Showing papers in "Aids Care-psychological and Socio-medical Aspects of Aids\/hiv in 2004"

Popular opinion leaders and HIV prevention peer education: resolving discrepant findings, and implications for the development of effective community programmes.

Abstract: A series of community-level trials undertaken in the United States over the past 10 years established the effectiveness of an HIV prevention intervention that systematically identifies, recruits, trains, and engages the popular opinion leaders (POLs) of a population to serve as behaviour change endorsers Recently, several investigators reported unsuccessful attempts to implement peer education programmes for men who have sex with men in the United Kingdom and raised questions about whether peer-based programmes are effective or feasible However, POL is a theory-based and very specialized intervention, and the UK peer education programmes did not incorporate many of POL's core or essential elements Consequently, they were not evaluations of POL In this article, core elements of the popular opinion leader model are presented; interpretations are made of possible reasons for the discrepant findings of the UK peer education and US POL interventions; and practical issues for applied programme development a

Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa.

Abstract: AIDS-related stigmas are pervasive in some segments of South African society and stigmas can impede efforts to promote voluntary counselling and testing and other HIV-AIDS prevention efforts. The current study examined associations among the belief that AIDS is caused by spirits and supernatural forces, AIDS-related knowledge and AIDS-related stigmas. A street intercept survey with 487 men and women living in a Black township in Cape Town, South Africa showed that 11% (n=54) believed that AIDS is caused by spirits and supernatural forces, 21% (n=105) were unsure if AIDS is caused by spirits and the supernatural, and 68% (n=355) did not believe that AIDS is caused by spirits and supernatural forces. Multiple logistic regression analyses controlling for participant age, gender, years of education and survey venue showed that people who believed HIV-AIDS is caused by spirits and the supernatural demonstrated significantly more misinformation about AIDS and were significantly more likely to endorse repulsion ...

Substance use and high-risk sex among men who have sex with men: a national online study in the USA.

Abstract: This paper describes drug and sexual risk behaviors during a six-month period in 2001 of 2,916 gay and bisexual men who were recruited online. Bivariate and multivariate analyses examined correlates of unprotected anal intercourse (UAI). Drug and alcohol use were also examined by US region. UAI was associated with using alcohol or drugs, including poppers, crystal methamphetamine, cocaine, marijuana and Viagra before or during sex. Meeting sex partners both online and offline and having multiple sex partners were also predictive of UAI. Significant regional differences were seen in the prevalence of drug use and alcohol use. Findings are discussed in relation to the need to integrate messages about the relationship between drug use and sexual behavior into HIV prevention programs.

Social context of HIV risk behaviours among male-to-female transgenders of colour.

Abstract: To explore the social context of drug use and sexual behaviours that put male-to-female (MTF) transgenders at risk for HIV, focus groups were conducted consisting of African American, Latina and Asian and Pacific Islander MTF transgenders (N=48) who reside or work in San Francisco, California. Participants were likely to report having unprotected sex with primary partners to signify love and emotional connection, as well as to receive gender validation from their partners. In contrast, viewing sex work with customers as a business encouraged intentious to use condoms. Safer sex intentions with customers were frequently undermined by urgent financial needs, which stemmed from transphobia, employment discrimination and costly procedures associated with gender transition. Participants reported using drugs as a way to cope with or escape life stresses associated with relationships, sex work, transphobia and financial hardship. Interventions with at-risk MTF transgenders should address the interpersonal and so...

Influences of social power and normative support on condom use decisions: a research synthesis.

Abstract: A meta-analysis of 58 studies involving 30,270 participants examined how study population and methodological characteristics influence the associations among norms, control perceptions, attitudes, intentions and behaviour in the area of condom use. Findings indicated that control perceptions generally correlated more strongly among members of societal groups that lack power, including female, younger individuals, ethnic-minorities and people with lower educational levels. Furthermore, norms generally had stronger influences among younger individuals and among people who have greater access to informational social support, including males, ethnic majorities and people with higher levels of education. These findings are discussed in the context of HIV prevention efforts.

Predictors of antiretroviral adherence.

Abstract: This study was conducted in order to help determine the key factors that predict adherence to antiretroviral medications. A total of 115 HIV/AIDS patients who were having trouble adhering to their antiretroviral regimens completed face-to-face interviews in which adherence levels, medication side effects, mental health, social support, patient-provider relationship characteristics, substance use and health anxiety were assessed. Three measures of adherence were used: adherence over the past three days, adherence over the past week, and adherence over the past month. Logistic regression analyses indicated strongest prediction of three-day adherence, with mental health, social support, patient-provider relationship characteristics and side effects contributing to prediction. Past week adherence was associated with age and social support measures, and showed a marginal association with side effects. Past month adherence was less strongly predicted, with social support and alcohol use contributing to prediction. Thus, a variety of factors were found to determine adherence, and implications of the findings for adherence models and interventions are discussed.

Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in Northern Tanzania

Abstract: Guided by the conceptual framework of the Health Belief Model, this study aimed to identify factors associated with pregnant women's expressed willingness to accept voluntary counselling and HIV-testing (VCT). A cross-sectional interview survey of 500 pregnant women, complemented by focus group discussions, was conducted in the Kilimanjaro region of Tanzania. Constructs derived from the Health Belief Model explained 41.7% of women's willingness to accept VCT. Perceived high personal susceptibility to HIV/AIDS, barriers related to confidentiality and partner involvement, self-efficacy regarding alternative feeding methods and religion were all shown to be associated with willingness to accept VCT. The women's acceptance of VCT seems to depend upon their perceiving that VCT and alternative feeding strategies provide clear benefits, primarily for the child. Whether a positive attitude to VCT and alternative feeding strategies are transformed into actual behaviour depends on a set of complicated decisions in ...

WHOQOL-HIV for quality of life assessment among people living with HIV and AIDS: results from the field test

Abstract: Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres ( Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties ( a values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being ( F = 13.1, p 34 years) demonstrated poorer QoL on physical (F = 20.6, p < 0.001) and levels of independence (F = 18.3, p < 0.001), while younger people showed poorer environmental (F = 34.6, p < 0.001) and spiritual (F = 23.5, p < 0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.

Reflecting on the experience of interviewing online: perspectives from the Internet and HIV study in London.

Abstract: This paper considers some of the strengths and weaknesses of conducting synchronous online interviews for qualitative research. It is based on a study among gay/bisexual men that used both qualitative and quantitative methods to explore the association between seeking sex through the Internet and HIV transmission risk. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one by the first author (MD) about their experience of using the Internet to find sexual partners and negotiating condom use for anal sex. Thirty-five men were interviewed online, while 93 were interviewed face-to-face (i.e. offline). This paper draws on MD's experience of conducting these interviews--both online and face-to-face. Synchronous online interviews have the advantage of being cheap, convenient and attractive to people who do not like face-to-face interviews. However, some of the social conventions and technical limitations of computer-mediated-communication can introduce ambiguity into the online dialogue. To minimize this ambiguity, both interviewer and interviewee have to edit their online interaction. One of the distinctive features of the online interview is that it emerges as a form of textual performance. This raises fundamental questions about the suitability of the synchronous online interview for exploring sensitive topics such as risky sexual behaviour.

Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa.

Abstract: Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N = 272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N = 119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.

Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the smart sex quest project

Abstract: There is an increasing interest in developing interventions for HIV and STD prevention that can be delivered on the Internet. However, we know little about what it takes to identify, recruit and retain participants in interventions so that we can test their efficacy and effectiveness. Objectives for this investigation were to evaluate rates of recruitment and retention in an Internet-based randomized controlled trial (RCT) to increase sexually transmitted disease (STD) prevention among men who have sex with men (MSM). The Smart Sex Quest study was a RCT conducted online. Eligible participants were MSM, at least 18 years old and US residents. After completing a baseline risk assessment, participants were exposed to tailored or control messages and asked to return to the site at three months for a follow-up interview. From January 2002 through June 2003, 3,625 persons logged on as potential study participants; of these, 563 were not eligible, while 1,286 left the site without filling out a baseline survey. ...

Mental disorders and drug abuse in persons living with HIV/AIDS

Abstract: This article reviews the literature on the prevalence of mental and substance use disorders among persons living with HIV/AIDS. Drug use, both injection and non-injection, substantially increases the risk for HIV infection. While injection drug users have the highest prevalence rates for HIV, substantially elevated rates of HIV infection are also present among crack cocaine users and individuals with substance use disorders generally. Persons with HIV/AIDS and a mental and/or substance use disorder have highly variable patterns of accessing services. Persons with HIV/AIDS who have a serious mental illness are more highly involved with services than other groups. Most individuals with co-occurring disorders report some involvement with outpatient primary medical care, although ancillary services such as mental health and substance abuse treatment, transportation assistance, and case management improve involvement in medical care. Women with HIV/AIDS and co-occurring mental and substance use disorders experience unique vulnerabilities, particularly those related to exposure to traumatic events. Given the complexity of needs with which triply or multiply diagnosed individuals present, effective treatment programmes are likely to be those that provide some degree of integrated care.

Women from Africa living with HIV in London: a descriptive study

Abstract: There are no studies that have examined the particular needs and experiences of African women living with HIV in the UK at a time when they represent an increasingly large proportion of the UK HIV epidemic. This study explores the illness biographies and daily lives of HIV-positive African women receiving treatment in London. Sixty-two women from 11 African countries attending HIV specialist clinics in five London hospitals participated in self-completion questionnaires and in depth semi-structured interviews. Using a narrative approach, women were asked to talk about their HIV status in the broader context of their life history. Important differences exist within this group based mainly on nationality, income, education level and legal status in the UK. However, marked similarities also emerged which were related in part to their situation as migrants and were compounded by their illness. Stigma, both actual and perceived, had a profound impact on women's lives, making control of information about their situation a matter of acute concern. This had an effect on how women accessed health services and voluntary sector agencies. The resilience of women in dealing with difficulties in their lives was strengthened by religious belief. Such similarities and differences need to be properly understood by health and social care professionals if they are to offer the most appropriate care for this growing population of patients.

Use of gay Internet sites and views about online health promotion among men who have sex with men.

Abstract: In May-June 2002, 4,974 men who have sex with men (MSM), average age 31 years, completed a self-administered questionnaire online accessed through two popular gay Internet sites in the UK (gaydar and gay.com UK). Most men were white (95%), employed (83%), lived in the UK (91%) and self-identified as gay (85%). Nearly half (46%) had not been tested for HIV, while 6% said they were HIV-positive. One-third (31%) reported high-risk sexual behaviour in the previous three months, i.e. unprotected anal intercourse with a partner of unknown or discordant HIV status. Nearly all the men (82%) had looked for a sexual partner on the Internet and three-quarters had been doing so for more than a year. Almost half the men (47%) said they preferred to meet men through the Internet rather than in bars or other 'offline' venues. Although nearly 40% of men said the most important reason for using these Internet sites was to find sexual partners, a further 17% said they primarily used them to have contact with other men, 16% because they were bored, 12% for entertainment, 4% because they were lonely and 3% because they were addicted to it. The majority of men in this survey had favourable attitudes towards online health promotion. Most men thought that Internet sites should allow health workers into chat-rooms (75%); would click on a banner to find out about sexual health (78%); and said if they met a health worker in a chat-room they would find out what they had to say (84%). In multivariate analysis, being HIV-positive, older age and high-risk sexual behaviour were all independently associated with an increased frequency of using the Internet to look for sex (p < 0.05). The Internet has emerged as an important meeting place for men who have sex with men. As online HIV prevention initiatives are developed it will be important to monitor the extent to which the favourable attitudes seen here are reflected in preventive behaviours.

Enabling households to support successful migration of AIDS orphans in southern Africa

Abstract: Most southern African orphans are cared for by extended families but the implications of the spatial dispersal of such families are seldom recognized: orphans often have to migrate to new homes and communities. This paper, based on qualitative research conducted with children and guardians in urban and rural Lesotho and Malawi, examines orphans’ migration experiences in order to assess how successful migration might best be supported. Most children found migration traumatic in the short term, but over time many settled into new environments. Although much AIDS policy in southern Africa stresses the role of communities, the burden of care lay with extended family households. Failed migrations, which resulted in renewed migration and trauma, were attributable to one of two household-level causes: orphans feeling ill-treated in their new families or changes in guardians’ circumstances. Policy interventions to reduce disruption and trauma for young AIDS migrants should aim at facilitating sustainable arrangem...

Giving care to people with symptoms of AIDS in rural sub-Saharan Africa.

Abstract: In rural sub-Saharan Africa, most care for patients with AIDS is provided at home by relatives Caring for those with AIDS is assumed to be a substantial burden, but little is known from the perspectives of those who provide the care In this paper we use interviews with caregivers, supplemented with survey data from a larger study in rural Malawi, to investigate this issue We focus on the caregivers' diagnoses of the illness of their patients, the type and duration of the care they provided, the support they received from relatives and other members of the community, and the extent to which caregiving was experienced as an emotional, physical, and financial burden Although none of the caregivers knew of a formal diagnosis and few explicitly named their relative's disease as AIDS, most appeared to suspect it They described the illness using the typical symptoms of AIDS as they are locally understood and sometimes related the illness to their patient's sexual history The care, typically given by close female relatives of the patient, was limited to the care that would be given to anyone who was seriously ill What was striking, however, was the compassion of the caregivers and the attempts they made to provide the best care possible in their circumstances For most caregivers, kin and members of the community provided social, moral, and physical support, as well as modest financial assistance Caregiving was physically and emotionally demanding and confined the caregivers to their home, but most caregivers did not consider caregiving a problem primarily because the patients were close relatives The financial impact of caregiving was typically modest because the caregivers had very little income and few possessions to sell

Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance use and its implications for health outcomes.

Abstract: Many individuals living with HIV have been exposed to some type of traumatic event during their lives and may be living with symptoms of post-traumatic stress disorder (PTSD). A substantial number of these individuals are also likely to show evidence of a co-morbid substance use disorder (SUD). There is reason to believe that the co-occurrence of HIV and PTSD or co-morbid PTSD and SUD (PTSD/SUD) may predict poorer health outcomes. There are several pathways through which PTSD or PTSD/SUD might adversely impact the health of individuals living with HIV, including participation in negative health behaviours, low levels of adherence to antiretroviral medications, and/or a direct, deleterious effect on immune function. Psychological interventions are needed to treat PTSD and PTSD/SUD in HIV-positive individuals, and reduce the negative impact of these conditions on health outcomes. This article will explore data on the prevalence of trauma exposure, PTSD, and PTSD/SUD among individuals living with HIV, the pathways through which these conditions might affect health, possible interventions for PTSD and PTSD/SUD for individuals living with HIV, and methods for integrating care for individuals with these disorders. Future directions for research related to HIV, PTSD, and PTSD/SUD will also be discussed.

Measuring quality of life among HIV- infected women using a culturally adapted questionnaire in Rakai district, Uganda

Abstract: To examine self-reported quality of life and health status of HIV-infected women and a comparison sample of HIV-uninfected women in rural Uganda, we culturally adapted a Lugandan version of the Medical Outcomes Survey-HIV (MOS-HIV). We administered a cross-sectional survey among 803 women (239 HIV-positive and 564 HIV-negative) enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda. The interview took 20 minutes and was generally well-accepted. Reliability coefficients were >0.70, except for role functioning, energy and cognitive function. MOS-HIV scores for HIV-positive women were correlated with increasing number of physical symptoms and higher HIV viral load. Compared to HIV-negative women, HIV-positive women reported lower scores than HIV-negative women for general health perceptions, physical functioning, pain, energy, role functioning, social functioning, mental health and overall quality of life (p all /=4 symptoms. In summary, HIV-positive women reported significantly poorer functioning and well-being than HIV-negative women. We conclude that patient-reported measures of health status and related concepts may provide a feasible, reliable and valid method to assess the impact of HIV/AIDS and future therapeutic interventions to improve patient outcomes in rural Africa.

Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States.

Abstract: The current study delineated patterns and predictors of adherence to antiretroviral therapy in 329 persons living with HIV disease in rural areas of 12 US states. Participants provided self-report data on patterns of HIV medication adherence, reasons for missing medication doses, psychological symptomatology, life-stressor burden, social support, ways of coping, coping self-efficacy, the quality of their relationship with their main physician, and barriers to health care and social services. Based on adherence data collected via retrospective, self-report assessment instruments, only 50% of participants adhered consistently to antiretroviral therapy regimens in the past week. Consistent adherence was more common in White participants, persons who had progressed to AIDS, and 'native infections' (i.e. persons who were born, raised, and infected in their current place of residence). Logistic regression analyses indicated that consistent adherence was reported by persons who drank less alcohol, had a good relationship with their main physician, and engaged in more active coping in response to HIV-related life stressors. As the number of rural persons living with HIV disease continues to increase, research that identifies correlates of non-adherence and conceptualizes approaches to optimize adherence in this group is urgently needed.

Abused women report greater male partner risk and gender-based risk for HIV: findings from a community-based study with Hispanic women

Abstract: The purpose of this study was to assess the relationship between intimate partner violence (IPV) and sexual risk in terms of safer sex behaviour and intent, individual and gender-based HIV risk factors, and male partner HIV risk, among a lower-income community-based sample of Hispanic women reporting a current male sexual partner. Baseline survey data on HIV-related behaviours and risk factors gathered from participants (N=170) of an HIV intervention evaluation study for Hispanic women were used for current analyses. Participants were age 18-36 years, predominantly born outside of the continental US (88.8%) and not English fluent (68.2%). Adjusted logistic regression analyses and 95% confidence intervals were conducted to assess the relationships between male-perpetrated IPV in the past three months and sexual risk variables. One-fifth (21.2%) of the sample reported male-perpetrated IPV in the past three months. Abused women were significantly more likely than those not abused in the past three months to report high STD/HIV risk perceptions (OR=3.02, 95% CI=1.33-6.88), gender-based risk including sexual control by male partners (OR=3.09, 95% CI=1.41-6.76) and male partner risk including male infidelity (OR=4.58, 95% CI=1.57-13.32). Results support the need for emphasis on IPV prevention within HIV prevention programmes and demonstrate the need for HIV prevention efforts directed at men with a history of IPV perpetration.

Intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study.

Abstract: This study aimed to understand whether and how highly active antiretroviral treatment (HAART) affects views and patterns of disclosure and how disclosure interacts with treatment decisions. One hundred and fifty-two HIV-positive adults (52 MSM, 56 women and 44 IDU men) from four US cities participated in two to three-hour, semi-structured interviews in 1998-99. Results indicate that HAART interacts with and shapes HIV disclosure issues in several ways. Medications may 'out' people living with HIV. Thus, in different settings (e.g. work, prisons, drug rehabs and public situations), some try to hide medications or modify dosing schedules, which can contribute to non-adherence, and affect sexual behaviours. Disclosure of HIV and/or HAART may also result in antagonism from others who hold negative attitudes and beliefs about HAART, potentially impeding adherence. Observable side effects of medications can also 'out' individuals. Conversely, medications may improve appearance, delaying or impeding disclosure. Some wait until they are on HAART and look 'well' before disclosing; some who look healthy as a result of medication deny being HIV-positive. Alternatively, HIV disclosure can lead to support that facilitates initiation of, and adherence to, treatment. HIV disclosure and adherence can shape one another in critical ways. Yet these interactions have been under-studied and need to be further examined. Interventions and studies concerning each of these domains have generally been separate, but need to be integrated, and the importance of relationships between these two areas needs to be recognized.

Behavioural responses of South African youth to the HIV/AIDS epidemic: a nationwide survey.

Abstract: South Africa is reported to have the largest number of people living with HIV/AIDS in the world. The present study investigated the behavioural responses of South African youth to the HIV/AIDS epidemic. A multi-stage stratified cluster sample of 2,430 youths aged 15-24 was selected, 46.9% of them males and 53.1% females. Nurses administered questionnaires to consenting youths, measuring behavioural risks and also took an oral fluid specimen for HIV antibody testing. It was found that the median age of sexual debut for both sexes was 16.5 years; most of the youths were sexually experienced with no variation by sex; sexual experience was highest among Africans living in informal urban areas; partner turnover was low and multiple partners were more common among African males living in urban informal settings; sexual frequency among sexually active youth was relatively low; secondary abstinence during the past 12 months was 24%; condom use at last sexual intercourse was high, at 52.8% for males and 47.6% for females, especially among Africans living in urban informal settings; and the majority of youths (74%) indicated that they had discussed HIV prevention with their partners during the past 12 months. These results suggest that South African youth are heeding the message to abstain, be faithful and use a condom; messages that are at the core of South Africa's HIV/AIDS prevention programme.

Health-related quality of life and patient-provider relationships in HIV-infected patients during the first three years after starting PI-containing antiretroviral treatment.

Abstract: The aim of this study was to investigate factors associated with better health-related quality of life (HRQL) during the first three years after starting PI-containing antiretroviral treatment. Clinical, social and behavioural data from the APROCO cohort enabled us to analyze simultaneously the association between HRQL and patients' relationships with their health care providers. A self-administered questionnaire collected information about HRQL (MOS-SF36) and relationships with medical staff (trust and satisfaction with information). Two aggregate scores, the physical (PCS) and mental (MCS) component summaries (adjusted for baseline HRQL), were used as dependent variables in the linear regressions to identify factors associated with HRQL. We had complete longitudinal data for 360 of the 611 patients followed through M36. Factors independently associated with a high MCS were (male) gender, no more than one change in treatment, (few) self-reported symptoms and trust in the physician. Factors independently associated with high PCS levels were employment, no children, (few) self-reported symptoms and satisfaction with the information and explanations provided by the medical staff. These results underline the need to improve patient A/ provider relationships to optimize long-term HRQL. Socio-behavioural interventions should focus on this goal.

The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment

Abstract: Identifying which mental disorders, substance use, and regimen factors influence non-adherence is a critical step in developing patient-customized interventions. In this cross-sectional study, 120 adults with HIV taking antiviral therapy completed interviews and questionnaires on their medication regimen, adherence behaviours, mental distress, and substance use patterns. They provided access to medical records for measures of immune health. Demographic characteristics, regimen factors, mental health indicators, and substance use variables were evaluated as predictors of four dichotomous non-adherent behaviours: running out of medications, not always taking medications as directed, taking below 95% of protease inhibitor doses, or having notations of non-compliance in the medical record. Non-adherence was prevalent and was related to immune health. Recent crack cocaine use was a risk factor for both taking a low proportion of PI medication and charted non-compliance notations. Heroin use and screening positive for social phobia were risk factors for running out of medication. Screening positive for any anxiety disorder reduced the risk of failing to take medications as directed. Clinicians caring for patients with HIV should screen for non-adherence using multiple behavioural indicators, and assess and treat substance use and anxiety disorders to reduce the risk of non-adherence.

Perceived barriers to employment among persons living with HIV/AIDS

Abstract: This study examined factors associated with contemplating returning to work among unemployed persons living with HIV/AIDS (PLHA) in a large urban city in the United States. A mailed, self-administered survey gathered information from 757 unemployed PLHA. Chi-square and logistic regression analyses were used to determine associations between contemplating returning to work and sociodemographic characteristics, health factors and perceived barriers to employment. We found that most unemployed PLHA (74%) were thinking of returning to work, but perceived significant barriers such as loss of disability income benefits (73%), loss of publicly-funded health insurance (67%) and workplace discrimination (66%). Univariate analyses indicated that contemplating returning to work was significantly associated with sociodemographic characteristics, health factors and perceived barriers to employment in the following areas: (1) availability of health insurance, (2) personal health and physical ability, (3) health concern...

Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in northern Thailand

Abstract: We assessed the relation between accurate beliefs about HIV transmission and inaccurate beliefs about HIV transmission and emotional reactions to people with AIDS (PWA) and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV. In Chiang Rai, northern Thailand, 219 respondents filled in a structured questionnaire assessing accurate and inaccurate HIV transmission beliefs, emotional reactions towards PWA and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV according to variables from Protection Motivation Theory. Complete accurate beliefs about documented modes of HIV transmission were present in 47% of the respondents, while 26% of the respondents held one or more inaccurate beliefs about HIV transmission. Incomplete beliefs about documented modes of transmission were significantly related to stigmatizing beliefs towards people with AIDS (PWA), to lower vulnerability of HIV infection and lower selfefficacy in protection. Those who held inaccurate beliefs about HIV transmission reported more fear towards PWA and homosexuals and more irritation towards PWA and commercial sex workers. Persons who held inaccurate beliefs about HIV transmission also reported more stigmatizing attitudes, perceived AIDS as less severe, perceived a lower vulnerability and were less motivated to use condoms. Results of this study suggest that inaccurate beliefs about HIV transmission are related to fear and stigmatizing and undermine HIV prevention behaviour.

Transition from paediatric to adult services: experiences of HIV-positive adolescents.

Abstract: In this small, preliminary study, semi-structured interviews were conducted with seven adolescents to explore their experiences of transition between paediatric and adult HIV care services. In general, the transition process established between the two health care units was considered by most participants to be beneficial, particularly the introduction of adult service providers early on in the transition preparation period. Four of the participants found the transition ‘easy’, whereas three had concerns that possibly delayed their transition, including coordination of haemophiliac and HIV care and fear of an adult environment. Individuals who had experienced little input into their care decisions during their paediatric appointments were more positive and ready for transition than those who had been more involved. Confidence and attachment with paediatric staff generally involved those who had been more involved in their care decision making. On transition, some of the participants were not prepared for ...

HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA.

Abstract: Although homelessness has frequently been associated with substance abuse, and has been established as a predictor of HIV risk among substance abusers, little is known about the impact of homelessness on HIV risk among female sex workers. This analysis investigated the contribution of homelessness to sexual risk taking among a sample of 485 female sex workers recruited into an HIV prevention programme in Miami, Florida, 41.6% of whom considered themselves to be currently homeless. Findings indicated that in comparison to non-homeless sex workers, significantly more homeless sex workers were daily users of alcohol and crack, and their past month sex work reflected significantly more frequent vaginal and oral sex acts, higher levels of unprotected vaginal sex and more numerous sexual activities while 'high' on drugs. At the same time, a significantly greater proportion of homeless sex workers encountered customers that refused to use condoms than did the non-homeless sex workers. There were no significant differences in HIV seropositivity between the homeless and non-homeless women (22.5 and 24.9%, respectively), primarily because the majority of the women in the study cycled in and out of homelessness.

Literature on integrated HIV care: a review.

Abstract: With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.

Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals.

Abstract: Previous research has reported rates of posttraumatic stress disorder (PTSD) following diagnosis with a life-threatening disease ranging from 5 to 42%. However, few studies have examined the impact of PTSD symptoms on disease markers or adherence to medical regimens. The present study represents an initial examination of the relationships among self-reported PTSD symptoms stemming from diagnosis with HIV, CD4 cell counts, salivary cortisol levels and adherence to highly active antiretroviral therapy (HAART) in 110 African-American and Caucasian individuals with HIV. Results revealed that the relationship between PTSD and disease progression is multifaceted: PTSD symptoms were related to worse adherence to HAART therapy, but were also associated with lower morning salivary cortisol levels and higher CD4 cell counts.