Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS.

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health. The similarity in functional health status and depression between user groups, despite high users' poorer health and greater social vulnerability, supports client reports that services have reduced client isolation and improved health-related quality of life. Finally, high users had lower expenditures for government-provided health and social services overall, particularly HIV specialists and AIDS medication, but significantly more expenditures for emergency room services and complementary therapies. The results suggest community-based services can enhance health-related quality of life for persons living with HIV/AIDS by increasing providers' capacity to identify and address client depression and its consequences.     

Evaluation of services for people with HIV/AIDS in an inner-city health authority: perspectives of key service providers

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers It is the service provider data which will be presented here Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/ AIDS in the Camberwell Health District Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer) However, they also identified a number of problems which were either unique or more severe for people with the virus Services for people with HIV/AIDS were generally felt to be poorly coordinated and a number of areas of overlap and gaps in service provision were identified     

Help seeking behaviour and health and social services utilisation by people suffering from urinary incontinence.

It is estimated that urinary incontinence can effect up to 23% of the population at some time during their adult years, with 9% currently experiencing symptoms. This study found that the majority of sufferers had spoken to or had contacted their GP about their incontinence, and that people currently suffering from incontinence were significantly more likely to have seen their GP within the last month than those who were continent. Help seeking behaviour was also influenced by the severity of incontinence, with people suffering from severe incontinence significantly more likely to have sought help than those with light to moderate incontinence. Two thirds of sufferers who did not seek help were too embarrassed to do so. Significantly more people who were incontinent that did not seek help in a health authority without an established continence service did not know that health services were available, compared with those in a health authority having an established continence service. It is important for health care providers to ensure that the public knows what services are on offer and how to access them. Significantly more incontinence sufferers in the health authority with an established continence service chose not to seek help from a health professional compared with those in the health authority without service, which could indicate there was an element of informed choice in not accessing the services available. Significantly more people who were incontinent than continent required help with their activities of daily living and personal self care. They were also significantly more likely than those who were continent to require formal and informal contacts provided by health services, local authority, the church or voluntary sector. It is important that people suffering from incontinence have their health and social needs assessed so that services can be effectively targeted.     

Psychological distress in family members living with human immunodeficiency virus/acquired immune deficiency syndrome

This article describes the psychological distress experienced by family members living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Survey data were collected from 133 individuals, (47 parents, 53 siblings, 33 adult family members who have HIV/AIDS) representing 80 families. In-depth interview and observational data were collected from a subset of the sample. The physical and psychological health of individual family members was assessed by the 53-item Brief Symptom Inventory. Parents, siblings, and people living with AIDS (PWAs) reported higher levels of overall distress and scored higher on symptom dimensions and clinically discrete symptoms than normative comparison groups. Implications of these findings for research, clinical practice, and health and social service policy are identified and discussed.     

Mediation analysis of health‐related quality of life among people living with HIV infection in China

The effects of stigma, social support, and depressive symptoms on health‐related quality of life are well documented in the literature, but how these psychological factors interact with each other, and the combined effects when taken together on the health‐related quality of life for people living with HIV, remain unclear. This cross‐sectional study investigated 114 people living with HIV who were taking antiretroviral medication using the HIV/AIDS‐related Stigma Scale (Chinese version), the Social Support Rating Scale, the Center for Epidemiological Studies Depression Scale, and the Medical Outcomes Study–HIV health survey. Multiple linear regression analyses were used to examine the mediation effect of the psychosocial factors on health‐related quality of life. Results showed that stigma and social support did not have direct effects, but indirect effects on health‐related quality of life through a full mediation effect of depressive symptoms. The results indicate that interventions targeting depression might be the most effective approach to improving health‐related quality of life among people living with HIV who are taking antiretroviral medication in China.     

Mental health status and use of general medical services for persons with human immunodeficiency virus

BACKGROUND: Serious medical illness often is accompanied by psychological distress. Individuals experiencing mental disorders or symptoms have higher rates of morbidity and mortality, worse social functioning, and use of general medical services. OBJECTIVES: We sought to examine the association between mental health and use of general medical services for persons in care for HIV. DESIGN AND PARTICIPANTS: We used longitudinal data from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of 2267 HIV+ adults receiving care and who completed all 3 interviews during an 18-month period. MAIN OUTCOME MEASURES: Probability of use and general medical expenditures, by type of service. RESULTS: HIV+ individuals who screened positive for depression or had 5 or more mental health symptoms at baseline spent 20% to 25% more for general medical services in the following 12 months than HIV+ adults without mental health symptoms, after adjusting for disease severity and patient characteristics. Higher spending was largely the result of greater use of inpatient and emergency services. CONCLUSIONS: Psychological distress remains an independent predictor of general medical service use, although the magnitude of effect diminishes with better controls for physical well-being and previous service use. Identifying HIV patients with symptoms of affective or anxiety disorders may reduce overall treatment costs modestly.     

Gender differences in knowledge and perceptions of HIV resources among individuals living with HIV in the Southeast

OBJECTIVES: Ancillary services have been associated with beneficial health utilization outcomes among individuals infected with the human immunodeficiency virus (HIV), including greater retention in medical care and greater likelihood of antiretroviral use. Our primary objectives were to examine gender differences in barriers to ancillary services among people living with HIV in the Southeastern United States. METHODS: Survey and chart abstraction data were collected from six tertiary infectious diseases clinics in the Southeast. Using multivariate analyses, we examined the relationship between gender and 1) knowledge of how to access HIV and acquired immunodeficiency syndrome (AIDS) resource information and 2) opinions about the helpfulness of local services for people with HIV/AIDS. RESULTS: Women were less knowledgeable about HIV/AIDS resources and rated local services less favorably than men. Middle-aged and older African-American women rated local services as less helpful than other survey participants did. CONCLUSIONS: These findings indicate a need for outreach services that are designed to address the specific needs of older African-American women, and women in general.     

Western health practitioners' view about African traditional health practitioners' treatment and care of people living with HIV/AIDS

African traditional health practitioners are an important source of health care for many South Africans. Thus, they are a health resource in this society. However, the integration of traditional health practitioners into the mainstream of health care is a complex process. Various factors contribute to this complexity, including the skepticism and reservation with which some western health practitioners view traditional health practitioners. This paper highlights the perceived strengths and weaknesses of the traditional healing system for people living with HIV/AIDS, as perceived by western health practitioners. The use of traditional practitioners as a choice of health care is attributed to both the strengths and weaknesses of this system of health care. The strength of the traditional healing system is in its sharing of the worldview and belief system of its users, it being an alternative to an inefficient western health care system (official system), privacy and absence of time limitations per consultation, treating patients psychologically, and scientifically unexplained physiological relief of the symptoms of specific illnesses. The perceived weaknesses of the traditional healing system include harmful treatment regimens, especially for people living with HIV/AIDS; prolonging the seeking of appropriate health care when traditional remedies fail to produce the desired effect; destroying interpersonal relationships of people living with HIV/AIDS through witchcraft accusations; psychological torment caused by the belief that HIV/AIDS can be cured by traditional remedies/intervention; and increasing the workload of western practitioners who are requested by patients to conduct multiple HIV tests after undergoing various traditional treatment regimens to cure HIV/AIDS. It is recommended that traditional practitioners be encouraged to adapt harmful traditional healing practices to the benefit of their patients in a non-judgemental and non-critical manner. In addition, joint workshops should be conducted with traditional and western practitioners to demystify traditional healing practices.     

HIV感染者/AIDS病人及其家属的生活质量调查及相关因素分析

目的调查分析HIV感染者/AIDS病人及其家属的生活质量及其相关因素,为建立HIV感染者/AIDS病人社区综合关怀支持模式、改善HIV感染者/AIDS病人及其家属的生活质量提供依据.方法选择四川省HIV感染率和AIDS患病率较高的两个县(资中县和凉山州昭觉县)作为目标社区,共计调查71名HIV感染者/AIDS病人及其162名家属和97名健康者,采用生活质量综合评定问卷(GQOLI-74)、社会支持评定量表(SSS)及自制的一般情况记录表收集相关资料,用SPSS统计软件进行统计分析.结果HIV感染者/AIDS病人及其家属的GQOLI-74总分及躯体功能、心理功能、社会功能和物质生活状态4个维度分均低于正常对照(分别为F=36.512、F=11.046、F=31.616、F=34.235、F=2.386,P值均＜0.01),HIV感染者/AIDS病人及其家属生活质量总分与疾病状况、社会支持存在明显相关性.结论HIV感染者/AIDS病人及其家属的生活质量均较低,这与疾病状况、社会支持等因素有关.     

基于社区的HIV/AIDS患者心理支持模式的研究

目的探讨基于社区HIV/AIDS患者心理支持模式。方法建立以社区为基础,由心理学专家、社区志愿者、社区医生、社区护士、患者家属等组成的心理支持团队,通过心理咨询、健康教育、反歧视宣传、同伴交流等活动,为HIV/AIDS患者提供心理关爱和情感支持。结果基于社区的心理支持模式,能有效地帮助HIV/AIDS患者走出心理困境、降低焦虑抑郁程度、提高生活满意度。采用患者单一条目自我评分法,心理支持前后焦虑抑郁和生活满意度的差异有统计学意义(P0.01)。结论建立以社区为基础的心理支持模式有着传统心理支持不可比拟的优势,对充分发挥社区在艾滋病防治方面的功能及动员社会力量控制艾滋病的传播有重要的现实意义。     

Caring for adults with a learning disability in the community

A recurring theme within the literature is gaps in the delivery of services for people with a learning disability living in the community. These gaps occur between health professionals, primary and secondary care and specialisms within nursing. Gaps also exist between social service policy and implementation, health and social care. Recent national and local reports have sought to address these issues by promoting ways for health and social services to work in partnership. The theme of health promotion is highlighted in all these documents, but implementation of health promotion has been firmly placed within the boundaries of primary care. This poses a dilemma for primary care: does the primary care team or a more specialist community learning disability team provide better care for people with a learning disability? This article summarizes strategies and policies within the literature and difficulties that need to be considered when offering a service to people with a learning disability.     

Health promotion for women with human immunodeficiency virus or acquired immunodeficiency syndrome

PURPOSE: The purpose of this pilot study was twofold: first, to modify Stuifbergen's health promotion intervention initially developed for women with multiple sclerosis for use among women with human immunodeficiency virus or acquired immunodeficiency syndrome (HIV/AIDS) and to evaluate the feasibility of the newly modified health promotion intervention named "Put Health Into Living" (PHIL). The pilot study was completed in two phases. DATA SOURCES: In phase I, data were derived from a literature review, a focus group of women with HIV/AIDS (n= 7), a panel of experts who reviewed the intervention for content, and three female community workers who evaluated the intervention for the context of living with HIV/AIDS, cultural relevancy, and literacy. During phase II, a pretest/posttest one-group design was used to determine the feasibility of the study methods, content, and format of the health promotion intervention among 10 women with HIV/AIDS. CONCLUSIONS: The pilot study demonstrated the importance of a health promotion intervention for a vulnerable population. Participants verbalized the benefits of attending a health promotion program to gain knowledge and skills to promote their health. One woman said, "I have been positive for 20 years now and no one has talked to me just about my overall health." Participants indicated the PHIL intervention offered a supportive group environment, an overall health focus, and an acceptable format. IMPLICATIONS FOR PRACTICE: Health promotion is a desirable goal for persons living with a chronic disease, and the PHIL intervention has the potential to benefit persons living with HIV/AIDS if subsequent evidence is found in further testing of the intervention.     

The sexual health needs of people with learning disabilities

The sexual health of people with learning disabilities raises important management and practice issues for health services, and should be examined in the context of the current policy emphasis on advocacy, person-centred services and social inclusion (Department of Health, 2001). People with learning disabilities may have limited access to mainstream health services, and sexual health and genitourinary medicine (GUM) services are no exception (DoH, 2001; 1998). They are often excluded from society, either because they are 'segregated' within specialist support services in the community or because they live in isolation with carers, and health and social care models do not always join up locally to meet their needs.     

社区组织对艾滋病病毒感染者与病人的服务效果分析

目的：分析社区组织为艾滋病病毒感染者和病人（ people Living with HIV/AIDS,PLHA）提供服务的效果,为政府购买其服务提供依据。方法选取一基层社区组织,通过现有资料收集、关键人物访谈、专项调查等对社区组织为PLHA提供服务的过程、效果和经济指标进行比较分析。结果该社区组织2012年和2013年服务的PLHA人数、检测治疗指标均达到国家要求,超过全国和四川省的平均水平;病毒抑制达到较高水平;机会性感染发生、病死率均维持较低水平,且低于我国其他地区;服务的人均成本下降超过30％。结论该社区组织为PLHA提供服务的成效明显;社区组织为PLHA提供服务具有较多优势;社区组织应加强自身建设以更好为PLHA提供服务;各地政府和相关部门要加强对社区组织参与艾滋病防治工作的支持。     

Barriers and facilitators to the utilization of adult mental health services by Australia's Indigenous people: Seeking a way forward

Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well‐being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people.     

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.