Defensive mothering in HIV-positive mothers

Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades

The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.

'I was told not to do it but…': Infant feeding practices amongst HIV-positive women in southern Thailand

BACKGROUND AND OBJECTIVES

mothers living with HIV are encouraged not to breastfeed as it can transmit HIV to their infants. However, there is little known about how Thai women with HIV perceive and experience their infant feeding practices. This paper explores the breastfeeding experiences among Thai women living with HIV in southern Thailand.

METHODS

semi-structured interviews and drawing methods were used with 30 HIV-positive women in rural communities of southern Thailand. Thematic analysis was used for data analysis.

FINDINGS

HIV-positive mothers had ambivalent feelings about not being able to breastfeed their infants. They perceived themselves as a 'contaminated mother'. Healthcare centres and hospitals supply free infant formula for HIV-positive mothers up to one and a half years. Despite this, many mothers had to deal with some difficulties. Some infants developed an allergy to the infant formula. The free infant formula was not sufficient for some infants and the mothers had to find alternative means for the well-being of their infants: many mothers relied on condensed milk whereas some fed mashed banana. The women made every effort to fulfill their ideology of being a good and responsible mother.

CONCLUSION

this paper contributes a conceptual understanding about the lived experiences of breastfeeding among women living with HIV in southern Thailand. The findings have implications for midwifery care and health policy. The provision of different options of feeding should be made available to infants along with accessible resources and professional support and guidance.

Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review

Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.

'Dying from' to 'living with': framing institutions and the coping processes of African American women living with HIV/AIDS

How do HIV-positive individuals transition from believing and behaving as though they have a 'death sentence' to interpreting and coping with HIV as a chronic but manageable illness? Using interview data collected from 30 HIV-positive African American women beginning in 2005, we reveal how and why interactions with non-profit and government institutions help to explain variation between those who thrive and those who do not following an HIV diagnosis. We argue that 'framing institutions' shape the form and tenor of coping trajectories by offering initial information about one's HIV status, a conceptual framework for understanding what it means to have HIV, language to talk about one's condition, and resources to begin restructuring one's life in the wake of a diagnosis. Ultimately, we highlight how a diverse array of non-profit and government institutions not only play a critical part in helping women cope with HIV but also renegotiate their self-conceptions as black women in the wake of receiving another stigmatizing social marker. In short, organizational ties shape women's movement from beliefs and behaviors that suggest that they are 'dying from' this disease to attitudes and actions consistent with the notion that they can 'live with' HIV.

Perceptions and health care needs of HIV-Positive mothers in India

BACKGROUND

An estimated 2.5 million Indians live with HIV/AIDS. Spread primarily through heterosexual contact, the epidemic is shifting toward women, 29% of whom are currently infected, with still more cases going unreported. As the primary caregivers for their families, women face many challenges when it comes to accessing care; these include dealing with discrimination from family, community, and health care providers, and a general lack of education, social support, and nutrition guidance and sustenance.

OBJECTIVES

The purpose of this study was to explore the perceptions and experiences of a group of HIV-positive mothers living in India to learn about the challenges they face in terms of assessing health care services, dealing with mental health stressors, and giving them a voice in designing the structure of a culturally sensitive and tailored intervention for women like themselves.

METHODS

This study used a qualitative approach using focus groups consisting of a convenience sample of 60 HIV-infected mothers recruited from a large maternity hospital and sexually transmitted disease clinic in Chennai, India. Using a semi-structured interview guide, information was solicited from participants and qualitative content analysis conducted to determine common themes discussed among the groups.

RESULTS

Participants described challenges they face on a day-to-day basis, living with HIV and factors that prevent or help them to seek, obtain, and maintain care. The women also provided recommendations for future intervention plans, to include counseling, nutritional support, psychological support, and educational services for women living with HIV.

CONCLUSIONS

Findings of this study provided a rich backdrop upon which a community-based AIDS program for HIV-positive mothers in India can now be designed.

Weighing distress: decision-making surrounding management of the pregnancy experience among HIV-infected Thai women

The researchers conducted this grounded theory study in order to describe the decision making surrounding management of the pregnancy experience of 38 pregnant, HIV-infected Thai women. Data were collected using in-depth interviews and an open-ended questionnaire, and they were analyzed using constant comparative analysis. We found that "weighing distress" was the core category of the decision-making process. The supporting categories were being ambivalent about continuing the pregnancy, exploring alternative options, and selecting the appropriate choice. Health care providers should encourage family members to participate and be involved in the women's decision-making processes.

"Under My Umbrella": the housing experiences of HIV positive parents who live with and care for their children in Ontario

Positive Spaces, Healthy Places (PSHP) is the first longitudinal community-based research (CBR) initiative in Canada to examine housing stability and its relationship to health related quality of life (HRQOL) for people living with of HIV/AIDS (PHAs). As part of our mixed method data collection strategy in-depth, semi-structured interviews were conducted with 50 PHAs across Ontario to provide a deeper understanding of the impact that housing instability has on their mental and physical health. Emerging from the qualitative interviews were the unique issues and concerns that were reported by parents who live with and care for their children. These parents face dire housing, economic and social challenges that are associated with significant risks for poor health outcomes. Poor housing conditions, unsafe neighborhoods, barriers to supports for themselves and their children, HIV related stigma, discrimination, racism, and poverty have been identified by these families as being among their most pressing concerns. This results in increased stress and anxiety that has a negative impact on the mental health of HIV positive parents. In order to more effectively support HIV positive parents and their children, health and social service practices and policies must respond to the unique challenges that face these families.

Depressive symptoms among HIV-positive pregnant women in Thailand

PURPOSE

To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)-positive, pregnant women in Thailand.

DESIGN

Correlational, cross-sectional study.

METHODS

Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty-seven HIV-positive pregnant women completed questionnaires in Thai on depressive symptoms, self-esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms.

FINDINGS

Seventy-eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms (beta= .192, p<.05) were positively associated with depressive symptoms, but self-esteem (beta=-.442, p<.001), emotional support (beta=-.193, p<.01), and financial status (beta=-.209, p<.01) were negatively correlated with depressive symptoms.

CONCLUSIONS

The study results have added new knowledge about depressive symptoms and their predictors in HIV-positive pregnant women in Thailand.

CLINICAL RELEVANCE

Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV-positive individuals. The high rate of depression in our study suggests that HIV-positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self-esteem should be strengthened for HIV-positive pregnant Thai women.

Vida reprodutiva de pessoas vivendo com HIV/AIDS: revisando a literatura

No contexto atual da epidemia de HIV/AIDS, temáticas como a reprodução e a transmissão materno-infantil tornaram-se frequentes e têm suscitado diversos posicionamentos por parte de pessoas portadoras e das equipes de saúde. O presente artigo teve por objetivo examinar o impacto da infecção por HIV/AIDS na vida reprodutiva de pessoas portadoras, considerando o direito à maternidade e à paternidade. Foi realizada uma revisão da literatura acerca de aspectos biológicos, psíquicos e sociais que compõem o cenário da assistência em saúde reprodutiva. Constatou-se que a prevalência da lógica biomédica e o impacto social da epidemia restringem o exercício do direito à maternidade e à paternidade dos indivíduos portadores de HIV/AIDS. Diante disso, entende se que as políticas públicas e as ações em saúde devem ser direcionadas pelo respeito ao princípio da integralidade e pelo respeito à autonomia individual, dentro de um contexto de apoio e orientação psicossocial.

Coping with HIV: Caribbean people in the United Kingdom

Although Caribbean people in the United Kingdom are increasingly being affected by HIV/AIDS, there has been no examination of how they are coping with the illness. We investigate the coping strategies of HIV-positive Caribbean people using in-depth interviews with a purposively selected group of 25 residents of South London. The main coping strategies were more cognitive than behavioral: restricted disclosure, submersion, faith, and positive reappraisal. These strategies were intertwined in complex ways, and most were rooted in contextual factors, particularly cultural ones. Themes of loss, silence, and reinvention suffused respondents' narratives. Interventions should consider the high degree of stigmatization of HIV/AIDS in the Caribbean community, reluctance to disclose, the likelihood of an initial severe reaction to diagnosis, and external stressors. HIV-positive Caribbean people who are coping well could serve as mentors and role models for poor copers and newly diagnosed patients; establishing Caribbean-specific support groups might also assist coping.

Experiência da maternidade no contexto do HIV/Aids aos três meses de vida do bebê

O estudo investigou a experiência da maternidade em portadoras do HIV/Aids aos três meses de vida do filho/a. Participaram seis mães (19 a 30 anos), de nível sócio-econômico baixo, três das quais já eram portadoras da doença quando engravidaram, enquanto as demais souberam no parto. As mães foram entrevistadas e suas respostas foram examinadas por meio de uma análise de conteúdo qualitativa baseada em quatro eixos teóricos: vida-crescimento, relacionar-se primário, matriz de apoio e reorganização da identidade. Os resultados mostraram que as mães tinham muitas preocupações com a possibilidade de infecção do filho/a e com a saúde do bebê, além de sentimentos de incerteza quanto ao futuro, culpa e medo do preconceito. Esses temores pareciam mais intensos para as mães que tiveram seu diagnóstico no parto. O estigma do HIV/Aids, conflitos familiares, dificuldades com o diagnóstico e o tratamento, além de restrições sócio-econômicas e em sua rede de apoio exigiam grande esforço emocional dessas mulheres, sugerindo a necessidade de intervenções psicossociais visando à adesão ao tratamento, à qualidade de vida e ao desenvolvimento do bebê.

HIV peer counseling and the development of hope: perspectives from peer counselors and peer counseling recipients

Peer counseling is becoming an increasingly viable treatment option when working with people living with HIV and AIDS, especially during the diagnostic process. Unfortunately, little research has looked at the perceived benefits of peer counseling from the perspectives of clients receiving the services and those providing the services. In addition, research suggests that hope can help people living with HIV to deal with the HIV diagnosis and to improve their lifestyles; however, the authors were unable to locate any research exploring the benefits of peer counseling in fostering the hope of people living with HIV/AIDS. The present paper, following a community-based research paradigm embedded within a qualitative case study methodology explores the benefits of peer support counseling from the perspective of 12 participants living with HIV who have had experiences with peer counseling. Participants identified several thematic benefits of peer support counseling, including the role of peer counselors in the process of fostering hope. Roles and benefits of peer counseling, in relation to the facilitation of hope for people living with HIV/AIDS, suggest potentially interesting implications for future research and practice in HIV/AIDS care.

Aspectos psicológicos da gestação e da maternidade no contexto da infecção pelo HIV/Aids

A epidemia de HIV/aids tem atingido cada vez mais mulheres em idade reprodutiva, sendo que muitas já são mães ou se tornam mães quando descobrem a infecção. Os estudos revisados indicam que a infecção pelo HIV/Aids pode alterar de muitas formas a experiência da gestação e da maternidade, gerando uma sobrecarga psicológica relacionada ao estigma e ao risco de transmissão para a criança. Apesar disso, pesquisas sugerem que muitas mulheres portadoras do HIV/Aids buscam transmitir uma identidade materna positiva para os filhos e se preocupam intensamente com o futuro deles. Foram encontrados poucos estudos brasileiros sobre aspectos psicológicos da maternidade nesse contexto, em especial a respeito do impacto da profilaxia para prevenção da transmissão vertical sobre a experiência da gestação, do parto e do puerpério. As dificuldades em aderir ao tratamento e a práticas sexuais seguras denotam a falta de atenção às demandas específicas dessas mães, sendo que o foco das políticas de saúde permanece sobretudo dirigido para a criança.

Guardianship planning among HIV-infected parents in the United States: results from a nationally representative sample

OBJECTIVE

The purpose of this work was to determine the rates and predictors of guardianship planning and preferred guardians among HIV-infected parents.

PARTICIPANTS AND METHODS

Data were analyzed from interviews with 222 unmarried parents (who had 391 children) from a nationally representative sample of HIV-infected adults receiving health care. Outcome measures included parental report on the level of guardianship planning and on who their preferred guardian for each child was. Level of guardianship planning was categorized as follows: (1) parent had not identified a guardian; (2) parent had identified a guardian, but the guardian had not agreed; (3) identified guardian had agreed; and (4) legal documentation of guardianship plan was complete. We conducted bivariate and ordered logistic regression analyses on the level of guardianship planning and multinomial logistic regression on identification of preferred guardians.

RESULTS

Twelve percent of unmarried HIV-infected parents had not identified a guardian; 6% had identified a guardian but gone no further; 53% said the identified guardian had agreed; and 28% had prepared legal documentation. The preferred guardians included other biological parents (17%), spouse/partners who were not biological parents (2%), grandparents (36%), other relatives (34%), friends (7%), unrelated adoptions (1%), and others (3%). Parents with the lowest CD4 counts and parents living without other adults were more likely to have completed the guardianship planning process. Nonrelatives were most often preferred by mothers and parents with higher CD4 counts; grandparents were most often preferred by younger parents and parents who prefer speaking Spanish.

CONCLUSIONS

Pediatricians and others who take care of children with HIV-infected parents may be able to provide counseling and referrals for guardianship planning.

Self-care and mothering in African American women with HIV/AIDS

African American women are the most rapidly growing group of people in the United States diagnosed with HIV/AIDS. The purpose of this study was to explore experiences of self-care and mothering among African American women with HIV/AIDS. It is important to recognize how culture affects illness management, childrearing, and daily living to design culturally appropriate nursing interventions for African American women. Critical ethnography was used to study 10 African American mothers from the rural Southeast who were HIV positive and mothered children who were HIV positive. Domains derived from the research were disabling relationships, strong mothering, and redefining self-care. The cultural theme was creating a life of meaning. African American mothers with HIV/AIDS in the rural Southeast used culturally specific self-care and mothering strategies reflective of cultural traditions. This study acknowledges strengths of African American women and generates theory that will enhance nursing care to this population.

Burden: the phenomenon of mothering with HIV

If most mothers continually struggle to comply with perceptions of the "good mother" in the face of fatigue, self-doubt, and overwhelming emotion, what must the experience be like for HIV-infected women with dependent children to live and to mother day-to-day with an increasingly chronic, but still fatal, disease? The purpose of this phenomenological study was to gain an understanding of the mothering and end-of-life issues faced by HIV-infected women with dependent children. Sixteen HIV-infected women reflecting diversity of ethnicity, age, number and ages of children, and health status were interviewed in depth. A phenomenon of mothering with HIV revealed a constitutive pattern of burden. Themes revealed were the burden of the diagnosis and health status, the burden of whether or not to reveal to children, the burden of an unknown future for themselves and their children, and relieving the burden of the diagnosis.

Dynamics of hope in adults living with HIV/AIDS: a substantive theory

AIM

The aim of this paper was to discuss a substantive theory on the dynamics of hope in adults living with the human immunodeficiency virus/acquired immune deficiency syndrome.

BACKGROUND

Existing literature describes how the dynamics of hope have profound connections with human essence and life, wellbeing and health, suffering and illness, and nursing care, in general as well as in the context of human immunodeficiency virus/acquired immune deficiency syndrome.

METHOD

The data consisted of five original articles describing the dynamics of hope in people living with human immunodeficiency virus/acquired immune deficiency syndrome and their significant others in Finland. Meta-synthesis was adapted to synthesize the original studies into a substantive theory.

FINDINGS

The core category that emerged was the dynamically alternating balance between interconnected hope, despair and hopelessness based on folding (closing down of) and unfolding (opening up of) possibilities with regard to the dynamics of hope in dealing with the changing self and life with human immunodeficiency virus/acquired immune deficiency syndrome. The dynamics of hope include the subprocesses of hope, despair and hopelessness.

CONCLUSION

The dynamics of hope in adults living with human immunodeficiency virus/acquired immune deficiency syndrome is an important phenomenon in nursing practice and nursing science. In taking care of people living with acquired immune deficiency syndrome, factors contributing to folding possibilities should be minimized, if possible, and factors contributing to unfolding possibilities should be nourished. The present study adds to the knowledge-base of nursing science about the dynamics of hope in people living with acquired immune deficiency syndrome. Future research should focus on testing this theory in people living with acquired immune deficiency syndrome.

Despair and hopelessness in the context of HIV - a meta-synthesis on qualitative research findings

AIM

The aim of the study was to explore the concepts of despair and hopelessness in the context of human immunodeficiency virus based on previous studies.

BACKGROUND

Some of the consequences of living with human immunodeficiency virus or as a significant other to a person with human immunodeficiency virus include despair and hopelessness.

METHODS

The study is based on five earlier studies describing the dynamics of hope (including despair and hopelessness) in adult persons living with human immunodeficiency virus.

RESULTS

Despair consists of two sub-processes. The downward sub-process of despair refers to stopping and being stuck in a situation, losing grip and sinking into a narrowing existence, focusing on impossibility and losing perspective of the future. Furthermore, the downward orientation means questioning the possibility of hope. The upward sub-process of despair implies fighting against sinking and fighting to rise back up with a glimmer of hope. Hopelessness is the polar opposite of hope and includes sub-processes of helplessly giving up everything (including hope) and living in emptiness in the face of an assumed non-existing future, collapsing mentally, and becoming paralyzed without reason to live.

CONCLUSIONS

The results of this study support the findings of previous studies revealing that despair and hopelessness are possible elements in the life situation of persons living with human immunodeficiency virus and significant others to persons living with human immunodeficiency virus. The results of this study help to define the contents of despair and hopelessness, and help us to distinguish one from the other. The dual-dimensionality of despair has not been pointed out in previous studies and in this way the present study offers new information about the phenomenon of despair.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study offer clinical guidelines on a conceptual level about how to detect these phenomena in persons living with human immunodeficiency virus and their significant others. Furthermore, the findings offer a starting point for interventions used to alleviate despair and hopelessness. Suggestions for suitable interventions are offered. The results of this study underline the clinical relevance of these phenomena in adding new information to the previously documented consequences of despair and hopelessness.

The Grounded Theory Method and Maternal-Infant Research and Practice

Perinatal nurses have found qualitative methods helpful in capturing the social, cultural, and relational aspects of their work with women and their families. This article describes the components of the grounded theory method and illustrates each with examples from recent maternal-infant studies. Grounded theory is an inductive method of qualitative analysis that generates theory from data. The grounded theory method includes several key strategies such as theoretical sensitivity, theoretical sampling, constant comparison, increasingly abstract consideration of the data, and discovery of a core variable or basic social process that describes the pattern of the phenomenon under study. This method may strengthen qualitative nursing studies because of its generalizability and applicability across settings. By remaining grounded in and connected to the data, grounded theory can be adapted to many contexts, making it useful to the practicing nurse. Knowledge generated from grounded theory has great potential to assist us in our inquiry into the needs of mothers, fathers, infants, and their families.

The process of disclosing HIV serostatus between HIV-positive mothers and their HIV-negative children

The current study explores the impact of HIV disease on mothers as they face the task of balancing their own physical and psychological needs with the needs of their families as well as the additional burden of deciding whether to disclose their HIV status to their children. Qualitative interviews were conducted with 35 women and 19 children 10-18 years of age. Mothers were interviewed about the experience of being an HIV-positive mother and issues regarding disclosure. Children were also interviewed about the experience of having a mother who is HIV-positive and issues regarding disclosure. The decision to disclose was dependent on the child's developmental level, the degree of the mother's illness, and in some cases this decision was taken from mothers when someone else disclosed their HIV status to their children. Positive aspects of disclosure from the mother child dyads included open, honest communication, and closer relationships between mothers and their children. Common negative themes emanating from the data included fear, uncertainty, forced secrecy for fear of being ostracized based on the stigma associated with the disease, behavioral changes in the children, and shifting responsibilities between the mother and the child. Findings of the study suggest that disclosure, and all it entails, remains a vital issue for mothers who are HIV-positive. In addition, the findings reflected that children and their mothers have very different perspectives regarding the process and the effects of disclosure of the mother's HIV status. Clinical implications and recommendations for further research are discussed.

Motherhood in the context of maternal HIV infection

Metasummary and metasynthesis techniques were used to integrate findings pertaining to motherhood in 56 reports of qualitative studies conducted with HIV-positive women. Motherhood in the context of maternal HIV infection entailed work directed toward the illness itself and the social consequences of having HIV infection in the service of two primary goals: the protection of children from HIV infection and HIV-related stigma and the preservation of a positive maternal identity. Motherhood both intensified and mitigated the negative physical and social effects of HIV infection. HIV-positive mothers engaged in a distinctive kind of maternal practice-virtual motherhood-to resist forces that disrupted their relationships with and ability to care for their children, as well as their identities as mothers.

Classifying the findings in qualitative studies

A key task in conducting research integration studies is determining what features to account for in the research reports eligible for inclusion. In the course of a methodological project, the authors found a remarkable uniformity in the way findings were produced and presented, no matter what the stated or implied frame of reference or method. They describe a typology of findings, which they developed to bypass the discrepancy between method claims and the actual use of methods, and efforts to ascertain its utility and reliability. The authors propose that the findings in journal reports of qualitative studies in the health domain can be classified on a continuum of data transformation as no finding, topical survey, thematic survey, conceptual/thematic description, or interpretive explanation.

Dynamics of Hope in HIV/AIDS Affected People: An Exploration of Significant Others’ Experiences

Hope is an important protective phenomenon in human life, particularly given that long-lasting despair or hopelessness may threaten human existence. However, previous knowledge on the topic related to people affected by HIV/AIDS is scant. The purpose of this study was to explore the dynamics of hope in significant others of people living with HIV/AIDS and persons living with HIV (PLWH) or AIDS (PLWA) from the perspective of significant others in Finland. Eleven interviews were conducted with six significant others. The data were analyzed using the grounded theory method. The dynamics of hope, as it emerged from the data, is constructed of three main elements: hope, despair, hopelessness, and their reciprocal relationships. An alternating balance between hope, despair, and hopelessness based on the factors contributing to them emerged as central in the dynamics of hope. The dynamics of hope are closely connected to the basic process of searching for one’s own way with HIV/AIDS, in becoming HIV-positive, and living with HIV/AIDS. In significant others, the dynamics of hope are closely connected to the basic process of HIV, changing from abstract to concrete in a relationship with a PLWH/PLWA.

Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women

A qualitative metasynthesis of qualitative findings ought to be more than a mere summary of those findings. Yet the processes by which the interpretive innovation expected of qualitative metasynthesis projects can be achieved remain opaque. Several analytic devices for the metasynthesis of findings were clarified in the course of an ongoing methodological project involving 45 reports of qualitative studies of HIV-positive women. These devices include the creation of a taxonomy of findings, the explicit use of sustained comparisons, the translation of in vivo concepts, and the use of imported concepts. Any qualitative metasynthesis of findings constitutes an interpretation at least three times removed from the lives represented in them. Clarifying the analytic devices used to create such metasyntheses is essential to demonstrating that despite being far away from participants' lives, these interpretations remain close to them.

Redefining treatment: how biological mothers manage their children's treatment for perinatally acquired HIV

Current medical thinking supports early initiation of aggressive approaches to the management of perinatally acquired HIV infection. Biological mothers, however, may not endorse this way of managing their child's condition. For this study, grounded theory methods were used to conduct secondary analysis of eight semi-structured in-depth interviews with parents of children with perinatally acquired HIV. Biological mothers' perspectives on their children's treatment for perinatally acquired HIV infection, the strategies they used to manage their children's treatment and sociocultural influences on mothers' beliefs and actions are explored and described. Creation of a framework that may be useful for future research and recommendations for clinical practice are offered.

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study

BACKGROUND

Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective.

AIM

The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS.

METHODS

The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method.

FINDINGS

The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'.

CONCLUSIONS

The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Mother-child interaction in the presence of maternal HIV infection

This comparative study evaluated mother-child interaction in southeastern U.S. mother-child dyads where the mother was HIV positive and determined if the presence of maternal HIV infection was associated with differences in the quality of the mother-child interaction. A comparison was made between two groups of mother-child dyads, one where the mother was HIV positive (N = 25) and one where the mother was not HIV positive (N = 25). The Barnard model of mother-infant interaction guided this study. The quality of interaction within the dyads was assessed using the Nursing Child Assessment Teaching Scales (NCATS). Associated maternal, child, and environmental factors were described using an interview form, Centers for Epidemiologic Studies Depression Scale, and the Bayley Infant Neurodevelopmental Screener. The quality of mother-child interaction in the two groups was compared using chi square and paired t tests. Findings from this research showed no statistically significant difference in mother-child interaction (measured by NCATS) between the HIV-positive and HIV-negative groups. Although maternal symptoms of depression were noted in more of the HIV-positive mothers, covariant analysis failed to show this factor had any significant influence on mother-child interaction scores between the groups. It was noted that total sample (N = 50) group mean scores on NCATS maternal subscale and total interaction were significantly lower than published population norms. As the mother-child interaction has critical implications for the child, strategies to improve reciprocity need to be developed in this population, and attention must be paid to mental health needs of HIV-positive women.

Protease inhibitors: changing the way AIDS case management does business

The purpose of the qualitative evaluation study discussed in this article was to examine the AIDS case management model under which five nonprofit AIDS service organizations (ASOs) in Midcity were operating. The study was organized around 40 qualitative interviews with executive directors, directors, and case managers. The finding was that AIDS case management is evolving to accommodate the changing environmental/contextual conditions that have resulted from combination drug therapies (protease inhibitors) introduced in 1996. The agencies are responding to the changes individually rather than as a network, and responses vary among the agencies. Institutional theory, an examination of the interconnectedness of clients, the ASOs, and their environmental context guided the analysis of the findings.