泰安市艾滋病病毒感染者/艾滋病患者生存状况

目的了解泰安市HIV/AIDS患者的生存状况,为制定相关的救治救助政策和干预措施提供科学依据。方法使用自行设计的调查问卷、焦虑自评量表、抑郁自评量表和社会支持评定量表对本地区能随访到的全部HIV/AIDS患者进行面对面的问卷调查。结果调查的36例HIV/AIDS患者感觉自己生活质量很好或较好的仅占22.22%,4/36评定有焦虑,13/36评定有抑郁,家庭收入低于当地农民平均水平;年龄小于30岁、最近1个月参与社交活动多、最近1次CD4细胞检测结果高、没有接受抗病毒治疗的HIV/AIDS患者自我感觉生活状况较好,差异有统计学意义(P<0.05)。结论HIV/AIDS患者自我感觉生活状况差,部分存在心理问题,经济收入较低,应进一步加大心理支持和社会救助。     

Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

医学应对方式与社会支持对艾滋病病毒感染者/病人生存质量影响的研究

目的探讨社会支持与应对方式对艾滋病病毒感染者/病人生活质量的影响。方法采用Feifel等编制的医学应对问卷、肖水源等编制的社会支持评定量表以及美国波士顿健康研究所编制的健康状况调查问卷对57例艾滋病病毒感染者/病人进行问卷调查。结果艾滋病病毒感染者/病人生存质量在生理职能、躯体疼痛以及情感职能方面的得分低于常模,在精力方面的得分高于常模;社会支持与健康状况、精力、情感职能和社会功能呈明显正相关;艾滋病病毒感染者/病人回避应对方式与屈服应对方式得分高于常模水平;面对应对方式与精神健康和情感职能呈正相关;屈服应对方式与生理机能、健康状况、精力和精神健康呈负相关。结论应该对艾滋病病毒感染者/病人开展心理健康教育,帮助艾滋病病毒感染者/病人充分利用社会支持,提高其生存质量;同时鼓励艾滋病病毒感染者/病人采用更加积极的应对方式来面对疾病带来的痛苦,更好的生活下去。     

The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.     

HIV感染者/AIDS病人社会支持现状及关怀对策

目的研究HIV感染者/AIDS病人(PLWHA)社会支持现状,探讨其影响因素,为制定关怀对策提供依据。方法采用社会支持评定量表(SSRS)和评价方法,对PLWHA进行面对面问卷调查。结果 PLWHA的SSRS总分和三个维度分方面,50岁以上者相对低下,差异均有统计学意义(p<0.05);SSRS总分、客观支持分和主观支持分方面,未婚单身/分居/离婚者和在本市居住的非本市户籍者中居住年限在1年内者均相对低下,差异有统计学意义(P<0.05);SSRS总分和客观支持分方面,男性、吸毒/同性恋/输血途径、独居者均相对低下,差异有统计学意义(p<0.05);SSRS总分和主观支持分方面,无业者低于有工作者,差异有统计学意义(p<0.05);SSRS总分方面,家庭经济状况一般及以下者均相对低下,差异有统计学意义(p<0.05);主观支持方面,文化程度在大专及以上者、无子女者和生活来源为退休金/社保/亲属支持/救济金者均相对低下,差异有统计学意义(p<0.05);客观支持和支持利用度方面,抗病毒治疗年限≥2年者相对低下,差异有统计学意义(p<0.05)。结论 PLWHA社会支持受多方面因素的影响,应在随访关怀过程中,有针对性的加强社会支持水平体系的构建,以提高PLWHA的生活质量。     

The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.     

Family systems and HIV/AIDS in South Africa

This study examines the role of family in the care and support of people living with HIV/AIDS (PLWHA) as a way of reducing the burden of stigma in the family. The PEN-3 model provided the cultural framework for this study. Data were drawn from participants' responses in 27 focus groups interviews conducted in South Africa. Participants were asked to discuss experiences of people living with HIV and AIDS in the family. The results highlight the positive and supportive aspects of the family, acknowledge the existential and unique aspects, and discuss the negative experiences shared by participants. This study's findings stress the need to take into account families' experiences with HIV and AIDS in the development of interventions aimed at reducing the burden of the disease on family systems and improving care and support for PLWHA.     

Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda

Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings.     

上海市金山区HIV感染者和AIDS患者经济状况和医疗保障调查

目的通过对上海市金山区随访管理的人类免疫缺陷病毒（HIV）感染者和艾滋病（AIDS）患者家庭经济状况和医疗负担的调查,为制定相关的救助关怀政策提供可靠的依据。方法采用统一的问卷调查表,对HIV感染者和AIDS患者面对面或电话进行问卷调查,利用EpiDate软件建立数据库,并用SPSS 15.0软件进行统计分析。结果共调查随访管理的HIV感染者和AIDS患者34例,本区户籍30例,外地居住该区的4例。调查发现金山区的HIV感染者和AIDS患者,家庭月收入低于3 000元的占47.06%,夫妻双方同被感染对家庭经济收入和生活质量影响更大。结论金山区的HIV感染者和AIDS患者大部分属于低收入家庭,感染艾滋病后生活水平进一步下降,尤其夫妻双方同被感染。     

RURAL PEOPLE UTILISING CITY HOSPITALS: ISSUES FOR SERVICE PROVISION

ABSTRACT: The geographic distribution of health services in Australia means that rural people may need to travel long distances from their homes to obtain specialist services. Because sophisticated and expensive medical technologies are centralised, it is not uncommon for rural people to need to access metropolitan health services for many forms of treatment. This study sought to investigate the experiences of central Victorian people for whom illness or injury necessitated their admission to metropolitan hospitals. Because of distance from both metropolitan hospitals and social support structures, these people were likely to have differing experiences from city people admitted to hospital. However, it was found that not only were variables of rurality and social support significant, but socio-economic status and family structure were also found to be important. Even though respondents identified distress and other problems associated with the metropolitan admission, they rationalised the whole experience in terms of the specialized treatment they received; treatment that was not available in country hospitals.     

Health and Treatment Implications of Food Insufficiency among People Living with HIV/AIDS,Atlanta, Georgia

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.     

Community-based therapeutic care in HIV-affected populations

Community-based therapeutic care (CTC) is a community-based model for delivering care to malnourished people. CTC aims to treat the majority of severely malnourished people at home, rather than in therapeutic feeding centres. This paper describes the potential of the CTC approach to provide effective care and support for people living with HIV and AIDS (PLWHA). CTC includes many of the components of a home-based care model for PLWHA. It provides outpatient treatment for common complications of HIV and AIDS, such as acute malnutrition and simple infections, and an energy-dense ready-to-use food that could be made with the appropriate balance of micronutrients for the HIV-infected patient. Through the de-centralisation of outpatient treatment sites, CTC improves accessibility by moving treatment closer to people's homes and helps to promote the sustainability of care by building on the capacity of existing health infrastructure and staff. The CTC model contains many features that are appropriate for the care and support of HIV-affected people and, in its present form, can provide effective physical care for many HIV-affected individuals. We are currently working to adapt the CTC model to make it more suitable for the support of PLWHA in the longer term.     

Position of the Academy of Nutrition and Dietetics: Nutrition Security in Developing Nations: Sustainable Food,Water, and Health

It is the position of the Academy of Nutrition and Dietetics that all people should have consistent access to an appropriately nutritious diet of food and water, coupled with a sanitary environment, adequate health services, and care that ensure a healthy and active life for all household members. The Academy supports policies, systems, programs, and practices that work with developing nations to achieve nutrition security and self-sufficiency while being environmentally and economically sustainable. For nations to achieve nutrition security, all people must have access to a variety of nutritious foods and potable drinking water; knowledge, resources, and skills for healthy living; prevention, treatment, and care for diseases affecting nutrition status; and safety-net systems during crisis situations, such as natural disasters or deleterious social and political systems. More than 2 billion people are micronutrient deficient; 1.5 billion people are overweight or obese; 870 million people have inadequate food energy intake; and 783 million people lack potable drinking water. Adequate nutrient intake is a concern, independent of weight status. Although this article focuses on nutritional deficiencies in developing nations, global solutions for excesses and deficiencies need to be addressed. In an effort to achieve nutrition security, lifestyles, policies, and systems (eg, food, water, health, energy, education/knowledge, and economic) contributing to sustainable resource use, environmental management, health promotion, economic stability, and positive social environments are required. Food and nutrition practitioners can get involved in promoting and implementing effective and sustainable policies, systems, programs, and practices that support individual, community, and national efforts.     

Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa

AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two-thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive-affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive-affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa.     

Perceived health as related to income, socio-economic status, lifestyle, and social support factors in a middle-aged Japanese

BACKGROUND: Few studies have examined the association of perceived health with socio-economic status, especially income, and social isolation and support in Japan. The purpose of this study is to clarify the associations among perceived health, lifestyle, and socio-economic status, as well as social isolation and support factors, in middle-aged and elderly Japanese. METHODS: Subjects were 9,650 participants aged 47-77 years who completed a self-administered questionnaire in 2000 in the second survey of a population-based cohort (the Komo-Ise study). The questionnaire included items on sociodemographic and socio-economic factors, social isolation and support, lifestyle, past history of chronic disease and perceived health. Perceived health was dichotomized into excellent or good health and fair or poor health. A logistic regression analysis was used to determine the odds ratios of socio-economic status, social characteristics and lifestyle in relation to self-reported fair or poor health. RESULTS: We found that household income, physical activity, sleeping, smoking habit, and BMI had a strong association with self-reported fair or poor health in middle-aged and elderly Japanese men and women. Male subjects tended to report fair or poor health as household income decreased. The results for women differed in that social isolation and low social support had a stronger association for self-reported fair or poor health than low household income. CONCLUSIONS: The results indicated that perceived health was associated with socio-economic and social characteristics among middle-aged and elderly residents in Japan.     

The Role of Cultural Practices and the Family in the Care for People Living With HIV/AIDS Among the Igbo of Anambra State,Nigeria

The HIV/AIDS pandemic is one of the worst epidemics that have been experienced by humankind. It is indeed a major event of our time. The pandemic has killed so many people around the world and Sub-Saharan Africa is the worst hit. The nature of the pandemic lent it to stigma and discrimination, which have made caring for people living with HIV/AIDS (PLWHA) a big problem. It has also brought so much suffering on PLWHA around the world. This article examines the role of culture and the family in the care for PLWHA in Anambra State. Quantitative and Qualitative data collection methods (questionnaire and in-depth interviews) are used to elicit information from respondents. A total of 1000 copies of a questionnaire were administered on adult males and females and 914 were completed and analyzed. Furthermore, in-depth interviews were conducted on 10 opinion leaders using an interview guide. Data were analyzed in themes based on the objectives and the data from in-depth interviews were used to support data from the questionnaire. The results showed that certain cultural practices such as cultural obligations to sick, blood relations, collective ownership of children, affinity to blood relations, and strong marital bond enhance care and support for PLWHA. Also, the burden of care for PLWHA was found to be on the family in the study area. In conclusion, cultural practices and the family play major roles in the care for PLWHA in the area and should be harnessed in order to make life more comfortable for PLWHA.     

The role of cultural practices and the family in the care for people living with HIV/AIDS among the Igbo of Anambra State, Nigeria

The HIV/AIDS pandemic is one of the worst epidemics that have been experienced by humankind. It is indeed a major event of our time. The pandemic has killed so many people around the world and Sub-Saharan Africa is the worst hit. The nature of the pandemic lent it to stigma and discrimination, which have made caring for people living with HIV/AIDS (PLWHA) a big problem. It has also brought so much suffering on PLWHA around the world. This article examines the role of culture and the family in the care for PLWHA in Anambra State. Quantitative and Qualitative data collection methods (questionnaire and in-depth interviews) are used to elicit information from respondents. A total of 1000 copies of a questionnaire were administered on adult males and females and 914 were completed and analyzed. Furthermore, in-depth interviews were conducted on 10 opinion leaders using an interview guide. Data were analyzed in themes based on the objectives and the data from in-depth interviews were used to support data from the questionnaire. The results showed that certain cultural practices such as cultural obligations to sick, blood relations, collective ownership of children, affinity to blood relations, and strong marital bond enhance care and support for PLWHA. Also, the burden of care for PLWHA was found to be on the family in the study area. In conclusion, cultural practices and the family play major roles in the care for PLWHA in the area and should be harnessed in order to make life more comfortable for PLWHA.     

Experiences of Stigmatization and Discrimination in Accessing Health Services: Voices of Persons Living With HIV in Ghana

Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n = 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, implications are discussed for policy, social work, and public health practices.     

Network stigma towards people living with HIV/AIDS and their caregivers: An egocentric network study

HIV stigma occurs among peers in social networks. However, the features of social networks that drive HIV stigma are not well understood. The objective of this study is to investigate anticipated HIV stigma within the social networks of people living with HIV/AIDS (PLWHA) (N = 147) and the social networks of PLWHA's caregivers (N = 148). The egocentric social network data were collected in Guangxi, China. More than half of PLWHA (58%) and their caregivers (53%) anticipated HIV stigma from their network peers. Both PLWHA and their caregivers anticipated that spouses or other family members were less likely to stigmatise them, compared to friend peers or other relationships. Married network peers were believed to stigmatise caregivers more than unmarried peers. The association between frequent contacts and anticipated stigma was negative among caregivers. Being in a close relationship with PLWHA or caregivers (e.g., a spouse or other family member) was associated with less anticipated stigma. Lower network density was associated with higher anticipated stigma among PLWHA's alters, but not among caregivers' alters. Findings may shed light on innovative stigma reduction interventions at the social network level and therefore improve HIV/AIDS treatment utilisation.