Microcredit for people affected by HIV and AIDS: Insights from Kenya

Consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV and AIDS service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement to their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other AIDS service organisations and donors is necessary to muster appropriate and rapid responses in areas experiencing severe impacts of HIV and AIDS.     

Poverty as a barrier to antiretroviral therapy access for people living with HIV/AIDS in Kenya

Understanding barriers to access to essential health services is critical for devising effective strategies to improve access and align such strategies with national health and development policy objectives. However, while considerable empirical evidence exists on correlates of HIV prevalence and populations at risk of contracting HIV, there is very little such evidence on access to antiretroviral therapy. This paper addresses this gap through a cross-sectional analysis of coverage of antiretroviral therapy and its correlates across 47 counties in Kenya. It considers health-sector and social factors, and applying instrumental variables to address error-in-variables and reverse-causality issues regarding HIV prevalence. Poverty was the most robust and — statistically and substantially — significant determinant of treatment coverage. The gap in treatment coverage between the poorest and richest counties amounted to about 40 percentage points and has not narrowed between 2012 and 2015. Health sector capacities independently played a role and exacerbated the poverty gap. For Kenya, the results suggest that policies on expanding treatment access need to be differentiated across counties to greatest effect and to align the HIV/AIDS response with national health and social policy objectives. Regarding global HIV/AIDS policies, the findings suggest a need to recognise “people left behind” owing to socio-economic and specifically poverty-related barriers to access to services.     

Barriers to counselling support for HIV/AIDS patients in south-western Cameroon

The potential synergy between counselling and HIV/AIDS prevention is gaining recognition in Cameroon as counselling sessions are more often organised at health centres. In order to evaluate the actual achievements of these efforts, a qualitative ethnographic survey (based on interviews and focus group discussions) was conducted in two public and two private hospitals in the South-West Province. Churches and public health officials in Cameroon are struggling with the psycho-social, philosophical, psychological, theological, social, moral, ethical and cultural dimensions of HIV/AIDS, as they seek out viable prevention strategies. Health centres are also struggling to embrace the full meaning of counselling and to make psychological and spiritual support to AIDS patients available through the centres. Patients using these health centres may receive HIV testing against a backdrop of cultural standards that allow unsafe sex and bar open discussion on sex and sexuality. We propose that reversing the trend of the epidemic requires the intervention of the State, organisations in civil society and the family. Equally crucial is the role played by the churches — especially in confronting issues of stigmatisation and abandonment that often accompany patient disclosure, and in providing spiritual, emotional and psychological support to patients undergoing treatment.     

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营养不良是导致人免疫缺陷病毒(HIV)感染者和艾滋病患者出现不良预后的重要因素,国内一些研究证据发现,营养不良在HIV感染者和艾滋病患者中普遍存在。对接受抗病毒治疗的患者,都应定期对其进行常规营养不良筛查,以早期发现营养不良。营养咨询是医学营养治疗的基础,可有效促进蛋白质和热量摄入达到标准。对于经咨询后经口摄入仍不能达标的患者,应首先给予肠内营养支持。血脂是接受艾滋病抗病毒治疗(ART)患者需要长期关注的问题,对于脂代谢异常者,应首先考虑调整膳食结构。总之,营养不良已经成为中国HIV感染者和艾滋病患者面临的主要挑战。现有各种艾滋病关怀项目应重视患者的热量和蛋白质摄入问题。应将医学营养治疗纳入国家和社区艾滋病治疗指南的一部分。     

HIV/AIDS and family support systems: A situation analysis of people living with HIV/AIDS in Lagos State

Current statistics about the HIV/AIDS epidemic in Nigeria do not reveal the broader social and economic impacts of the disease on the family. The study therefore primarily aimed to address the socio-economic effects of HIV infection on individuals and their families. The study was carried out in Lagos State. In-depth interviews were employed to collect information from 188 people living with HIV/AIDS through support groups in the state, while four focus group discussions were conducted to elicit information from people affected by AIDS about the socio-economic impacts of HIV/AIDS on families in Nigeria. From the survey, among people living with HIV/AIDS, 66% of females and males were in the age group 21–40 years, while 10% were older people above 60 years of age. Findings revealed that as HIV/AIDS strikes at parents, grand parents are assuming responsibility for bringing up the children of the infected persons and the orphans of those killed by the virus. It was striking that some of the older caregivers could not meet the requirement of these children. They are often forced to work more than they would have, or borrow in order to cope with the needs of these extra mouths. Some of the infected people have sold their properties to enable them to cope with the economic effects of the virus, while their children have had to drop out of school, since they could not afford the school fees and other related expenses. It was suggested that PLWHA should be economically empowered with adequate medical treatment, in order to reduce the impact of the disease on the family.     

Towards an improved investment approach for an effective response to HIV/AIDS

Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.     

A program of symptom management for improving self-care for patients with HIV/AIDS

The purpose of this study was to investigate the effect of a symptom management program on self-care of medication side effects among AIDS/HIV-positive patients. Sixty-seven patients from a sexually transmitted disease control center, a medical center, and a Catholic AIDS support group in Taipei were randomly assigned to three groups: one-on-one teaching, group teaching, and a control group. All subjects in each teaching group attended a 60- or 90-minute program on highly active antiretroviral therapy (HAART) side effect self-care education and skill training once per week for 3 weeks; subjects also underwent counseling by telephone. A medication side effect self-care knowledge questionnaire, Rosenberg's Self-Esteem Scale (RSES), and unscheduled hospital visits were used to evaluate the effectiveness of the symptom management program. The results revealed there were significant differences in mean difference of knowledge and unscheduled hospital visits between baseline and post-testing at 3 months for symptom management in the two groups. The mean difference of the self-esteem scale was not significant between the two groups. In summary, the symptom management program effectively increased the ability of AIDS/HIV-positive patients to self-care for medication side effects. We recommend that this program be applied in the clinical nursing practice.     

Increasing workload of an HIV/AIDS counselling service in a London teaching hospital, 1990-91.

The number of new patients referred to the HIV/AIDS Counselling Unit at the Royal Free Hospital, London, increased from 926 in 1989-90 to 1450 in 1990-91. Follow-up contacts nearly doubled during the same period of time. Growing demand for HIV testing as well as the shift to the treatment of HIV as a chronic condition increased the workload of the HIV/AIDS counsellors.     

Care for people living with HIV/AIDS: an assessment of day care centers in northern Thailand

A cross-sectional survey of 271 day care center (DCC) members at 9 district hospitals was undertaken using an interviewer-administered questionnaire to assess the psychosocial and economic impact of the services provided by DCCs to people living with HIV/AIDS (PLWHA) and the costs of attending DCCs in Chiang Rai Province in Thailand. Data on the socioeconomic and demographic background of the participants, their reasons for attending DCCs, their medical services usage, the changes DCCs made on their lives, and the cost of attending DCCs were collected. "Receiving information" (37%) and "meeting friends" (32%) were the two most common reasons while fewer participants gave "physical examination" (6%) and "counseling" (0.4%) as their reasons for attending DCCs. Nearly half became more positive about their lives and 40% learned how to live with the disease. Through DCCs, 24% and 58% were receiving prophylaxis for tuberculosis and Pneumocystis carinii pneumonia respectively, and 15% were taking antiretrovirals. The majority (85%) lived with 30 minutes of DCCs, and incurred travel cost up to 30 Baht (1 USD approximately 40 Baht). The mean monthly income of those with jobs was 1,565 Baht and 42% lost wages when attending DCCs, more than half of whom were the main income earners in their families. In conclusion, DCCs benefit PLWHA through their educational and psychological support. However, they can be further utilized for their medical services. As an expansion of antiretroviral treatment is planned in Thailand, the DCCs' role should be fully explored and clearly defined. Minimizing economic and geographical barriers to access are some of the most immediate challenges.     

The impact of HIV/AIDS on labour productivity in Kenya

OBJECTIVES: To estimate the impact of HIV/AIDS on individual labour productivity during disease progression. METHODS: We used a retrospective cohort design to study the productivity and attendance of tea estate workers who died or were medically retired because of AIDS-related causes between 1997 and 2002 in western Kenya. We compared daily output in kilograms of tea leaves plucked, use of paid and unpaid leave and assignment to less strenuous tasks by 54 workers who died or were medically retired because of AIDS to those of comparison workers, matched on time and tea field using longitudinal regression. RESULTS: HIV-positive workers plucked less tea in the 18 months preceding AIDS-related termination and used more leave in the 3 years before termination. After adjusting for age and environmental factors, cases plucked between 4.11 and 7.93 kg/day less in the last year and a half before termination. Cases used between 9.2 and 11.0 more sick leave days, between 6.4 and 8.3 more annual leave days, between 19.9 and 11.8 more casual leave days, and spent between 19.2 and 21.8 more days doing less strenuous tasks in the 2 years before termination than did comparison pluckers. Tea pluckers who terminated because of AIDS-related causes earned 16.0% less in their second year before termination and 17.7% less in the year before termination. CONCLUSION: These results provide empirical estimates of the impact of HIV/AIDS on labour productivity. As workers often bring unrecorded 'helpers', actual differences may be greater. Decreased attendance and output may put sick workers in jeopardy of losing their jobs and impose financial burdens on employers.     

Public reactions to people with HIV/AIDS in The Netherlands.

A national telephone survey was conducted to (a) assess present-day public reactions to people with HIV/AIDS in the Netherlands, (b) measure how knowledge about highly active antiretroviral therapy (HAART) is related to public reactions to people with HIV/AIDS, and (c) investigate determinants of willingness to have personal contact with people with HIV/AIDS. Dutch adults (N = 751) participated in a telephone interview conducted to measure cognitive, emotional, and behavioral reactions to people with HIV/AIDS. This study has shown that public reactions to people with HIV/AIDS seem to be moderately positive in the Netherlands. Knowledge about HAART is related to lower risk perceptions, a positive attitude toward homosexuals, less fear, and more willingness to have personal contact with people with HIV/AIDS. In particular, cognitive and emotional factors are meaningfully related to willingness to have personal contact with people with HIV/AIDS. Implications for Dutch AIDS educational campaigns aimed at stigma reduction are discussed.     

Widowhood in the era of HIV/AIDS: A case study of Slaya District,Kenya

Luo women are believed to acquire contagious cultural impurity after the death of their husbands that is perceived as dangerous to other people. To neutralise this impure state, a sexual cleansing rite is observed. In the indigenous setting, the ritual was observed by a brother-in-law or cousin of the deceased husband through a guardianship institution. However, with the emergence of HIV/AIDS, many educated brothers-in-law refrain from the practice and instead hire professional cleansers as substitutes. If the deceased spouses were HIV positive, the ritual places professional cleansers at risk of infection. Thereafter, they could act as a bridge for HIV/AIDS transmission to other widows and to the general population. This paper provides insights into reasons for continuity of widowhood rites in Siaya District. Twelve focus group discussions and 20 in-depth interviews were conducted. The cultural violence against Luo widows could spread HIV/AIDS, but Christianity and condoms act as coping mechanisms.     

Differential effects of unemployment on depression in people living with HIV/AIDS: a quantile regression approach

ABSTRACT

Unemployment is associated with depression in people living with HIV (PLWH). However, few studies have examined the effects of unemployment on PLWH with different levels of depression. The current study explores the plausible differential effects of unemployment on the different percentiles of depression in PLWH employing a quantile regression (QR) approach, based on a recent survey of 411 PLWH in China. Among participants, 47.7% had elevated depressive symptoms, and 23.8% were unemployed. The effects of unemployment on depression were statistically significant with a trend of initial increase followed by a decline at the quantile levels of 0.51–0.90 of depression. The maximum effect of unemployment status on depression was statistically significant at the 70th and 75th percentiles of depression (coefficient?=?7.0, p?<?.01). Tailored strategies and interventions should be implemented to address the differential needs of PLWH with various levels of depressive symptoms.     

Food security in HIV/AIDS response: Insights from Homa Bay,Kenya

This paper examines the viability and effectiveness of a pilot farming initiative in reversing impacts of HIV/AIDS on the most affected households in Homa Bay, Kenya. The paper argues that once patients are stable, they can effectively be engaged in farming with minimal financial and technical support, resulting in enhanced food security of the affected households. More importantly, it helps to reduce HIV/AIDS-related stigma and improve the individual's self-esteem. Some of the key challenges of the pilot initiative were the limited number of agricultural extension workers and absence of facilities to enable them to deliver services to the farmers, the high cost of farm inputs, the unavailability of farm inputs when they were needed, poorly developed agricultural markets, and the absence of irrigation facilities. The paper recommends the sensitive scaling-up of this approach. However, farming initiatives by HIV/AIDS service NGOs should be linked to at least three key aspects: (a) treatment, care and support to HIV/AIDS affected households; (b) micro grant schemes or subsidies to enable farmers to purchase farming tools and farm inputs; and (c) comprehensive on-farm training support. To ensure effectiveness and wider reach, government needs to view agriculture through an HIV lens and promote a multisectoral approach that recognises the relationship between HIV/AIDS and food security. A number of immediate actions are required to strengthen this relationship, such as increased public investment to augment extension services, subsidise farm inputs, and develop infrastructure including agricultural markets.     

艾滋病病毒感染者及病人生活质量及其影响因素

随着高效抗反转录病毒疗法(HAART)等有效治疗方法的展开,艾滋病病毒(HIV)感染者及病人(PL-WHA)死亡率降低,已经逐渐成为慢性、可处理的人群,所以提高其生活质量显得尤其重要。近年来,PLWHA生活质量的评定量表、影响因素以及改善措施的研究等均有不同程度的报道。文章就近年来国内外对PLWHA生活质量及其影响因素、改善措施方面的研究进展进行综述,并对以后此方面研究的发展做了讨论。