Living with haemophilia and HIV/AIDS: support and coping

Non-supportive interactions in the experience of women family caregivers

The purpose of this ethnographic study was to identify and describe types of non-supportive interactions perceived by 59 women family caregivers in four diverse situations. Participants included 15 mothers of infants born prematurely, 14 mothers of a child with a chronic disease (asthma or diabetes), and women caring for an adult family member with either cancer (15) or dementia (15). Data collection methods included an initial in-depth interview with all women, followed by a second interview with a smaller group of caregivers including a card sort exercise that was based on thematic content analysis of the first interview data. A typology of non-supportive interactions was developed from analysis of the first two interviews and confirmed in a final interview with a subset of study participants. Interviews were audio-taped and transcribed verbatim. Women in all caregiving situations described experience with three types of non-supportive interactions. These interactions were negative, ineffective, or lacking expected support. The women's appraisal of interactions as supportive or non-supportive was rooted in their personal expectations and the context of their situation. Information about types of non-supportive interactions can sensitise professionals, family and friends to mismatches between their assistance and caregivers' requirements, potentially avoiding negative consequences.

Social support among women who died of ovarian cancer

GOALS OF WORK

We investigated the effects of social support in the last 6 months of life for women who died of ovarian cancer.

MATERIALS AND METHODS

The study population included women enrolled in one of three Managed Care Organizations who died of ovarian cancer (1995-2000). Information was collected on demographics, living environment, presence of escorts to oncology encounters, comorbidities, medications, outpatient and inpatient encounters, and referrals to home health and hospice. Two characteristics of social support were examined: living with others and being escorted to one or more oncology visits.

RESULTS

Of 421 subjects, both aspects of social support were known for 345 (82%). Of these, 227 (66%) lived with others and were escorted, 33 (10%) lived with others but were never escorted, 59 (17%) lived alone but were escorted, and 26 (8%) lived alone and never were accompanied. Women living alone were less likely to be taking a psychotropic medication (57% vs 70%, p = 0.021) and were somewhat less likely to receive hospice referral (42% vs 53%, p = 0.054). Women who were never escorted had fewer outpatient encounters (12.60 vs 15.77, p = 0.033) and were less likely to be referred to home health (18% vs 30%, p = 0.046).

CONCLUSIONS

This study indicates that social support has some beneficial effects on receipt of personal health services. Friends and family may act as proponents for the patient in obtaining services. Health care professionals should be encouraged to assess the cancer patient's social situation and identify areas where help may be needed.

Psychosocial problems of bereaved families of HIV-infected hemophiliacs in Japan

This study sought to investigate the psychosocial difficulties faced by bereaved families of HIV-infected hemophiliacs in Japan, with the goal of clarifying appropriate ways to offer them support. Interviews were conducted with 46 family members from 36 families, and a written survey was mailed to 392 families. Valid responses from 225 families (307 family members) were analyzed (response rate 57.4%). We found that even at a mean 7-9 years after their family member's death, the bereaved continued to express deep feelings of sorrow and grief, and further, expressed strong feelings of resentment, anger, guilt and regret, anxiety over discrimination, and loneliness. Notably, 95% of the mothers endorsed feeling "sorry for giving birth to a hemophiliac child". Additionally, even after their family member's death, approximately 70% of the respondents continued to restrict their daily activities due to stigmatization or anxiety over discrimination. Finally, 59% of the respondents were found to have posttraumatic stress disorder-like symptoms according to the Impact of Event Scale-Revised, and 46% were found, according to General Health Questionnaire-12 (a measure of mental disorder) criteria, to suffer mental health problems. These results indicate that bereaved families of HIV-infected hemophiliacs in Japan have special characteristics and psychosocial needs, and still suffer significant psychosocial difficulties years after the bereavement.

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers

The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included five people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly field notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had benefitted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks.

Myocardial infarction: survivors' and spouses' stress, coping, and support

Despite evidence that spouses play an important role in the recovery of MI survivors, there have been few studies of pertinent psychosocial factors from the perspectives of both survivors and spouses. Accordingly, the aim of this study was to describe stress, coping strategies and social support experienced by survivors and spouses. This study was limited to first-time MI to focus on a time of uncertainty and transition. Twenty-eight persons (14 couples) participated. Both survivors and their spouses reported similar post-MI stresses: emotional impact, lifestyle changes, encounters with health professionals, and their partners' reactions. Spouses and survivors used diverse strategies to cope with the stresses of MI. Seeking informational support was prevalent. Both spouses and survivors engaged in 'protective buffering' of their partners. Couples described deficient support, conflict and miscarried helping efforts within their relationships. Spouses and survivors referred to inadequate informational support from health professionals.

Most frequently used alternative and complementary therapies and activities by participants in the AMCOA study

This literature review examines the current state of the scientific evidence published in peer-reviewed journals indexed in MedLine for the 10 most commonly noted alternative activities reported by the first 1,016 eligible participants in the Alternative Medical Care Outcomes in AIDS study. The most frequently used activities are aerobic exercise (64%), prayer (56%), massage (54%), needle acupuncture (48%), mediation (46%), support groups (42%), visualization and imagery (34%), breathing exercises (33%), spiritual activities (33%), and other exercise (33%). Despite frequency of usage, clinical research is not reported on MedLine to support the use of most of these activities for HIV/AIDS. The limitations of using MedLine as the sole source for this review are discussed.

The expressed needs of a group of HIV-infected gay men subsequent to hospital care

A qualitative study was conducted to explore how a group of HIV-infected gay men experienced their encounters with the health care community and to develop a theoretical understanding of the care given from the patient's perspective. Ten HIV-infected gay men were recruited from an outpatient clinic in a city in the southeastern part of the United States. Collection and analysis of data was conducted with a qualitative approach using a constant comparative method. The themes summarizing the findings were integration, recognition, security, availability of facilities, and confirmation. These themes contain both negative and positive experiences and conceptualize different needs from a patient's perspective. The role of the nurses' attitudes to and perceptions of gay HIV-infected men was emphasized.

AIDS in southern Thailand: stories of krengjai and social connections

HIV-disease in southern Thailand has reached epidemic proportions. The declining Thai economy, coupled with social discrimination among people with the disease, has adversely affected individual, family and community krengjai. Among Thai's, krengjai is used to describe social order, avoid personal conflict, and maintain harmony in relationships. Using the framework of story, this narrative study explores the experiences of five individuals with HIV-disease and their tenuous relationship with krengjai.

Health status and satisfaction of asymptomatic HIV-positive haemophiliacs in Kyushu, Japan

The purpose of this study was to elucidate the effects of human immunodeficiency virus (HIV) on haemophiliacs with physical functional disabilities induced by haemophilia in Kyushu, Japan. The subjects were 38 adult haemophiliacs who were selected from 129 patients registered with the North Kyushu Haemophilia Centre. They were divided into 21 asymptomatic HIV-positive and 17 HIV-negative adult haemophiliacs. Coagulation factor levels, modified DePalma classification, Arthritis Impact Measurement Scale 2 (AIMS 2), and a satisfaction in daily life (SDL) questionnaire were used to investigate the clinical severity of their haemophilia and arthropathy, physical functional disabilities, and satisfaction. Although there were no significant differences in the objective assessments of health status between the HIV-positive and -negative haemophiliacs, the HIV-positive haemophiliacs were significantly more dissatisfied with their social activities and mood, according to AIMS 2, and with social intercourse, job, self-development, and social security and pension according to SDL assessment. These dissatisfactions were due to the effects of HIV, in addition to the physical functional disabilities that were caused by haemophilia. Dissatisfaction with social security and pension may be a specific feature in HIV-positive haemophiliacs in Japan resulting from the origin of HIV infection.

The emerging needs of persons living with haemophilia and HIV/AIDS in British Columbia

The Haemophilia Programme Enhancement Project (HPEP) was initiated in 1991 to assist Haemophilia Programme staff meet the increasing and complex needs of persons living with haemophilia and HIV/AIDS. A review of the HPEP in 1997 revealed that the needs of this population have changed due to the advances in medical treatment, laboratory monitoring and the proliferation of HIV/AIDS expertise and resources. Continued roles for the HPEP include triage and liaison with HIV specialists to ensure appropriate care, given the possible haematological complications that coexist with HIV and/or liver disease. Access to resources remains problematic for those living in remote regions of British Columbia, and a strong advocacy presence is needed. Services to families and children of persons with HIV and haemophilia is required, especially around disclosure and preparation for the stresses incurred during hospitalization. The fact that many long-term survivors are living in relatively good health has sparked renewed optimism amongst this group. Those who continue to do well are in the process of re-evaluating their lives and may need assistance in establishing both short- and long-term goals. Interventions to sustain hope could include individual and family counselling, facilitated support meetings and a commitment to the provision of vocational rehabilitation counselling, re-training and job placement. For the first time in years, many persons living with haemophilia and HIV are facing an opportunity to look forward into the future and devise ventures which will enhance their feelings of productivity.

Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs

This quantitative research has attempted to investigate the psychological effects of hospitalisation and source isolation, and assessed whether were they influential in affecting a patient's cognitive coping with these two stressors. The research evaluated whether isolating a person because of an infection was a more stressful event (causing negative effects on four measured psychological constructs) than routine hospital admission. The research was conducted in two large District General Hospitals and one elderly care hospital. Individuals admitted to one of the research sites, and who satisfied the sample criteria, were adopted. The total number of subjects was 40. The research design was quasi experimental (post test only control group design), using a quantitative approach. Following a period of hospitalisation or isolation subjects in the control group (Group 1, hospitalised subjects n = 20) and subjects in the experimental group (Group 2, isolated subjects, n = 20) were given the following to complete: the Hospital Anxiety and Depression Scale, the Health Illness (Powerlessness) Questionnaire, and the Self Esteem Scale. These measured four psychological constructs: anxiety, depression, self esteem and sense of control. The quantitative data generated were analysed using descriptive statistics and the Student's t-test. The findings confirmed and validated previous research that hospitalisation results in many negative feelings that have detrimental effects on psychological well being and coping. However, more significantly, infected subjects who were isolated demonstrated feelings of anxiety, and depression that were significantly higher, and feelings of self esteem and sense of control that were significantly lower than those demonstrated by hospitalised subjects. Thus it could be argued that isolation has an even greater negative effect on their coping. Further research therefore needs to examine how specific nurse interventions can ameliorate the identified negative effects of isolation and so facilitate effective coping and positive psychological well being.

Needs assessment of caregivers of people with HIV/AIDS

This descriptive study assessed 34 caregivers of people with HIV/AIDS to learn their perceived needs, concerns, and use of services. Results indicated the most common health problems of the care recipient were fatigue and weight loss; care recipients needed help with climbing stairs, walking, and bathing; caregivers helped with the household chores, transportation, and companionship; caregivers were concerned about coping with loss and responsibilities; caregivers had help from family, case manager, and neighbor; caregivers wanted help such as a companion and counseling. Discussion relates to the implications of the study for health care professionals.