Emotional and behavioral resilience among children with perinatally acquired HIV in Thailand and Cambodia

OBJECTIVES

Psychosocial challenges associated with perinatally acquired HIV (PHIV) infection are well known, yet many children infected with HIV since birth demonstrate positive outcomes, referred to as resilience. The purpose of this study was to evaluate emotional-behavioral development and identify salient predictors of resilience among long-term survivors of PHIV.

DESIGN

Prospective investigation of children with PHIV compared with demographically similar perinatally HIV-exposed but uninfected (PHEU) and HIV-unexposed, uninfected (HUU) children, all from Thailand and Cambodia.

METHODS

The Child Behavior Checklist (CBCL; parent version) was administered at baseline and annual follow-up visits (median follow-up of 3 years) to children age 6-14. Resilience was defined as consistent CBCL scores on the Internalizing, Externalizing or Total Problem T scales within normative ranges (T-scores <60) at every time point. Generalized estimating equations examined CBCL scores over time and logistic models examined demographic, socioeconomic, and cultural predictors of resilience.

RESULTS

Participants included 448 children (236 PHIV, 98 PHEU, 114 HUU), with median (interquartile range) age at first evaluation of 7 (6-9) years. Children with PHIV exhibited similar rates of resilience as PHEU and HUU on the Externalizing and Total Problems scales. Resilience on the Internalizing scale was more likely in PHEU (71%) compared with PHIV (59%) or HUU (56%), P = 0.049. Factors associated with resilience in adjusted models included: HIV-exposed but uninfected status, higher household income, Cambodian nationality, female sex, and caregiver type.

CONCLUSION

Despite biopsychosocial risks, resilience is observed among PHIV and PHEU children. Further study is needed to understand mechanisms underlying associated factors and intervention priorities.

Factors influencing quality of life (QOL) amongst elderly caregivers of people living with HIV/AIDS in Phayao province, Thailand: a cross-sectional study

Background: There are many impacts on quality of life among elderly people living with HIV patients. This study aimed to assess factors influencing quality of life among elderly people living with HIV/AIDS in a northern province of Thailand. Methods: This cross-sectional study was conducted in Phayao province, Thailand. A systematic sampling technique was employed to select study participants. 152 elderly participants aged 60 years and older with a family member living with HIV/AIDS were recruited to the study. They were interviewed using the World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD) questionnaire. Stepwise multiple regression analysis was performed to determine the factors influencing quality of life among elderly people affected by family member living with HIV/AIDS. Results: The results of the study showed the mean age of elderly participants was 67.20 + 52 years, most of which were female (97 persons, 63.8%). The mean time taking care of HIV/AIDS patients was 6.61 + 4.96 years. In term of health status among the elderly participants, the majority did not have chronic diseases (61.4%), amongst those with chronic diseases (38.6%), hypertension and diabetes were the most common. The average quality of life score was at a fair level.  The time taking care of HIV/AIDS patients and health status were significant predictors of quality of life among participants 8.1 % ( R 2 =.081; p < .05). Conclusion: In order to improve quality of life among elderly caregivers to family member living with HIV/AIDS, time taking care of HIV/AIDS patients and health status should be focused on, amongst other factors. Help and support from the government, community, health organizations, academic research, and family members can help improve quality of life amongst the elderly.

Scripting Remittances: Making Sense of Money Transfers in Transnational Relationships

This article proposes a conceptual framework for studying remittances as social transactions that can take a number of different forms. For the past three decades, the dominant framework for understanding remittance relationships has been the continuum of senders’ motives from altruism to self-interest. This approach has its roots in economics and has shaped much of the quantitative research on remittances. In parallel, a growing body of ethnographic research has examined transnational money transfers with perspectives and data that differ from those of economists. The insights from these ethnographic studies are valuable, but remain fragmented and marginal in research on remittances. Two key points emerge from the ethnographic literature: Remittances are at the core of composite transactions with material, emotional, and relational elements, and there is great variation in the nature and logic of these transactions. The framework proposed here is designed to engage with both complexity and variation. It systematically draws upon a large body of ethnographic literature and introduces remittance scripts as an analytical tool.

PRIORITISING SUSTAINABILITY FACTORS FOR AUSTRALIAN COMMUNITY BUILDINGS’ MANAGEMENT USING ANALYTICAL HIERARCHY PROCESS (AHP)

The essence of Australian community buildings’ sustainable management drives through a previously established decision-making structure with four sustainability aspects and accompanying 18 criteria. Informed decisions are supported with a decision-making model that generates sustainability impacts of building components based on this decision-making structure. Building components’ individual impacts can be assigned using a numbering scale incorporated with linguistic terms. However, similar importance given to each aspect or criterion is arguable when the combined effect is considered. Hence, they should be given different weightings and their combination with individual impacts will produce final sustainability impacts. For calculating weightings, the study uses Analytical Hierarchy Process (AHP), widely used technique in Multi Attribute Decision-Making (MADM). The study also conducted an industry-wide questionnaire across Australian local councils because pair-wise comparison data is essential for weighting calculation. This paper presents the survey data and analysis results that captured weightings of sustainability aspects and criteria.

Health-promoting practices and the factors associated with self-reported poor health in caregivers of children orphaned by AIDS in southwest Uganda

Informal caregivers worldwide are faced with the dilemma of maintaining their health and meeting the caregiving demands of their loved ones. This study explores the health outcomes of caregiving, caregivers' health-promoting practices and the challenges to providing care among caregivers to children orphaned by AIDS in southwest Uganda. A descriptive design and interview questionnaires were used to collect data from 204 caregivers. The average age of the caregivers was 41.36 (±10.9) years and most of them (53%) were grandmothers to the orphans. The majority (65%) of the caregivers were caring for at least three orphans, had been in the caregiver role for more than five years (61%), and stated that their health had been negatively impacted by caregiving (61%). According to self-reports, the most common new health problems since taking up the caregiving role were chronic ill health (97%), social isolation (95%) and mental stress (92%). The health-promoting practices most often engaged in were eating a balanced diet (67%), seeking spiritual support (58%), and performing self-care activities (44%). The challenges to caregiving most often reported were poverty (88%) and a lack of time to seek personal medical care (59%). The predictors of self-reported poor health among the caregivers were stress (odds ratio [OR] = 3.43; p ≤ 0.01), caring for three or more orphans (OR = 2.19; p ≤ 0.01), female gender (OR = 1.77; p ≤ 0.01), and having spent more than five years as a caregiver to an orphan (OR = 1.35; p ≤ 0.01). The findings suggest that caregivers commonly experience poor health and their health-promoting practices are inadequate. There is a need for organised and formal health-promotion programmes for caregivers of children orphaned by AIDS, especially in rural areas of developing countries. Interventions for health promotion can be achieved through integrated programmes that provide health education, social services, respite from caregiving and counselling.

Illumination with a Dim Bulb? What do social scientists learn by employing qualitative data analysis software (QDAS) in the service of multi-method designs?

Although there has been much optimistic discussion of integrating quantitative and qualitative findings into sociological analysis, there remains a gap regarding the application of mixed approaches. We examine the potential gains and pitfalls of such integration in the context of the growing analytic power of contemporary qualitative data analysis software (QDAS) programs. We illustrate the issues with our own research in a mixed-methods project examining low fertility in Italy, a project that combines analysis of large nationally representative survey data with qualitative in-depth interviews with women across four (4) cities in Italy. Despite the enthusiasm for mixed-methods research, the available software appears to be underutilized. In addition, we suggest that the sociological research community will want to address several conceptual and inferential issues with these approaches.

Interventions for families affected by HIV

Family-based interventions are efficacious for human immunodeficiency virus (HIV) detection, prevention, and care, but they are not broadly diffused. Understanding intervention adaptation and translation processes can support evidence-based intervention (EBI) diffusion processes. This paper provides a narrative review of a series of EBI for families affected by HIV (FAH) that were adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years. The FAH interventions targeted parents living with HIV and their children or caregiver supports. Parents with HIV were primarily mothers infected through sexual transmission. The EBIs for FAH are reviewed with attention to commonalities and variations in risk environments and intervention features. Frameworks for common and robust intervention functions, principles, practice elements, and delivery processes are utilized to highlight commonalities and adaptations for each location, time period, and intervention delivery settings. Health care, housing, food, and financial security vary dramatically in each risk environment. Yet, all FAH face common health, mental health, transmission, and relationship challenges. The EBIs efficaciously addressed these common challenges and were adapted across contexts with fidelity to robust intervention principles, processes, factors, and practices. Intervention adaptation teams have a series of structural decision points: mainstreaming HIV with other local health priorities or not; selecting an optimal delivery site (clinics, homes, community centers); and how to translate intervention protocols to local contexts and cultures. Replication of interventions with fidelity must occur at the level of standardized functions and robust principles, processes, and practices, not manualized protocols. Adopting a continuous quality improvement paradigm will enhance rapid and global diffusion of EBI for FAH.

Intergenerational relationships within families of HIV-infected adults under antiretroviral treatment in Northern Thailand

Thailand has been severely affected by AIDS/HIV. The epidemic has undermined the health of the population of working age, placing stress on intergenerational relations and threatening the social fabric. Older people in families affected by the disease, although not the main victims, have experienced major changes in relationships with their adult children and grandchildren. However, the availability of antiretrovirals has transformed HIV infection from a lethal to a chronic disease. Intergenerational relationships are analysed with data from a quantitative survey of HIV-infected adults currently receiving antiretroviral treatment in Northern Thailand. The introduction of antiretroviral treatment has eased the pressure on families. Where HIV-infected adults are more dependent on their older parents, it is because they are single and childless or single parents. While ageing parents remain a source of support for their adult children, the introduction of antiretroviral treatment has radically changed the prospects for HIV-infected adults and their regained health allows them to work, take care of their family and fulfil their filial duties as expected in Thai society. If Thailand's original aim in introducing health policies in this area was to curtail the HIV epidemic, its positive impact on intergenerational relations is an additional benefit.

‘This is where we buried our sons’: people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda

Much research on the impact of HIV and AIDS on older people fails to differentiate between age groups, and treats those aged from 50 years to the highest ages as homogeneous. The ‘oldest old’ or those aged over 75 years may be particularly vulnerable through declining health and independence as a result of the AIDS epidemic, which has forced some to take on roles that younger relatives would have performed had they lived. In this paper we describe the past and current experience of eight people in advanced old age living in rural Uganda who were informants for an ethnographic study of the impact of HIV and AIDS on households during 1991–92 and again in 2006–07. The aim of the study was to understand how they had coped with the impacts of the epidemic. From the eight case studies, it is concluded that family size, socio-economic status and some measure of good fortune in sustained good health enabled these people to live to an advanced age. While we recommend that targeted social protection is important in helping the poorest among the oldest, we suggest that sustaining respect for age and experience, and ensuring that older people do not feel discarded by family and society are as important as meeting their practical needs.

An Asia Pacific six-country study on HIV-related discrimination: Introduction

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

A situational analysis of HIV/AIDS-related discrimination in Bangkok, Thailand

Unlike its other Asian counterparts, the national prioritizing of HIV/AIDS in Thailand, through the development of a number of preventive initiatives, has resulted in a declining rate of incidence. While there are no laws overtly protecting the rights of people living with HIV/AIDS (PLWHA), substantial written policy has been enacted. Yet in spite of this highly protective legislative and policy environment, discrimination against PLWHA continues to occur in practice. Focusing on the healthcare sector, through the framework set out in the UNAIDS 'Protocol for the Identification of Discrimination against People Living with HIV' (the Protocol) this study found that discriminatory attitudes and practices arose primarily due to a lack of appropriate monitoring of levels of compliance by health care providers. The disparity between written policy and practice can be explained by the underlying personal and cultural factors and the authors strongly contend that for written policies to effectively work, further research needs to be conducted into the individual and cultural values of Thai health personnel.

The elderly and AIDS: Coping with the impact of adult death in Tanzania

The elderly are one of the key groups of survivors who may be adversely affected by the death of prime-age adults from AIDS. We use a longitudinal survey of households from Northwestern Tanzania in 1991-94 to compare the activities and welfare of the elderly in households before and after the death of a prime-age adult with that of the elderly in households that did not have an adult death. The elderly in households that had an adult death were more educated, more likely to engage in wage employment and spent less time farming than the elderly in households that did not have a death during the survey. Time spent by the elderly in household chores rose following an adult death and participation in wage employment fell; there was no evidence of increased participation in farm work. The physical well-being of the elderly, as measured by body mass index (BMI), was lower prior to an adult death and higher afterward. Finally, the elderly with the lowest BMI are those in poor households that did not have an adult death during the survey. Thus, policymakers should be concerned about the adverse impacts of adult deaths on the physical well-being of the elderly-primarily during the period of illness prior to a prime-age adult death-but they should also focus on the larger groups of poor elderly with much lower physical health status.