisms for IPV survivors. Indashyikirwa is a Rwandan IPV prevention programme, which established 14 women’s safe spaces, whereby men and women could access support for IPV, be referred or accompanied to other services. This paper draws on qualitative interviews with safe space facilitators, attendees, staff and observations of activities at various points across the programme. Thematic analysis was conducted to assess the process and impact of the spaces. Attendees generally preferred the women’s safe spaces over formal services for IPV disclosure and support, and the spaces also enhanced the quality of and linkage to formal IPV response services. The safe spaces further supported well-being and economic empowerment of attendees. Lessons learned from implementing this model are offered, including how to ensure safe, inclusive and integrated sources of support within broader IPV prevention efforts.
Collapse
|
14
|
Implementation science for integration of HIV and non-communicable disease services in sub-Saharan Africa: a systematic review. AIDS 2018; 32 Suppl 1:S93-S105. [PMID: 29952795 DOI: 10.1097/qad.0000000000001897] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE As the burden of chronic non-communicable diseases (NCDs) rises across sub-Saharan Africa (SSA), global donors and governments are exploring strategies to integrate HIV and NCD care. Implementation science is an emerging research paradigm that can help such programs achieve health impact at scale. We define implementation science as a systematic, scientific approach to ask and answer questions about how to deliver what works in populations who need it with greater speed, appropriate fidelity, efficiency, and relevant coverage. We identified achievements and gaps in the application of implementation science to HIV/NCD integration, developed an HIV/NCD implementation science research agenda, and detailed opportunities for capacity building and training. DESIGN We conducted a systematic review of the application of implementation science methods to integrated HIV/NCD programs in SSA. METHODS We searched PubMed, CINAHL, PsycINFO, and EMBASE for evaluations of integrated programs in SSA reporting at least one implementation outcome. RESULTS We identified 31 eligible studies. We found that most studies used only qualitative, economic, or impact evaluation methods. Only one study used a theoretical framework for implementation science. Acceptability, feasibility, and penetration were the most frequently reported implementation outcomes. Adoption, appropriateness, cost, and fidelity were rare; sustainability was not evaluated. CONCLUSIONS Implementation science has a promising role in supporting HIV/NCD integration, although its impact will be limited unless theoretical frameworks, rigorous study designs, and reliable measures are employed. To help support use of implementation science, we need to build sustainable implementation science capacity. Doing so in SSA and supporting implementation science investigators can help expedite HIV/NCD integration.
Collapse
|
15
|
Koegler E, Kennedy C, Mrindi J, Bachunguye R, Winch P, Ramazani P, Makambo MT, Glass N. Understanding How Solidarity Groups-A Community-Based Economic and Psychosocial Support Intervention-Can Affect Mental Health for Survivors of Conflict-Related Sexual Violence in Democratic Republic of the Congo. Violence Against Women 2018; 25:359-374. [PMID: 29911487 DOI: 10.1177/1077801218778378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Solidarity groups were established in eastern Democratic Republic of Congo to provide female survivors of conflict-related sexual violence an opportunity to generate income, establish networks of support, and cope with atrocities. Qualitative data were collected from 12 members of solidarity groups to explore factors that contributed to members' mental health. All women identified some improvement (physiological, psychological, economic, or social) since joining the solidarity group, but none of the women were free from ailments. Our findings suggest that a multifaceted intervention in women's own communities has the potential to improve multiple aspects of women's lives, including mental health.
Collapse
Affiliation(s)
- Erica Koegler
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 University of Missouri, Columbia, USA
| | | | - Janvier Mrindi
- 3 Foundation RamaLevina, Bukavu, Democratic Republic of the Congo
| | | | - Peter Winch
- 1 Johns Hopkins University, Baltimore, MD, USA
| | - Paul Ramazani
- 3 Foundation RamaLevina, Bukavu, Democratic Republic of the Congo
| | | | - Nancy Glass
- 1 Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
16
|
Yi S, Tuot S, Chhim S, Chhoun P, Mun P, Mburu G. Exposure to gender-based violence and depressive symptoms among transgender women in Cambodia: findings from the National Integrated Biological and Behavioral Survey 2016. Int J Ment Health Syst 2018; 12:24. [PMID: 29853990 PMCID: PMC5975411 DOI: 10.1186/s13033-018-0206-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background Transgender women are at significant risk of HIV, and they face intersecting barriers to health, social, and legal services. However, data regarding the unique needs and experiences of transgender women are globally scant. This study examined the relationship between gender-based violence and depressive symptoms among transgender women in Cambodia. Methods This cross-sectional study included 1375 sexually active transgender women recruited by using the respondent-driven sampling method in the capital city of Phnom Penh and 12 provinces between December 2015 and February 2016. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Multivariate regression analysis was conducted to explore factors independently associated with depressive symptoms. Results Of total, 45.0% of the participants had depressive symptoms, and 21.8% had severe depressive symptoms. After controlling for potential confounders, transgender women with depressive symptoms remained significantly more likely to report several negative experiences of gender-based violence such as a feeling that co-workers or classmates were not supportive regarding their transgender identity (AOR = 2.00, 95% CI = 1.22-3.28), having difficulties in getting a job (AOR = 1.67, 95% CI = 1.29-2.16), having been denied or thrown out of housing (AOR = 1.53, 95% CI = 1.02-2.26), having difficulties in getting health services (AOR = 2.40, 95% CI = 1.50-3.82), having been physically abused (AOR = 1.54, 95% CI = 1.15-2.08), and having been fearful of being arrested by police or authorities (AOR = 2.18, 95% CI = 1.64-2.91) because of their transgender identity. Regarding their childhood experiences, transgender women with depressive symptoms remained significantly more likely to report that someone had tried to touch them or make them touch in a sexual way when they were growing up (AOR = 2.08, 95% CI = 1.61-2.68). Conclusions Transgender women in Cambodia experience high levels of gender-based violence and depressive symptoms. To address these concerns, a combination of service and policy interventions are required. These may include training and sensitization of trained and lay health providers in screening for depressive symptoms and integration of mental health services into facility- and community-based HIV services with enforcement of policies and laws that protect the rights of transgender women against gender-based violence.
Collapse
Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia.,2Center for Global Health Research, Touro University California, Vallejo, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, No. 33, Street 71, Phnom Penh, Cambodia
| | - Phalkun Mun
- 4National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Gitau Mburu
- 5Division of Health Research, Lancaster University, Lancaster, UK
| |
Collapse
|
17
|
Abstract
Vertical transmission of HIV is responsible for about 14 % of new HIV cases reported each year in sub-Saharan Africa. Barriers that prevent women from accessing and using antiretroviral medications (ARVs) for themselves and their infants perpetuate the epidemic. To identify influences on access to and use of infant HIV health services, specifically nevirapine administration, we conducted a mixed methods study among HIV-positive women in Uganda. This included a cross-sectional survey (n = 384) and focus group discussions (n = 6, 5-9 participants each). Of the 384 women, 80 % gave nevirapine to their infants within 72 h of birth. Factors independently associated with nevirapine administration were lack of maternal adherence to ARVs (AOR 3.55, 95 % CI 1.36-9.26) and attending a support group (AOR 2.50, 95 % CI 1.06-5.83). Non-health facility births were inversely related to nevirapine use (AOR 0.02, 95 % CI 0.003-0.09). Focus group discussions identified four themes impacting access and use: attending a support group, health care worker attitudes, lack of partner support, and poor health messaging regarding ARVs. Improving health care worker messaging regarding ARVs and providing women with needed support to access and use infant ARV prophylaxis is critical to overcoming access barriers. Eliminating these barriers may prevent numerous HIV infections each year saving the lives of many HIV-exposed infants.
Collapse
|
18
|
Abstract
OBJECTIVE The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA). DESIGN Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching. METHODS Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews. RESULTS After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22). CONCLUSION This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators.
Collapse
|
19
|
The Experience of Pregnancy in Women Living With HIV: A Meta-Synthesis of Qualitative Evidence. J Assoc Nurses AIDS Care 2017; 28:587-602. [PMID: 28479291 DOI: 10.1016/j.jana.2017.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022]
Abstract
The lived experience of pregnancy from the perspectives of women living with HIV (WLWH) is not well understood. We aimed to understand the meaning of pregnancy for WLWH. A meta-synthesis was conducted to review and integrate qualitative studies about the phenomena; 12 databases were used to perform the search in English, Spanish, and Portuguese. Articles using qualitative methods published in peer-reviewed journals were included. Data were analyzed using the meta-synthesis method. We found that, for pregnant WLWH, pregnancy evolved as a mediated experience of commitment and dedication. The vital life experience of pregnancy was defined as an interplay of emotions, coping strategies, and feelings of satisfaction. Pregnancy in WLWH was experienced and impacted by societal beliefs, as the women focused all their efforts to take care of themselves and their babies.
Collapse
|
20
|
Loutfy M, Johnson M, Walmsley S, Samarina A, Vasquez P, Hao-Lan H, Madihlaba T, Martinez-Tristani M, van Wyk J. The Association Between HIV Disclosure Status and Perceived Barriers to Care Faced by Women Living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada. AIDS Patient Care STDS 2016; 30:435-44. [PMID: 27551959 PMCID: PMC5035367 DOI: 10.1089/apc.2016.0049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Generally, women are less likely than men to disclose their HIV status. This analysis examined the relationship between HIV disclosure and (1) perceived barriers to care and (2) quality of life (QoL) for women with HIV. The ELLA (EpidemioLogical study to investigate the popuLation and disease characteristics, barriers to care, and quAlity of life for women living with HIV) study enrolled HIV-positive women aged ≥18 years. Women completed the 12-item Barriers to Care Scale (BACS) questionnaire. QoL was assessed using the Health Status Assessment. BACS and QoL were stratified by dichotomized HIV disclosure status (to anyone outside the healthcare system). Multilevel logistic regression analysis was used to identify factors associated with disclosure. Of 1945 patients enrolled from Latin America, China, Central/Eastern Europe, and Western Europe/Canada between July 2012 and September 2013, 1929 were included in the analysis (disclosed, n = 1724; nondisclosed, n = 205). Overall, 55% of patients lived with a husband/partner, 53% were employed, and 88% were receiving antiretroviral therapy. Patients who were with a serodiscordant partner were more likely to disclose (p = 0.0003). China had a disproportionately higher percentage of participants who did not disclose at all (nearly 30% vs. <15% for other regions). Mean BACS severity scores for medical/psychological service barriers and most personal resource barriers were significantly lower for the disclosed group compared with the nondisclosed group (p ≤ 0.02 for all). Compared with the disclosed group, the nondisclosed group reported statistically significantly higher (p ≤ 0.03) BACS item severity scores for 8 of the 12 potential barriers to care. The disclosed group reported better QoL. Overall, HIV nondisclosure was associated with more severe barriers to accessing healthcare by women with HIV.
Collapse
Affiliation(s)
- Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | | | - Sharon Walmsley
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Immunodeficiency Clinic, Toronto General Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | - Anna Samarina
- Saint Petersburg City HIV Centre, St. Petersburg, Russia, Saint Petersburg Medical University named after ac. Pavlov I.P., St. Petersburg, Russia
| | | | - He Hao-Lan
- Infectious Disease, Guangzhou Eighth People's Hospital, Guangzhou, China
| | | | | | | |
Collapse
|
21
|
Yi S, Tuot S, Chhoun P, Pal K, Choub SC, Mburu G. Mental health among men who have sex with men in Cambodia: Implications for integration of mental health services within HIV programmes. Int J Equity Health 2016; 15:53. [PMID: 27009628 PMCID: PMC4806506 DOI: 10.1186/s12939-016-0342-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/15/2016] [Indexed: 01/09/2023] Open
Abstract
Background Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services. Methods A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress. Results In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress (GHQ-12 > 3), which indicates poor mental health. Higher levels of psychological distress were independently associated with older age (AOR = 1.09, 95 % CI 1.03–1.14), alcohol use (AOR = 3.3, 95 % CI 1.36–7.83), illicit drug use (AOR = 3.53, 95 % CI 1.12–11.18), poor self-reported quality of life (AOR = 7.45, 95 % CI 1.79–3.04), and reduced condom use at last sex (AOR = 0.40, 95 % CI 0.21–0.73). MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them (AOR = 1.80, 95 % CI 1.10–2.97), a parent or guardian had been physically abused (AOR = 3.51, 95 % CI 1.86–6.62), and a family member had been mentally ill (AOR = 4.01, 95 % CI 2.06–7.81) when they were growing up. Conclusions In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.
Collapse
Affiliation(s)
- Siyan Yi
- Research Department, KHANA, Phnom Penh, Cambodia
| | | | - Pheak Chhoun
- Programs Department, KHANA, Phnom Penh, Cambodia
| | | | | | - Gitau Mburu
- Program Impact Unit, International HIV/AIDS Alliance, Brighton, UK. .,Department of Health Research, Lancaster University, Lancaster, UK.
| |
Collapse
|
22
|
Mahr IL, Campbell C. Twenty Years Post-genocide: The Creation of Mental Health Competence among Rwandan Survivors Through Community-based Healing Workshops. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2015. [DOI: 10.1002/casp.2263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ines-Lena Mahr
- Department of Social Psychology; London School of Economics and Political Science; London UK
| | - Catherine Campbell
- Department of Social Psychology; London School of Economics and Political Science; London UK
| |
Collapse
|
23
|
Bakiono F, Guiguimdé PWL, Sanou M, Ouédraogo L, Robert A. Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months. BMC Public Health 2015; 15:1119. [PMID: 26563970 PMCID: PMC4643494 DOI: 10.1186/s12889-015-2444-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Burkina Faso, very little is known about the quality of life of persons living with HIV through their routine follow- up. This study aimed to assess the quality of life of persons living with HIV, and its change over a 1-year period. METHODS Four hundred and twenty four (424) persons living with HIV were monitored during twelve (12) months from September 2012 to September 2013 in Ouagadougou, the capital city of Burkina Faso. Three interviews were conducted in order to assess the quality of life of patients and its change over time, using the World Health Organization Quality of Life assessment brief scale in patients with Human Immunodeficiency Virus infection (WHOQOL HIV-BREF). The Friedman test was used to assess significant differences in quantitative variables at each of the three follow-up interviews. Groups at baseline, at 6 months and at 12 months were compared using Wilcoxon signed rank test for quantitative data and McNemar test for qualitative variables. Pearson Chi(2) was used when needed. Multivariable logistic regression models were fit to estimate adjusted odds ratio (OR) and 95% confidence intervals (95% CI). Trends in global quality of life score and subgroups (status related to Highly Active Anti Retroviral Treatment (HAART) using univariate repeated measures analysis of variance were assessed. A p-value less than 0.05 was considered significant. RESULTS At baseline, quality of life scores were highest in the domain of spirituality, religion and personal beliefs (SRPB) and lowest in the environmental domain. This trend was maintained during the 12-month follow-up. The global score increased significantly from the beginning up to the twelfth month of follow-up. Over the 12 months, the baseline factors that were likely to predict an increase in the global quality of life score were: not having support from relatives for medical care (P = 0.04), being under HAART (P = 0.001), being self-perceived as healthy (P = 0.03), and having a global quality of life score under 77 (P < 0.001). CONCLUSIONS Our findings suggest the need to promote interventions to empower people living with HIV/AIDS through income generating activities. Such activities will enhance the quality of life of persons living with HIV in Burkina Faso. This could focus mostly on treatment-naïve HIV patients, lacking support from relatives and those who perceive themselves as ill.
Collapse
Affiliation(s)
- Fidèle Bakiono
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200, Brussels, Belgium.
| | | | - Mahamoudou Sanou
- Unité de Formation et de Recherche en Sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso.
| | - Laurent Ouédraogo
- Unité de Formation et de Recherche en Sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso. .,Institut Régional de Santé Publique de Ouidah, Ouidah, Bénin.
| | - Annie Robert
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique, Université catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200, Brussels, Belgium.
| |
Collapse
|
24
|
Patterson AS. Engaging therapeutic citizenship and clientship: Untangling the reasons for therapeutic pacifism among people living with HIV in urban Zambia. Glob Public Health 2015; 11:1121-34. [PMID: 26256509 DOI: 10.1080/17441692.2015.1070053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article explores the reasons for therapeutic pacifism among people living with HIV (PLHIVs) in urban Zambia. It contributes to a growing ethnography on global health, biosociality, and patient-provider dynamics. Therapeutic citizenship is a biopolitical citizenship that includes claims and ethical projects that emerge from techniques to control and manage bodies. In some contexts, therapeutic citizenship has included activism and claims-making against local, national, and international power brokers. This article investigates therapeutic citizenship in the specific context of impoverished urban Zambian compounds, sites of food insecurity, unemployment, and political exclusion, as well as targets for donor, NGO, and faith-based organisation projects and PLHIV support group proliferation. The article utilises data from participant observations at two Lusaka AIDS clinics, interviews, and focused discussions with support groups of PLHIVs. It argues that PLHIVs continuously negotiate subjectivities related to kinship, clientship, religious belief, and political citizenship in processes that complicate therapeutic citizenship. Rather than fostering participation in PLHIV support groups or challenging 'politics as usual' through activist claims-making to institutions of biopower, these processes lead to therapeutic pacifism.
Collapse
Affiliation(s)
- Amy S Patterson
- a Department of Politics , University of the South , Sewanee , TN , USA
| |
Collapse
|
25
|
Leyva-Moral JM, de Dios Sánchez R, Lluva-Castaño A, Mestres-Camps L. Living with constant suffering: a different life following the diagnosis of HIV. J Assoc Nurses AIDS Care 2015; 26:613-24. [PMID: 25998265 DOI: 10.1016/j.jana.2015.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/18/2015] [Indexed: 11/18/2022]
Abstract
We used grounded theory in semi-structured interviews with 32 persons living with HIV (PLWH) in Barcelona, Spain, and found that PLWH live with constant suffering, a core category combining four realities: I need help; My life is constantly controlled; I have a new imposed life; and I have an uncertain reality. Participants described being constantly controlled by health policies and medications. They thought their lives were in the hands of others and that a new life, characterized by the constant fear of stigma, had been imposed on them. They felt they were losing freedom and vitality, as many questions remained unanswered, causing uncertainty related to health and public life. Emotional help was obtained mainly from peers and social networks. Our emergent theory shows a disruptive experience, with serious consequences to individual and social development. Health care has to focus on the real needs of PLWH to reduce suffering and uncertainty.
Collapse
|
26
|
Patel N, Kellezi B, Williams ACDC. Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database Syst Rev 2014; 2014:CD009317. [PMID: 25386846 PMCID: PMC11026826 DOI: 10.1002/14651858.cd009317.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Torture is widespread, with potentially broad and long-lasting impact across physical, psychological, social and other areas of life. Its complex and diverse effects interact with ethnicity, gender, and refugee experience. Health and welfare agencies offer varied rehabilitation services, from conventional mental health treatment to eclectic or needs-based interventions. This review is needed because relatively little outcome research has been done in this field, and no previous systematic review has been conducted. Resources are scarce, and the challenges of providing services can be considerable. OBJECTIVES To assess beneficial and adverse effects of psychological, social and welfare interventions for torture survivors, and to compare these effects with those reported by active and inactive controls. SEARCH METHODS Randomised controlled trials (RCTs) were identified through a search of PsycINFO, MEDLINE, EMBASE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Specialised Register (CCDANCTR), the Latin American and Caribbean Health Science Information Database (LILACS), the Open System for Information on Grey Literature in Europe (OpenSIGLE), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and Published International Literature On Traumatic Stress (PILOTS) all years to 11 April 2013; searches of Cochrane resources, international trial registries and the main biomedical databases were updated on 20 June 2014. We also searched the Online Library of Dignity (Danish Institute against Torture), reference lists of reviews and included studies and the most frequently cited journals, up to April 2013 but not repeated for 2014. Investigators were contacted to provide updates or details as necessary. SELECTION CRITERIA Full publications of RCTs or quasi-RCTs of psychological, social or welfare interventions for survivors of torture against any active or inactive comparison condition. DATA COLLECTION AND ANALYSIS We included all major sources of grey literature in our search and used standard methodological procedures as expected by The Cochrane Collaboration for collecting data, evaluating risk of bias and using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods to assess the quality of evidence. MAIN RESULTS Nine RCTs were included in this review. All were of psychological interventions; none provided social or welfare interventions. The nine trials provided data for 507 adults; none involved children or adolescents. Eight of the nine studies described individual treatment, and one discussed group treatment. Six trials were conducted in Europe, and three in different African countries. Most people were refugees in their thirties and forties; most met the criteria for post-traumatic stress disorder (PTSD) at the outset. Four trials used narrative exposure therapy (NET), one cognitive-behavioural therapy (CBT) and the other four used mixed methods for trauma symptoms, one of which included reconciliation methods. Five interventions were compared with active controls, such as psychoeducation; four used treatment as usual or waiting list/no treatment; we analysed all control conditions together. Duration of therapy varied from one hour to longer than 20 hours with a median of around 12 to 15 hours. All trials reported effects on distress and on PTSD, and two reported on quality of life. Five studies followed up participants for at least six months.No immediate benefits of psychological therapy were noted in comparison with controls in terms of our primary outcome of distress (usually depression), nor for PTSD symptoms, PTSD caseness, or quality of life. At six-month follow-up, three NET and one CBT study (86 participants) showed moderate effect sizes for intervention over control in reduction of distress (standardised mean difference (SMD) -0.63, 95% confidence interval (CI) -1.07 to -0.19) and of PTSD symptoms (SMD -0.52, 95% CI -0.97 to -0.07). However, the quality of evidence was very low, and risk of bias resulted from researcher/therapist allegiance to treatment methods, effects of uncertain asylum status of some people and real-time non-standardised translation of assessment measures. No measures of adverse events were described, nor of participation, social functioning, quantity of social or family relationships, proxy measures by third parties or satisfaction with treatment. Too few studies were identified for review authors to attempt sensitivity analyses. AUTHORS' CONCLUSIONS Very low-quality evidence suggests no differences between psychological therapies and controls in terms of immediate effects on post-traumatic symptoms, distress or quality of life; however, NET and CBT were found to confer moderate benefits in reducing distress and PTSD symptoms over the medium term (six months after treatment). Evidence was of very low quality, mainly because non-standardised assessment methods using interpreters were applied, and sample sizes were very small. Most eligible trials also revealed medium to high risk of bias. Further, attention to the cultural appropriateness of interventions or to their psychometric qualities was inadequate, and assessment measures used were unsuitable. As such, these findings should be interpreted with caution.No data were available on whether symptom reduction enabled improvements in quality of life, participation in community life, or in social and family relationships in the medium term. Details of adverse events and treatment satisfaction were not available immediately after treatment nor in the medium term. Future research should aim to address these gaps in the evidence and should include larger sample sizes when possible. Problems of torture survivors need to be defined far more broadly than by PTSD symptoms, and recognition given to the contextual influences of being a torture survivor, including as an asylum seeker or refugee, on psychological and social health.
Collapse
Affiliation(s)
- Nimisha Patel
- University of East LondonSchool of PsychologyRomford Road, StratfordLondonUKE15 4LZ
- International Centre for Health and Human RightsLondonUK
| | - Blerina Kellezi
- University of NottinghamSchool of Medicine, Division of Primary CareTower Building, University ParkNottinghamUKNG7 2RD
- Univeristy of OxfordCentre for CriminologyOxfordUK
| | - Amanda C de C Williams
- International Centre for Health and Human RightsLondonUK
- University College LondonResearch Department of Clinical, Educational & Health PsychologyGower StreetLondonUKWC1E 6BT
| | | |
Collapse
|
27
|
Patient outcomes in Lubumbashi, Democratic Republic of Congo after a disruption in HIV care due to decreased global fund appropriations. AIDS Behav 2014; 18:2135-43. [PMID: 24699713 DOI: 10.1007/s10461-014-0761-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines care seeking behaviors, clinical outcomes, and satisfaction with care of HIV-positive adults in Lubumbashi, DRC, one year after a disruption in care due to decreased global fund appropriations. We describe outcomes before and after the disruption. We compared characteristics of those who completed the survey and those who did not using the Wald F test. Most patients sought care after the disruption and continued antiretroviral therapy (ART), though use of cotrimoxizole prophylaxis declined. Though there was little change in WHO clinical stage at the new site of care, the majority of participants lost weight, adherence decreased, support group participation dropped, and satisfaction with care worsened. Patients were more likely to participate in the study if they were taking ART. This study highlights the importance of provider-patient communication during a transfer and the vulnerability of pre-ART patients to becoming lost to follow-up.
Collapse
|
28
|
Seedat S. Interventions to improve psychological functioning and health outcomes of HIV-infected individuals with a history of trauma or PTSD. Curr HIV/AIDS Rep 2013; 9:344-50. [PMID: 23007792 DOI: 10.1007/s11904-012-0139-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The experience of early or later life trauma in HIV-positive adults can have devastating mental and physical health consequences. Women bear the brunt of this double burden. Depression, posttraumatic stress disorder, and alcohol and drug use disorders are among the most common psychiatric disorders documented, both in infected women and men, in high-, middle-, and low-income countries. Traumatized individuals, particularly those with childhood sexual abuse characterized by repeated traumatization, are at high risk of engaging in risky behaviors, including substance abuse and sexual promiscuity. These issues are further compounded by stigma, discrimination, poverty, and low social support. While there is a significant need to pay more attention to psychiatric and psychological outcomes in the context of HIV-trauma and improve screening for traumatic stress in HIV care settings, there are currently few treatment and secondary prevention studies. Group cognitive-behavioral strategies, including prolonged exposure, coping skills training, and stress management have, to date, shown some evidence for efficacy in HIV-positive individuals with childhood trauma and in those with PTSD.
Collapse
Affiliation(s)
- Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa.
| |
Collapse
|