Ageism,resilience, coping,family support,and quality of life among older people living with HIV/AIDS in Nanning,China

Although the HIV epidemic continues to spread among older adults over 50 years old in China, little empirical research has investigated the interrelationships among ageism, adaptability, family support, and quality of life among older people living with HIV/AIDS (PLWHAs). In this cross-sectional study, among 197 older PLWHAs over 50 years old, path analytic modelling was used to assess the interrelationships among ageism, resilience, coping, family support, and quality of life. Compared with female PLWHAs, male PLWHAs had a higher level of resilience and coping. There were no significant differences in the scores of quality of life, ageism, family support, HIV knowledge, and duration since HIV diagnosis between males and females. The following relationships were statistically significant in the path analysis: (1) family support → resilience [β (standardised coefficient)?=?0.18], (2) resilience → ageism (β?=??0.29), (3) resilience → coping (β?=?0.48), and (4) coping → quality of life (β?=?0.24). In addition, male PLWHAs were more resilient than female PLWHAs (β?=?0.16). The findings indicate that older PLWHAs do not only negatively accept adversity, but build their adaptability to positively manage the challenges. Family-based interventions need take this adaptability to adversity into consideration.     

Costs and economic consequences of a help‐at‐home scheme for older people in England

Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help‐at‐home schemes offer a mix of community support with the aim to address a range of well‐being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals’ well‐being and the economic consequences for local and central government can contribute to decisions about sustainable long‐term care financing. This article presents results from a mixed‐methods study of a voluntary sector‐provided help‐at‐home scheme in England for people of 55 years and older. The study followed a participatory approach, which involved staff and volunteers. Data were collected during 2012 and 2013. Social care‐related quality of life was measured with the Adult Social Care Outcomes Toolkit for 24 service users (59% response rate) when they started using the scheme and 4–6 months later. A customised questionnaire that captured resource use and well‐being information was sent to 1064 service users (63% response rate). The same tool was used in assessment with service users who started using the scheme between November 2012 and April 2013 (100% response rate). Costs of the scheme were established from local budget and activity data. The scheme was likely to achieve a mean net benefit of £1568 per person from a local government and National Health Service (NHS) perspective and £3766 from the perspective of the individual. An expenditure of £2851 per person accrued to central government for the additional redistribution of benefit payments to older people. This article highlights the potential contribution of voluntary sector‐run help‐at‐home schemes to an affordable welfare system for ageing societies.     

‘You opened our eyes’: care‐giving after learning a child’s positive HIV status in rural South Africa

Caregivers of young children identified as HIV positive, residing in Agincourt, rural South Africa were advised of their child’s status. How was this knowledge received, and how did it influence care‐giving and support? Interviews were conducted in May to June 2008 with caregivers of HIV positive children aged 1–5 years, 1 year following the child’s HIV test and disclosure of status. Drawing on data from 31 semi‐structured questionnaires and 21 in‐depth interviews, we describe caregivers’ attitudes, reactions, fears and aspirations after learning a child’s HIV status, the perceived usefulness of the knowledge, barriers to care‐giving and support received. Sociodemographic data collected through the questionnaire were analysed using Stata. Qualitative data were coded in NVIVO 8 and analysed inductively to identify themes and their repetitions and variations. Although almost half of the caregivers responded negatively initially, 1 year later, almost all had accepted and valued knowing their child’s HIV status as this had enhanced their competency in care‐giving. Counselling from health providers and personal spirituality helped caregivers to accept the child’s status and cope with its implications. Most caregivers had high aspirations for the child’s future, despite some expressed difficulties associated with care‐giving, including financial constraints, information gaps and barriers to healthcare. The results indicate an opportunity for paediatric HIV screening in communities with high HIV prevalence. This would facilitate early uptake of available interventions, so enhancing the survival of HIV positive children.     

Health,well‐being,and social support in older Australian lesbian and gay care‐givers

Informal care‐givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care‐giver is known to be associated with poorer health and well‐being, and lesbian and gay care‐givers report experiences of stigma and discrimination in the care‐giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care‐givers. We compared care‐givers to non‐caregivers on a range of health and well‐being measures, including psychological distress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care‐givers who were caring for an LGBTI person to those who were caring for a non‐LGBTI person. Among the lesbian women, care‐givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indicators. Among the gay men, care‐givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well‐being compared to those caring for a non‐LGBTI person. Overall, results from this study suggest that older lesbian and gay care‐givers may be facing some challenges related to their well‐being and feeling supported, especially if they are caring for another LGBTI person.     

The burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria: a database study

Objective : To estimate the burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria. Methods : We analysed fall‐related, person‐identifying hospital discharge data and patient‐level hospital treatment costs for community‐dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005–06, rising to 310,031 hospital bed days in 2007–08. Seventy‐one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2–27). The annual costs of inpatient care, in June 2009 prices, for fall‐related injury in community‐dwelling people aged 65+ years in Victoria rose from $213 million in 2005–06 to $237 million in 2007–08. The burden of hospitalised fall‐related injury in community‐dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications : A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.     

Cost‐minimisation analysis of home care reablement for older people in England: A modelling study

Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations.     

Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: A qualitative provider interview study

Abstract

The aim of this study was to explore the perspectives of healthcare providers on the advantages and disadvantages of integrating HIV care services, including highly active antiretroviral therapy (HAART), into antenatal care (ANC) clinics in rural Kenya. We conducted a qualitative study using in-depth interviews and thematic analysis; 36 healthcare providers from six health centres in Nyanza Province, Kenya participated. Effects on service providers included increased workload due to the incorporation of specialised HIV services into ANC clinics. Providers observed that integration results in decreased patient time spent at the health facility, increased efficiency and closer provider-patient relationships; all leading to increased patient satisfaction. Providers also said that women would be more likely to receive HAART and adhere to their treatment as a result of improved confidentiality and decreased stigma. However, a minority of providers noted that integration could result in longer appointment times for HIV-positive women at ANC clinics leading to inadvertent disclosure. Integration could lead to strengthened ANC, postpartum care, prevention of mother-to-child transmission and HIV care for women and their families. However, integration efforts need to take into account potential negative effects on ANC provider workload, disclosure and the quality of care.     

New jobs old roles – working for prevention in a whole‐system model of health and social care for older people

The Partnerships for Older People Projects programme provided government funding for local and health authorities to pilot prevention and intervention services in partnership with the voluntary sector and older people between 2006 and 2009. This local evaluation of a pilot in southern England undertaken between 2007 and 2009 used a Theory of Change approach to gathering and reflecting on data with different groups involved in the delivery of this whole‐system based model of prevention. The model was delivered in the same way in seven social services locality areas within a large county authority. The method of data gathering enabled structured reflection on the implementation, development and projected outcomes of the model and a consideration of the key learning of working in a whole‐system way with partners and stakeholders. The whole‐system model, although complex and challenging to implement, was considered overall to have been a success and provided significant learning for partners and stakeholders on the challenges and benefits of working across professional and sectoral boundaries. New posts were created as part of the model. Two of these, recruited to and managed by voluntary sector partners, were identified as ‘new jobs’, but echoed ‘old roles’ within community and voluntary sector based health and social care. The authors reflect on the parallels of these roles with previously existing roles and ways of working and reflect on how the whole‐system approach of this particular pilot enabled these new jobs to develop in particularly appropriate and successful ways.     

‘My biggest fear was that people would reject me once they knew my status…’: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg,South Africa

Stigma is not a new concept; however, it remains highly significant in the context of HIV/AIDS in South Africa. There is wide consensus that HIV/AIDS‐related stigma compromises the well‐being of people living with the disease. This paper is part of a larger study that seeks to understand the social and cultural complexity related to the provision and outcomes of antiretroviral therapy (ART) in South Africa. It explores and analyses how patients on ART perceived and experienced stigma and how it has shaped their behaviour towards, as well as their understanding of the epidemic. The data have been collected by means of in‐depth face‐to‐face interviews, conducted between June and November 2007, with a sample of 44 patients in an HIV/AIDS clinic in a resource‐limited setting in Johannesburg, South Africa. The findings reveal that the level of felt and anticipated stigma is intense and affects all dimensions of living with HIV/AIDS, particularly disclosure and treatment. Stigma permeates the experience of HIV‐positive people on ART who participated in this study. The intensity of HIV/AIDS‐related stigma can threaten to compromise the value of ART, thus impacting on the daily lives of people living with HIV/AIDS (PLWHA). This study suggests that three decades into the epidemic, stigmatisation remains a core feature of the patient experience of HIV/AIDS. In the clinic in which this research was conducted, HIV/AIDS was regarded as a chronic condition increasingly manageable by ongoing access to ART. However, this approach was not shared by many family members, neighbours and employers who held highly stigmatised views.     

The experiences of neighbour,volunteer and professional support‐givers in supporting community dwelling older people

Public policy increasingly emphasises the importance of informal support networks to meet the needs of the ageing population. Evidence for the types of support neighbours provide to older people and how neighbours collaborate with formal support‐givers is currently insufficient. Our study therefore explored (i) types of informal neighbour support and (ii) experiences of neighbours, volunteers and professionals providing support. Interviews with nine Dutch neighbour support‐givers, five volunteers and 12 professionals were conducted and subjected to latent content analysis. Findings indicate that commitment occurred naturally among neighbours; along with providing instrumental and emotional support, neighbour support seems to be a matter of carefully ‘watching over each other’. Neighbour support‐givers, however, are often frail themselves and become overburdened; they furthermore lack support from professionals. Neighbour, volunteer and professional support‐givers seem to operate in distinct, non‐collaborative spheres. Findings suggest that policy‐makers should consider the opportunities and limitations of neighbour and volunteer support. Professionals have an indispensable role in providing back‐up and accountable, specialised support. They may be trained to adopt a visible and proactive attitude in neighbourhoods to facilitate, cooperate with and mediate between neighbour and volunteer support‐givers.     

农村孕产妇及相关人群艾滋病知识与态度调查

目的了解云南省农村孕产妇及相关人群对艾滋病传播与预防知识知晓水平和对感染人类免疫缺陷病毒（HIV）孕产妇的态度。方法问卷调查云南省某县4乡怀孕28周至产后3个月的孕产妇223人,及社区相关人群310人。结果孕产妇、丈夫、婆婆、育龄妇女、乡村医生、乡村干部对艾滋病知识知晓率分别为61.1%,64.3%,38.2%,67.1%,92.3%和84.3%,对包括3条母婴传播阻断知识的8个核心指标知晓率分别为5.4%,4.9%,0,3.3%,58.4%和15.0%。70%的孕产妇和50%的丈夫表示害怕与艾滋病感染者接触。70%的丈夫、13.4%的婆婆、23.7%的育龄妇女、甚至10%的乡村干部表示会远离或抛弃感染HIV的孕产妇。结论云南省农村孕产妇及相关人群对艾滋病传播途径知晓率较高,对母婴传播阻断知识了解甚少,对HIV感染者存在严重恐惧和歧视。     

Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population‐based study

There is limited knowledge about older people's length of stay (time until death) in institutional care and how it has changed over time. The aim of this study was to analyse changes in the length of stay for older people in institutional care between 2006 and 2012. All persons 65+ living in Kungsholmen (an urban area of Stockholm), who moved to an institution between 2006 and 2012, were included (N = 1103). The data source was the care system part of a longitudinal database, the Swedish National Study on Aging and Care. The average length of stay was analysed using Laplace regression for the 10th to the 50th percentile for the years 2006–2012. The regressions showed that in 2006, it took an average of 764 days before 50% of those who had moved into institutional care had died. The corresponding figure for 2012 was 595 days, which amounts to a 22.1% decrease over the period studied (P = 0.078). For the lower percentiles, the decrease was even more rapid, for example for the 30th percentile, the length of stay reduced from 335 days in 2006 to 119 days in 2012, a decrease of 64.3% (P < 0.001). The most rapid increase was found in the proportion that moved to an institution and died within a short time period. In 2006, the first 10% had on average died after 85 days, in 2012 after only 8 days; a decrease in the length of stay of 90.5% (P = 0.002). In general, there was a significant decrease in the length of stay in institutional care between 2006 and 2012. The most dramatic change over the period studied was an increase in the proportion of people who moved into an institution and died shortly afterwards.     

Inequality in prime‐age adult deaths in a high AIDS mortality setting: does the measure of economic status matter?

We analyze deaths among prime‐aged men and women during a 13‐year period in a high AIDS mortality setting and examine the distribution of deaths by the economic status of these individuals at baseline using the 1991–2004 Kagera Health and Development Survey (KHDS). We investigate whether the distribution of subsequent prime‐age adult deaths as measured by concentration indices depends on the measure of living standards used. We compare the performance of three measures: (1) per capita expenditure; (2) a modern wealth asset index replicating the asset index included in the 2004 Tanzanian AIDS Indicator Survey data file; and (3) a traditional wealth asset index, which includes only measures of traditional wealth. We find no evidence that economic status is linked to prime‐age adult deaths, for both men and women, regardless of the measure of economic status used. This finding suggests both that more generally the measure of economic status used does not appear to be crucial, and specifically that relationships using traditional measures of wealth do not seem to differ from those using conventional measures. Copyright © 2010 John Wiley & Sons, Ltd.     

“They (ARVs) are my life, without them I’m nothing”—experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa

This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.     

2012年中国新报告男男性行为HIV感染者随访1年婚姻行为情况分析

目的 分析我国男男性行为HIV感染者（MSM感染者）确证后婚姻及危险行为变化情况,为有针对性地开展干预,预防二代传播提供依据。方法 使用截至2012年12月31日的艾滋病网络直报病例报告卡和2013年12月31日艾滋病随访管理定时数据库,对2012年新报告MSM感染者的基本人口学特征、婚姻状况和高危行为及其变化情况进行分析。结果 2012年新报告MSM感染者中,66.1%（10 426/15 768）为未婚,69.6%（10 970/15 768）为高中及以上文化程度。2012年随访到的MSM感染者中,1年后有96.0%（14 451/15 049）仍接受随访,其安全性行为比例从首次随访前的67.7%（9 779/14 451）上升到91.1%（13 277/14 451）;发现感染HIV时已婚有配偶的MSM感染者中,64.1%在1年后仍维持有配偶状态;高中及以上文化程度（OR=1.540,95%CI：1.138～2.085）、职业为工人（OR=1.430,95%CI：1.131～1.808）、干部职员（OR=1.610,95%CI：1.236～2.098）和农民（OR=1.661,95%CI：1.214～2.271）相对于小学及以下文化程度和职业为商业服务的MSM感染者更易采取安全性行为。始终无配偶（OR=0.563,95%CI：0.439～0.722）、有配偶变无配偶（OR=0.624,95%CI：0.448～0.870）和无配偶变有配偶（OR=0.444,95%CI：0.288～0.687）较始终有配偶的MSM感染者更易发生危险性行为。结论 规范化的随访管理有助于MSM感染者采取安全性行为,随访过程中需针对无配偶/固定性伴、低文化程度、职业为商业服务的MSM感染者采取有效的干预措施,预防HIV的二代传播。     

Societal and individual drivers of fertility desires and intentions among people living with HIV: a cross sectional study of HIV clinic attendees in Soweto,South Africa

BackgroundHigh proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors.MethodsThis was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data.ResultsThe participants'' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81).ConclusionIndividual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.