Psychosocial Problems and Coping Patterns of HIV Seropositive Wives of Men with HIV/AIDS

Abstract

The sociocultural milieu provides HIV positive women with fewer resources and more role responsibilities. The present research aimed at studying the psychosocial problems encountered in living, post HIV infection, and the coping patterns adopted by HIV seropositive wives of men with HIV/AIDS. In the background of an exploratory research design, thirty (n = 30) HIV positive women, attending Counseling Clinics in Bangalore (South India), selected through purposive sampling, were assessed using an interview schedule and a standardized coping scale. Majority of the respondents were the primary caregivers for their infected spouse and/or children. Content analysis of the problems revealed increased financial difficulties; problems in child care and support; compromised help-seeking due to stigma; problems in sexual interactions and communication in their marital relationship; role strain in caregiving; gender discriminatory and inadequate care; and increased concerns about parenting efficacy, post HIV infection. Escape avoidance was the most preferred coping strategy adopted by them. Situating the illness in a socio-familial context is indicated, and implications for social work and mental health practice follow from the findings.     

Experiences to cope with HIV among infected women

The study aimed to describe HIV-positive women's reports and experiences in coping with the infection. A qualitative study was carried out in the context of a specialized care service in Fortaleza-CE in 2007. Participants were 14 women diagnosed with HIV infection, who participated in tape recorded interviews. The analysis of interviews contents revealed the category Motivations for coping with HIV/AIDS and the subcategories religiosity, social and family support, presence of children and professional complicity as positive factors for coping with the infection. In conclusion, these women need professional and family care and support to remain stimulated in the care process.     

Living with HIV infection: perceptions of patients with access to care at a non-governmental organization in Chennai, India

Through interviews, we examined explanatory frameworks of living with HIV infection among 50 HIV-positive individuals (23 women, 27 men) receiving care at a non-governmental organization in Chennai, India. Results were analysed according to three sets of issues, all of which were found to differ by gender: causal beliefs about HIV, impact of HIV, and care/treatment of HIV. HIV-positive participants attributed their infection to biological, moral and social causes, and the physical, financial and relationship dimensions of their lives were impacted upon by the infection. Furthermore, HIV-related stigma evoked fears about isolation and discrimination. Regarding care/treatment, men were most usually first initiated into the healthcare system while women often entered as a consequence of their partner's condition. Non-adherence to medication was reported by 32% of the participants due to financial constraints or side-effects. Although all participants were hopeful about a cure for HIV, women were less positive than men about treatment. Results highlight the importance of a gender-sensitive approach to HIV care, nuanced to accommodate an individual's gender, marital status and social background.     

农村艾滋病医护人员应对方式状况调查

[目的]调查艾滋病医护人员的应对方式,帮助他们有效使用积极应对方式。[方法]采用简易应对方式问卷对342名河南省县、乡、村三级艾滋病定点医疗机构的艾滋病医护人员进行测试,采用SPSS11.5对测试数据进行统计分析。[结果](1)高级职称艾滋病医护人员的积极应对显著多于初级职称人员。有子女者的积极应对方式多于无子女人员。男性、40岁以上和高收入艾滋病医护人员的消极应对方式分别多于女性、30岁以下和低收入人员。(2)一般医护人员的积极应对方式显著多于艾滋病医护人员,消极应对方式显著少于艾滋病医护人员。[结论]职称、性别、年龄和收入影响艾滋病医护人员的应对方式。应改善年轻、低职称和低收入艾滋病医护人员的应对方式,维护他们的身心健康。     

施甸县2008-2010年预防艾滋病母婴传播干预效果分析

目的分析云南省施甸县自开展预防艾滋病母婴传播工作以来,孕产妇人群中艾滋病病毒(HIV)感染情况和母婴传播情况及干预效果。方法以施甸县2008-2010年接受HIV检测的所有孕产妇和检测中HIV抗体阳性的孕产妇及其所分娩婴幼儿为目标人群,按照《云南省预防艾滋病、梅毒和乙肝母婴传播工作实施方案(试行)》要求采取综合干预措施,并运用χ2检验等统计方法,对预防艾滋病母婴传播工作报表进行分析。结果施甸县2008-2010年共有10513名孕产妇,参与HIV检测的孕产妇9905名,发现22例HIV阳性孕产妇,阳性率为0.22%,孕产妇HIV抗体检测阳性率呈现逐年上升趋势;在22例阳性孕产妇中,自愿终止妊娠者2例(占9.09%),产妇20例;对19例产妇和婴儿提供预防艾滋病母婴传播服务,服务利用率为95%;在19名婴儿中因难产于生后1天死亡1例,对存活的18名婴儿采取人工喂养;18名婴儿接受HIV检测,其满12个月、18个月检测均为阴性。结论通过大力开展孕产妇HIV抗体检测,加大健康教育工作力度,提供安全助产服务,及时服用抗病毒药物等综合预防艾滋病母婴传播干预措施,可及时掌握孕产妇人群中HIV的感染状况,能有效降低儿童通过母婴传播感染艾滋病的几率。     

Prevalence and public-health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in south-eastern Nigeria

HIV infection and anaemia are major public-health problems in Africa and are important factors associated with an increased risk of adverse pregnancy outcomes. The objective of this study was to determine the prevalence of HIV infection and anaemia among pregnant women attending antenatal clinics in southeastern Nigeria. To achieve this, a cross-sectional survey was conducted during July 2005-June 2006 using standard techniques. Of 815 pregnant women studied, 31 (3.8%, 95% confidence interval [CI] 2.5-5.1) were HIV-positive. Maternal age and gestational age were not associated with HIV infection (p > 0.05). The prevalence of anaemia (Hb < 11.0 g/dL) was 76.9%, and 15 (1.8%, 95% CI 0.9-2.7) had severe anaemia (Hb <7.0 g/dL). A significantly higher prevalence of anaemia was observed among individuals in their second pregnancy trimester (p < 0.05) and those infected with HIV (p < 0.05). Since HIV and anaemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of HIV infection and anaemia in pregnant women.     

Relationship between health care professionals and HIV positive women: a gender approach

This article presents the results of research in 2003 focusing on the relationship between health care professionals from a public clinic and HIV positive women, adopting a gender approach. Ten patients and seven attending professionals were interviewed on the following themes: gender representations; representations of HIV/AIDS in women; and accommodation and resistance strategies to internalized attitudes and values regarding the health professional/patient relationship. According to the results, health professionals attempted to adjust the treatment to the limited resources of both the institution and the patient, endeavoring to offer the most complete care possible. Their social imagery continues to portray the traditional role of woman/mother/wife, perceived as a victim. Meanwhile patients adopted a "fighting woman" image, reinforced by the "modern woman" ideology, produced in both public and private spheres, disguising the effects of the women's double workload. Contrary to the myth of passivity, patients took an active stance towards their treatment, negotiating with health professionals about their own needs and objective possibilities. Despite the material and symbolic limitations, the potential was identified for changes in health care in order to achieve full reproductive rights.     

Women and HIV

HEALTH ISSUE: The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in developed countries has changed from the early epidemic that affected primarily men who have sex with men, to one that increasingly affects other groups such as injecting drug users (IDU) and heterosexuals. As a result, the number and percentage of women with HIV and AIDS is increasing. KEY FINDINGS: The number of women in Canada living with HIV, including those with AIDS, has increased over time. An estimated 6,800 women were living with HIV at the end of 1999, an increase of 48.0 % from the 1996 estimate of 4,600. On an annual basis, women account for a growing proportion of positive HIV test reports among adults in Canada. This proportion increased from 10.7% in the period 1985-95 to 25% in 2001. Heterosexual contact is the main risk factor for HIV infection in women, accounting for 63% of newly diagnosed cases of HIV infection in adult Canadian women in 2001; the majority of the remainder is due to IDU. KEY DATA GAPS AND RECOMMENDATIONS: Research is needed to address specific information gaps regarding risk behaviours, testing patterns and HIV incidence and prevalence in women. This research needs to include the broader contextual factors that influence women's lives and their risk of HIV infection. Programmes and prevention efforts must be gender and age-specific and should target not only individual behaviours, but also the social and cultural context in which these behaviours occur.     

The last resort would be to go to the GP'. Understanding the perceptions and use of general practitioner services among people with HIV/AIDS

In England and Wales, departments of Genito-Urinary Medicine have led the clinical response to HIV infection and AIDS (HIV/AIDS). They provide an open-access self-referral service on a basis of strict confidentiality. People with HIV/AIDS have been found to be reluctant to involve their general practitioner (GP) in their care. Previous research has not investigated their decisions about service use in the context of their broader strategies for coping with the multiple psychological and social challenges, which are posed by HIV/AIDS as a chronic, stigmatised condition. We report a depth-interview study of twenty people with HIV/AIDS in a low-prevalence nonmetropolitan urban area of England. Their health care choices were products of complex judgements. Five concerns predominated: expertise, security, rights to care, confidentiality and the maintenance of normality. Transfer to GP care signified a transition from essential wellness to essential illness and represented a loss of biographical continuity. Their other concerns express problems of information management, which are universal features of stigmatising conditions. These may be heightened in the case of locally provided services, where any leakage of discrediting information is likely to impact directly on everyday life. These concerns should be understood and respected in policy initiatives to develop services.     

The role of religion in HIV-positive women's disclosure experiences and coping strategies in Kinshasa,Democratic Republic of Congo

Literature from the U.S. has documented the importance of spirituality on the psychological health of people living with HIV/AIDS; however there is little published data on the ways in which people living with HIV/AIDS in Africa turn to religion for support. We conducted 40 in-depth interviews with HIV-positive women who were pregnant or had recently given birth in Kinshasa, Democratic Republic of Congo to inform the development of a comprehensive family-centered HIV treatment and care program. Women described how they relied upon their faith and turned to church leaders when they were diagnosed with HIV and prepared to share their diagnosis with others. The women used prayer to overcome the initial shock, sadness and anger of learning their HIV diagnosis. They turned to their church leaders to help them prepare for disclosing their diagnosis to others, including their partners. Church leaders were also important targets for disclosure by some women. Women's faith played an important role in their long-term coping strategies. Conceptualizing their infection as a path chosen by God, and believing that God has the power to cure their infection comforted women and provided them with hope. In settings like the Democratic Republic of the Congo, where there is a strong foundation of faith, we need to recognize how individuals draw upon their different health belief systems in order to develop and implement coherent and effective prevention, treatment and care strategies.     

贵阳市HIV/AIDS社区支持与关怀项目研究

目的 总结分析2002年贵州省贵阳市实施HIV／AIDS社区支持与关怀项目取得的经验和存在的不足。为将来更好地开展城市HIV／AIDS社区支持与关怀提出相应的对策。方法 根据贵阳市的具体情况，采取开发决策层，动员大众媒体参与，组织社会各部门合作，建立感染自助组织，构建社区支持与关怀网络的措施，开展感染生产自救，引导家庭、社区和感染周围人群关心因吸毒而感染艾滋病病毒的病人。结果 通过关怀与支持项目的开展，使媒体和社区人群对艾滋病有了新的理解和认识，自愿检测咨询人数增加；部分感染家庭理解接纳了感染，感染自身的态度转变，积极参与各项活动并提出建议和想法。结论 开展HIV／AIDS社区支持与关怀，可以使社区群众提高对艾滋病的认识，消除对艾滋病病人、HIV感染的歧视。但试点工作是初步的，尚存在一些问题，需要进行深入的研究。     

Coping and perception of women with HIV infection

OBJECTIVE

To analyze women’s perceptions and coping regarding the discovery of an HIV infection.

METHODS

A qualitative study in an HIV/AIDS Specialist Helpdesk in Recife, PE, Northeastern Brazil, from January to September 2010, involving eight women living with asymptomatic HIV aged between 27 and 37 years, without criteria for diagnosis of AIDS infected through intercourse and monitored by the service for at least one year. Forms were used to characterize the clinical situation and semi-structured interviews to understand perceptions and feelings related to personal trajectory after diagnosis and different ways of facing the diagnosis in family and social life. Content analysis was performed as suggested by Bardin.

RESULTS

The thematic category that emerged was stigma and discrimination. The women had life trajectories marked by stigma, which was perceived as discrimination after the diagnosis and in the experiences of everyday life. The revelation of the infection was perceived as limiting to a normal life, leading to the need to conceal the diagnosis. The discriminatory attitudes of some health care professionals, non-specialist in HIV/AIDS, had a negative impact on future experiences in other health services. Besides the effects of institutional stigma, the perception of women was that the service did not include dedicated space for the expression of other needs beyond the disease, which could help in fighting the infection.

CONCLUSIONS

Living with HIV was strongly linked to stigma. The results show the importance of strengthening educational approaches and emotional support at the time of diagnosis in order to facilitate coping with the condition of seropositivity.     

Knowledge of Treatment to Reduce Perinatal Human Immunodeficiency Virus (HIV) Transmission and Likelihood of Testing for HIV: Results from Two Surveys of Women of Childbearing Age

Objective: To determine whether knowledge of zidovudine treatment to reduce the risk of mother-to-child transmission of HIV increases the likelihood of HIV testing among women of childbearing age at increased risk for HIV infection. Method: Data from two samples were analyzed. The Young Women Survey was a population-based, door-to-door survey of 2,545 women aged 18 to 29 years who were living in lower-income neighborhoods. For the Perinatal Survey, women receiving prenatal care or who had delivered within the previous six months (N = 850) were recruited at randomly selected sites. Most (71.2%) of these participants were covered by public payment sources for their prenatal care. Data were collected within California counties with high rates of HIV among newborns, high rates of HIV among female clients of alternative test sites, and high rates of AIDS among female injection drug users. Most participants from both surveys were women of color. Results: Participants who knew about zidovudine therapy for HIV-positive pregnant women were more likely to have had an HIV test, regardless of race/ethnicity, age, education, or number of previous births. The majority of women (79.3%) from both samples stated that they were more likely to take a test for HIV knowing about zidovudine treatment. Conclusions: HIV educators should include information on zidovudine therapy in campaigns designed to promote HIV testing among women. Prenatal care providers should incorporate a brief discussion about the benefits of zidovudine treatment when providing HIV counseling to patients.     

Addressing Sexual Problems in HIV Primary Care: Experiences from Patients

Evidence suggests that sexual problems are common among people living with HIV and may be related to sexual risk taking and treatment adherence. This study explored the extent to which sexual problems experienced by people with HIV are addressed in primary care as well as how primary care responses to sexual problems are experienced by patients. Structured interviews were conducted with 60 patients at an urban HIV clinic. The average age of the participants (37 male, 23 female) was 45.8 years (SD = 7.9). Sexual problems were common. The most common sexual problem experienced in the past year was a lack of interest in sex (53.3 % reported) and the least common problem was painful intercourse (reported by 20 %). There were no gender differences in reports of sexual problems, except that painful intercourse was more frequently reported by women than men. Relatively few individuals who experienced sexual problems had discussed them with their provider, but these individuals were generally pleased with the counseling they had received and could identify several factors that facilitated a positive patient–provider interaction. Those who offer primary care services to people with HIV should be aware of sexual problems their patients may be experiencing and should feel confident in their ability to successfully address these problems. Providers may need additional training in order to adequately address sexual problems among people with HIV in primary care settings.     

The impact of denial on health-related quality of life in patients with HIV

Background/purpose

The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.

Methods

In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12?months, including denial as a predictor and gender as a moderator.

Results

The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men??s baseline mental health-related QOL was more negatively affected by denial coping than women??s. Women tended to increase in QOL more slowly over time compared to men.

Conclusion

Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.     

The effects of HIV/AIDS intervention groups for high-risk women in urban clinics.

OBJECTIVE. This study reports the results of a behavior change intervention offered to women at high risk for human immunodeficiency virus (HIV) infection seen in an urban primary health care clinic. METHODS. Participants were 197 women randomly assigned to either an HIV/acquired immunodeficiency syndrome (AIDS) risk reduction group or a comparison group. Women in the HIV/AIDS intervention group attended five group sessions focusing on risk education; skills training in condom use, sexual assertiveness, problem solving, and risk trigger self-management; and peer support for change efforts. Women in the comparison group attended sessions on health topics unrelated to AIDS. RESULTS. At the 3-month follow-up, women in the HIV/AIDS intervention group had increased in sexual communication and negotiation skills. Unprotected sexual intercourse had declined significantly and condom use had increased from 26% to 56% of all intercourse occasions. Women in the comparison group showed no change. CONCLUSIONS. Socially disadvantaged women can be assisted in reducing their risk of contracting HIV infection. Risk reduction behavior change interventions should be offered routinely in primary health care clinics serving low-income and high-risk patients.     

Problems of HIV infection for women in Africa

Increasingly large numbers of babies in sub-Saharan African are born with congenital human immunodeficiency virus (HIV). Attention is directed to the risk of vertical transmission, breast feeding and transmission of HIV infection, the risk of progression of HIV-related disease during pregnancy, contraception and HIV infection, counseling, congenital HIV infection, and management. In Africa, heterosexual sex is the primary route of spread of HIV, meaning the virus affects both sexes equally. Further, most HIV-seropositive women are in the sexually active and reproductive age group. The effect of HIV on the immature fetal immune system can be such that the infant does not make antibodies to HIV. Consequently, an infected infant can have negative HIV antibody tests. Viral antigen tests now are helpful in the diagnosis of congenital HIV infection but are costly and not widely available. This difficulty in serological diagnosis means that the frequency of transmission from HIV-infected mothers in their infants remains unknown. There have been 5 reports of apparent spread of HIV through breast feeding, yet it seems unlikely that breastfeeding plays a significant role in the spread of HIV infection. The claim that pregnancy triggers progression of disease in HIV positive women is based on only a series of case reports of Acquired Immune Deficiency Syndrome (AIDS) in pregnancy and an apparently high incidence of AIDS in women who had previously delivered an affected infant. The personal experience of HIV-infected women in sub-Saharan Africa, followed for an average of 2 years after delivery, suggests that pregnancy does not commonly accelerate progression of HIV-related disease, since most remain asymptomatic. Those infected with HIV need good contraceptive advice, and whatever contraceptive a woman chooses, it also should be recommended that condoms are used too whenever there is a risk of sexual spread of HIV infection. Women need current information about their condition, but counseling requires more than factual information. Affected women need and deserve advice and support from their doctor or health worker. Most infants with congenital HIV infection present before age 1. In many cases HIV infection is diagnosed in the 2nd year of life. HIV-infected children present with a wide variety of problems the most common of which are pneumonia and failure to thrive. Mothers need to be reassured that problems arising from HIV infection, such as rashes, dehydration, and chest infections can be treated even though there is no cure as yet for their child's underlying weakness.     

Strategies to prevent HIV transmission among heterosexual African-American women

Background  

African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women.