Psychological interventions in infection with the human immunodeficiency virus

Towards a family-centered approach to HIV treatment and care for HIV-exposed children, their mothers and their families in poorly resourced settings

This article provides a summary of emerging psychosocial evidence relevant to the success of comprehensive family-centered approaches to HIV prevention, treatment, care and support programs in poorly resourced settings. This report synthesizes current evidence on maternal, paternal and family experiences of HIV prevention, diagnosis, treatment, adherence and disclosure, with special focus on HIV-infected mothers and HIV-exposed children. Taking a developmental approach, we explore the current challenges and opportunities towards a family-centered approach within the continuum of HIV treatment and care, beginning in pregnancy and following the course of childhood. The discussion is limited to early and middle childhood and excludes discussion of special issues emergent in adolescence, which would warrant discussion outside the scope of this article. Attention is drawn to the complexity of problems arising within the family context and the need for improvements in the integration of aspects of treatment, care and support. While this article focuses on examples from sub-Saharan Africa, the lessons learnt and future challenges outlined are applicable to most low- and middle-income countries, and to poorly resourced contexts in higher-income countries.

A atuação do psicólogo em ONG/AIDS

Desde o início da epidemia, a Psicologia tem contribuído na luta contra a AIDS através da assistência psicológica aos portadores do HIV e seus familiares e na prevenção às DST/AIDS. Associado à epidemia e às respostas do movimento social organizado, surgiu um novo contexto de atuação para os profissionais da Psicologia: as organizações não-governamentais de luta contra a AIDS. Considerando a escassez de literatura brasileira sobre a contribuição da Psicologia nesse contexto, o objetivo deste relato de experiência é descrever a atuação dos psicólogos em uma organização não governamental de Ribeirão Preto/São Paulo/Brasil, o Grupo Humanitário de Incentivo à Vida (GHIV). A diversidade de atividades realizadas pelos psicólogos nessa ONG vão do atendimento psicoterápico individual e coordenação de diferentes tipos de práticas grupais à organização da estrutura da ONG e à supervisão da atuação política dos membros da mesma. Entre os desafios gerados pela atuação do psicólogo nesse contexto estão a integração entre prática profissional e compromisso social e o lugar da pessoa portadora na relação com o psicólogo. Eles explicitam como a AIDS veio questionar práticas profissionais tradicionais e exigir alternativas na atenção em saúde.

Support group participation among persons with HIV: Demographic characteristics and perceived barriers

Support groups are widely available for persons living with HIV and some evidence supports their efficacy. However, limited information exists regarding characteristics of those who utilize HIV support groups. The present study examined demographic characteristics and perceived barriers of attenders and non-attenders of HIV support groups via a mail survey. The 35 respondents were predominantly white (71.4%), male (65.7%), homosexual/bisexual (57.1%) and diagnosed with HIV within the last five years (62.8%). Results suggested that HIV support group attenders had higher educational attainment and a longer time since diagnosis than non-attenders. Respondents who expressed interest in HIV support group participation were diagnosed more recently than those who did not express interest. Respondents who had attended other types of support groups reported fewer perceived barriers to participation in HIV support groups. Overall, findings suggest that the perception of barriers may be related to interest and participation in support groups for HIV and other problems.

Clinical practice guidelines for the psychosocial care of adults with cancer

Clinical practice guidelines are increasingly being developed in medical settings to provide evidence-based recommendations to guide the clinical care of patients. The development of Clinical practice guidelines for the psychosocial care of patients with medical illness is a newer initiative, and more complex as the target audience includes health care professionals from diverse backgrounds. In Australia, the National Breast Cancer Centre and National Cancer Control Initiative have collaborated to develop Clinical practice guidelines for the psychosocial care of adults with cancer, funded by the Australian Government Department of Health and Ageing. This paper outlines the development of these guidelines in the international context, gives an overview of their content, and describes strategies for their implementation and evaluation.

Grupo de apoio aberto para pessoas portadoras do HIV: a construção da homogeneidade

Há um debate na literatura a respeito da homogeneidade na composição dos grupos para portadores do HIV, segundo estágios da doença, formas de infecção e sexo dos participantes. Este estudo, baseado em uma concepção construcionista da terapia e da produção do conhecimento, buscou analisar como os sentidos sobre a soropositividade e o apoio eram negociados em uma sessão de um grupo de apoio voltado a esta população. Observamos que a homogeneidade e o apoio, antes de serem categorias a priori usadas para organizar o grupo, são ativamente construídas na e através da situação grupal por seus participantes. Implicações éticas e metodológicas decorrentes dessa análise apontam para o reconhecimento das condições sócio-históricas de construção dos sentidos da soropositividade e da hegemonia de algumas de suas descrições.

"Being dealt with as a whole person." Care seeking and adherence: the benefits of culturally competent care

The purpose of this study is to characterize the relationship between identity and health care experiences (including antiretroviral therapy utilization) among HIV-positive sexual minority males. This qualitative study used grounded theory with data collection occurring through focus groups and interviews. A questionnaire was used to complete a demographic profile. The study included 47 HIV positive participants from three minorities: gay men, bisexual men and transgendered persons, gender identifying as female and or living as women. Sessions elicited information on: (1) general experiences with health care, (2) experiences with HIV antiretroviral therapies and issues surrounding access, and (3) adherence to these therapies and identity in relation to health care. These textual data revealed three themes: (1) the importance of sexual identity and its social and cultural context, (2) the differences in the health concerns between the sexual minorities and (3) a wide spectrum of experiences with the health care system that provide information surrounding the access to and adequacy of health care. Successful health care providers are aware of different issues that may play a role in the provision of health care to these sexual minorities. Providers awareness of sexual and social identity and the related different cultural values, beliefs and custom enhance care seeking and therapeutic adherence. For sexual minorities, primary care remains the most important entry point into the health care system. Cultural competence of care providers can foster patient's care seeking and adherence to treatment.

Clinical care issues for women living with HIV and AIDS in the United States

As the number of women infected with HIV in the United States continues to increase, the medical community is faced with the challenge of providing adequate and appropriate care to them. This paper reviews key questions concerning the state of knowledge on the epidemiology, biology, and clinical care of women living with HIV and AIDS in the United States. Because heterosexual transmission accounts for a growing number of cases among women, biological factors and cofactors that may enhance women's susceptibility to HIV infection are also reviewed. HIV-related gynecological issues are presented separately to evaluate whether gynecological complications are distinct in HIV-uninfected and HIV-infected women. Questions of whether there are sex-specific differences in the efficacy and adverse effects of new antiviral agents are discussed. In addition, significant gaps are highlighted that still exist in our understanding of both the effects of HIV and HIV-related drugs upon pregnancy. Finally, the psychiatric stresses and complications that affect women living with HIV and AIDS are also discussed. In each section of this review, gaps in our knowledge of these issues are identified. To properly address these disparities in knowledge, not only do efforts to gather sex-specific biomedical data need to be more exacting, but there is a distinct need to conduct more sex-specific research concerning HIV.

Lipodystrophy Syndrome in Patients with HIV Infection

Current antiretroviral therapy has lead to longer survival in patients infected with HIV, but it is also associated with new and important problems. Body fat redistribution and metabolic abnormalities, the so-called lipodystrophy syndrome, are among the most prevalent and worrisome ones. While an increasing number of patients infected with HIV are becoming affected by this syndrome, the pathogenesis of this syndrome and how to prevent and treat the problem all remain largely unknown. Body fat changes stigmatise the bodies of patients infected with HIV giving them a similar look to that seen in patients some years ago when the wasting syndrome was more prevalent and HIV infection was ultimately fatal. The psychological impact of body fat changes may be severe enough to affect a patients' desire to continue with antiretroviral therapy. Metabolic abnormalities, probably with the exception of symptomatic diabetes mellitus and hypertriglyceridaemia-induced pancreatitis, do not have an immediate impact on the quality of the lives of patients with HIV. However, their potential long term cardiovascular and bone consequences may increase the morbidity and the mortality of patients infected with HIV through noninfectious diseases. The impact of lipodystrophy on patients infected with HIV is not readily captured with the classic instruments used to measure quality of life and hence it is necessary to modify them urgently. Though treating lipodystrophy seems fully justified, there is no proven treatment for this problem, although a number of treatments have been used with varying success. Despite the recognition that lipodystrophy may have important psychological repercussions, the best psychological approach for this problem is not known at present. Although lipodystrophy has its own peculiarities, existing knowledge about how to psychologically help other patients with deforming body changes might be of help for patients infected with HIV, or at least may act as a starting point.

A psychological epidemiology of people seeking HIV/AIDS counselling in Kenya: an approach for improving counsellor training

OBJECTIVE

This study develops a typology of psychological problems reported during HIV/AIDS counselling. This typology provides a framework for training paraprofessional counsellors (PPCs) in East Africa.

DESIGN

Study participants included 307 Kenyans tested for HIV at any of six clinics in Nairobi specialising in STDs, tuberculosis and other infectious diseases. Pre-test, post-test, and follow-up counselling was provided by 16 PPCs who are themselves HIV-positive. Data consisted of demographic, physical and psychological information reported by 168 clients who sought follow-up counselling.

METHODS

Counselling data were coded using an ipsative method; a unique code was assigned to every distinct topic. Factor analysis with a Varimax rotation reduced the original psychological variables into logical groupings. Multivariate analysis examined the relationship of factors and demographic characteristics.

RESULTS

Clients reported 1-10 physical and 1-23 psychological complaints in a single session. Sixty-five percent of female clients reported > or = eight psychological problems; 49% of males reported > or = eight psychological problems. Factor analyses allowed the 109 reported psychological events to be assigned to 15 categories of problems. Multivariate analyses explained little of the variance in the relationship between each client's demographic profile and the psychological factors.

CONCLUSIONS

Training for PPCs should be relevant to problems encountered during counselling. Results indicate that PPCs can expect clients to present one or more of the 15 factors during counselling. Demographic characteristics explained small amounts of variance in the distribution of factor scores. The 15 factors produced in this study, although descriptive and preliminary, could form the basis of a training curriculum for HIV PPCs.