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Kasande M, Natwijuka A, Katushabe Snr E, Tweheyo Otwine Snr A. Experiences of Caring for Adolescents Living with HIV (ALHIV): A Qualitative Interview with Caregivers. HIV AIDS (Auckl) 2022; 14:577-589. [PMID: 36575691 PMCID: PMC9790143 DOI: 10.2147/hiv.s388715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aims at exploring experiences of people caring for adolescents living with HIV, also known as caregivers. By 2021, 150,000 adolescents were living with HIV and 32,000 adolescents were dying of AIDS related causes. HIV/AIDS remains one of the most serious public health problems, especially among the adolescents. This has placed a heavy burden on many caregivers, yet they are essential in caring for ALHIV. However, focus of all interventions has excluded caregivers of ALHIV. Thus, this is the reason why this study is being conducted to find out caregivers' experience in caring for ALHIV. Participants and Methods A phenomenological study was carried out. Purposive sampling was used to select a total of 15 caregivers to participate in the study. These participants were subjected to in-depth semi-structured interviews. Their responses were recorded, transcribed and translated for thematic analysis. Results While analyzing the results, six themes emerged. They include: diagnosis and reaction to diagnosis, experiences on adolescent's HIV serostatus disclosure, stigma and discrimination, care disengagement, and lastly, challenges during care and coping strategies. Caregivers experienced feelings of fear, Guilt, suicidal thoughts after diagnosis. Stigma and discrimination of adolescents living with HIV which was common at school and from the neighbors and the adolescent stage were some of the challenges experienced by the caregivers and it makes it hard to retain ALHIV in care. Conclusion Families are the main source of caregiving to the adolescents living with HIV (ALHIV). The study's findings indicate that caregivers in the families experience challenges related to family needs, and psychological challenges resulting from the adolescence stage. So, families should not be left to shoulder the burden of caring for ALHIV. As a way forward, social network and financial support should also be strengthened for most caregivers as a coping strategy.
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Affiliation(s)
- Meble Kasande
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda,Correspondence: Meble Kasande, Bishop Stuart University, Faculty of Nursing and Health Sciences, P.O Box 09, Mbarara, Uganda, Tel +256 7812551, Email ;
| | - Andrew Natwijuka
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Eve Katushabe Snr
- Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
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When Pregnancy Coincides with Positive Diagnosis of HIV: Accounts of the Process of Acceptance of Self and Motherhood among Women in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413006. [PMID: 34948615 PMCID: PMC8700982 DOI: 10.3390/ijerph182413006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Literature has highlighted the unique period of vulnerability following an HIV diagnosis during pregnancy. Despite the high burden of HIV among pregnant women in South Africa, the experiences of women diagnosed with HIV during pregnancy have rarely been explored in isolation from those diagnosed at different times. This paper explored the experiences of women who were diagnosed with HIV when pregnant and assessed their emotional recovery beyond diagnosis. The study used a qualitative descriptive phenomenological approach to conduct interviews with women recruited from ART clinics in a health district in South Africa. Participants included 19 women sampled purposively. The interviews were transcribed verbatim and analysed following the thematic approach. Testing positive during pregnancy and being free of symptoms increased the shock, disbelief, and strong emotions exhibited. For the women, the diagnosis of HIV coincided with pregnancy and transformed pregnancy from excitement to anxiety. Although the transition from being HIV negative to becoming HIV positive and pregnant was overwhelming, with the passage of time, the women transitioned to feelings of acceptance. However, the process of acceptance was slow and varied, with some experiencing non-acceptance for extended periods. Non-acceptance of HIV diagnosis has serious adverse public health consequences for the individual. Integrating continuous HIV counselling and culturally appropriate psychosocial care into practice could foster acceptance for pregnant women with HIV diagnosis.
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Etoori D, Renju J, Reniers G, Ndhlovu V, Ndubane S, Makhubela P, Maritze M, Gomez-Olive FX, Wringe A. 'If the results are negative, they motivate us'. Experiences of early infant diagnosis of HIV and engagement in Option B. Glob Public Health 2020; 16:186-200. [PMID: 32673142 DOI: 10.1080/17441692.2020.1795220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few studies have explored the relationship between early infant diagnosis (EID) of HIV and mothers' engagement in care under Option B+. We conducted in-depth interviews with 20 women who initiated antiretroviral therapy (ART) under Option B+ in rural South Africa to explore the interactions between EID and maternal care engagement. Drawing on practice theory, we identified themes relating to Option B+ care engagement and EID. Women's practice of engagement with HIV care shaped their decision-making around EID. Mothers who disengaged from care during pregnancy were less inclined to utilise EID as they lacked information about its availability and benefits. For some mothers, tensions between wanting to breastfeed and perceptions that it could facilitate transmission led to repeated utilisation of EID as reassurance that the child remained negative. Some mothers used their child's negative result as a proxy for their status, subsequently disengaging from care. For some participants, an HIV diagnosis of their infant and the subsequent double burden of treatment visits for themselves and their infant, contributed to their disengagement. Women's care-seeking practices for themselves and their infants work in a symbiotic ecosystem and should be viewed interdependently to tailor interventions to improve EID uptake and Option B+ care engagement.
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Affiliation(s)
- David Etoori
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Violet Ndhlovu
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherly Ndubane
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Princess Makhubela
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meriam Maritze
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gomez-Olive
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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4
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Pinquart M. Featured Article: Depressive Symptoms in Parents of Children With Chronic Health Conditions: A Meta-Analysis. J Pediatr Psychol 2020; 44:139-149. [PMID: 30346613 DOI: 10.1093/jpepsy/jsy075] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Caring for children with chronic health conditions is associated with stressors that may impair mental health. The goal of our meta-analysis was to analyze depressive symptoms among parents who care for a child or adolescent with chronic physical disease and/or sensory disability and/or physical disability compared with parents of healthy children or test norms. Methods A systematic search through electronic databases identified 460 relevant studies that were included in a random-effects meta-analysis. Results Parents of children with chronic conditions showed small to moderate elevations of depressive symptoms compared with parents of healthy/nondisabled children and test norms (g = .46 SD units). Twelve studies using structured clinical interviews provided a weighted mean depression rate of 20.9%. The highest elevations were found among parents of young people with neuromuscular disorders, cancer, and cerebral palsy. Elevations of depressive symptoms were greater in cases with shorter durations of the chronic condition, in mothers compared with fathers, and in parents from economically less developed countries rather than developed countries. Conclusions Parents of children with chronic conditions, particularly parents of children with neuromuscular disorders, cancer, and cerebral palsy, should be screened for depression and receive psychosocial services aimed at reducing these symptoms, if needed.
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5
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Nieuwoudt S, Manderson L. Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: a qualitative exploration of policy translation. Int Breastfeed J 2018; 13:20. [PMID: 29930693 PMCID: PMC5992713 DOI: 10.1186/s13006-018-0164-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/14/2018] [Indexed: 12/27/2022] Open
Abstract
Background Mothers rely heavily on health worker advice to make infant feeding decisions. Confusing or misleading advice can lead to suboptimal feeding practices. From 2001, HIV positive mothers in South Africa were counseled to choose either exclusive breastfeeding or exclusive formula feeding to minimize vertical HIV transmission. On the basis of revised World Health Organization guidelines, the government amended this policy in 2011, by promoting exclusive breastfeeding and discontinuing the provision of free formula. We explored how health workers experienced this new policy in an HIV endemic community in 2015–16, with attention to their knowledge of the policy, counselling practices, and observations of any changes. Methods We interviewed eleven health workers, from four community health clinics, who had counseled mothers before and after the policy change. The transcribed interviews were analyzed thematically, using a hybrid coding approach. Results The scientific rationale of the policy was not explained to most health workers, who mostly thought that the discontinuation of the formula program was cost-related. The content of their counseling reflected knowledge about promoting breastfeeding for all women, and accordingly they mentioned the nutritional and developmental benefits of breastfeeding. The importance of exclusive breastfeeding for all infants was not emphasized, instead counseling focused on HIV prevention, even for uninfected mothers. The health workers noted an increased incidence of breastfeeding, but some worried that to avoid HIV disclosure, HIV positive mothers were mixed feeding rather than exclusively breastfeeding. Conclusions Causal links between the policy, counseling content and feeding practices were unclear. Some participants believed that breastfeeding practices were driven by finance or family pressures rather than the health information they provided. Health workers generally lacked training on the policy’s evidence base, particularly the health benefits of exclusive breastfeeding for non-exposed infants. They wanted clarity on their counseling role, based on individual risk or to promote exclusive breastfeeding as a single option. If the latter, they needed training on how to assist mothers with community-based barriers. Infant feeding messages from health workers are likely to remain confusing until their uncertainties are addressed. Their insights should inform future guideline development as key actors.
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Affiliation(s)
- Sara Nieuwoudt
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,2Developmental Pathways Health and Research Unit, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa
| | - Lenore Manderson
- 1School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000 South Africa.,3Institute at Brown for Environment and Society, Brown University, 85 Waterman St, Providence, RI 02912 USA
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6
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Dunning L, Kroon M, Fourie L, Ciaranello A, Myer L. Impact of Birth HIV-PCR Testing on the Uptake of Follow-up Early Infant Diagnosis Services in Cape Town, South Africa. Pediatr Infect Dis J 2017; 36:1159-1164. [PMID: 28767616 PMCID: PMC5926182 DOI: 10.1097/inf.0000000000001677] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Polymerase chain reaction testing at birth ("birth-testing") is suggested by new World Health Organization guidelines for rapid diagnosis of infants infected with HIV in utero. However, there are few data on the implementation of this approach in sub-Saharan Africa, and whether birth testing affects uptake of subsequent routine early infant diagnosis (EID) testing at 6-10 weeks of age is unknown. METHODS We reviewed 575 consecutive infants undergoing targeted high-risk birth testing in Cape Town, South Africa, and matched those testing HIV negative at birth (n = 551) to HIV-exposed infants who did not receive birth testing (n = 551). Maternal and infant clinical and demographic data, including EID testing uptake, were abstracted from routine records. RESULTS Overall, 3.8% of all birth tests conducted were positive while later EID testing positivity rates were 0.5% for those infants testing HIV negative at birth and 0.4% for those without birth testing. Infants who underwent birth testing were less likely to present for later EID compared with those without a birth test (73% vs. 85%; P < 0.001). This difference persisted after adjusting for maternal and infant characteristics (adjusted odds ratio, 0.60; 95% confidence interval: 0.41-0.86) and across demographic and clinical subgroups. Infants undergoing birth testing also presented for later EID at a significantly older age (mean age, 60 vs. 50 days; P < 0.001). CONCLUSIONS While the yield of targeted high-risk birth testing in this setting appears high, neonates testing HIV negative at birth may be less likely to present for subsequent EID testing. For birth testing implementation to contribute to overall EID program goals, structured interventions are required to support follow-up EID services after negative birth test results.
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Affiliation(s)
- Lorna Dunning
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Max Kroon
- Department of Neonatal Medicine, University of Cape Town, Cape Town, South Africa
| | - Lezanne Fourie
- Department of Neonatal Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrea Ciaranello
- Division of Infectious Disease, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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7
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Ashaba S, Kaida A, Burns BF, O'Neil K, Dunkley E, Psaros C, Kastner J, Tsai AC, Bangsberg DR, Matthews LT. Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda. BMC Pregnancy Childbirth 2017; 17:138. [PMID: 28482821 PMCID: PMC5423027 DOI: 10.1186/s12884-017-1321-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background In sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women. Methods We conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis. Results Twenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality. Conclusions The results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kasey O'Neil
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jasmine Kastner
- Research Institute McGill University Health Centre Montreal, Montreal, Canada
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David R Bangsberg
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynn T Matthews
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Hatfield-Timajchy K, Brown JL, Haddad LB, Chakraborty R, Kourtis AP. Parenting Among Adolescents and Young Adults with Human Immunodeficiency Virus Infection in the United States: Challenges, Unmet Needs, and Opportunities. AIDS Patient Care STDS 2016; 30:315-23. [PMID: 27410495 PMCID: PMC5335748 DOI: 10.1089/apc.2016.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Given the realistic expectations of HIV-infected adolescents and young adults (AYA) to have children and start families, steps must be taken to ensure that youth are prepared to deal with the challenges associated with their HIV and parenting. Literature reviews were conducted to identify published research and practice guidelines addressing parenting or becoming parents among HIV-infected AYA in the United States. Research articles or practice guidelines on this topic were not identified. Given the paucity of information available on this topic, this article provides a framework for the development of appropriate interventions and guidelines for use in clinical and community-based settings. First, the social, economic, and sexual and reproductive health challenges facing HIV-infected AYA in the United States are summarized. Next, family planning considerations, including age-appropriate disclosure of HIV status to those who are perinatally infected, and contraceptive and preconception counseling are described. The impact of early childbearing on young parents is discussed and considerations are outlined during the preconception, antenatal, and postnatal periods with regard to antiretroviral medications and clinical care guidelines. The importance of transitioning AYA from pediatric or adolescent to adult-centered medical care is highlighted. Finally, a comprehensive approach is suggested that addresses not only medical needs but also emphasizes ways to mitigate the impact of social and economic factors on the health and well-being of these young parents and their children.
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Affiliation(s)
- Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L. Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa B. Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Athena P. Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Shannon MT. HIV-infected mothers' experiences during their infants' HIV testing. Res Nurs Health 2015; 38:142-51. [PMID: 25739368 DOI: 10.1002/nur.21646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
Abstract
Both survival with HIV and rates of perinatal HIV infection have significantly declined during the past decade, due to antiretroviral therapies that interrupt HIV transmission to the fetus and newborn. Although HIV is no longer routinely fatal to mothers or transmitted to fetuses, and the testing of newborns for HIV has been improved, evidence about HIV-infected mothers' experiences during the months of their infants' HIV testing predates these improvements. This qualitative study on 16 mothers was an analysis of interviews conducted several weeks after testing was completed and all infants had been determined to be uninfected. Mothers reported that their experiences evolved during the months of testing. Initial reactions included maternal trauma and guilt associated with infant testing. They then reported learning to cope with the roller coaster ride of repeated testing with the help of information from clinicians. By the end of the testing period, ambiguity began to resolve as they engaged in tentative maternal-infant attachment and expressed desire for a sense of normalcy. Need for support and fear of stigma persisted throughout. These findings expand current knowledge about this experience and suggest clinical strategies to guide HIV-infected women during this stressful period.
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Affiliation(s)
- Maureen T Shannon
- University of Hawaii at Manoa, School of Nursing and Dental Hygiene, 2528 McCarthy Mall, Webster Hall 402, Honolulu, HI, 96822
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10
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Daniel M. Keeping the secret: how HIV-positive children in Iringa, Tanzania, respond to the perceived need for silence and secrecy. J Child Adolesc Ment Health 2014; 27:11-23. [PMID: 25531823 DOI: 10.2989/17280583.2014.947995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children who live with HIV may experience two aspects of disclosure: receiving disclosure and disclosing their status to others. The objective of this paper is to explore how HIV-positive children respond to: (1) the disclosure process; and (2) the perceived need for secrecy and silence concerning living with HIV. Thirteen HIV-positive children between the ages of 10 and 15 years were recruited through a HIV treatment centre in Iringa, Tanzania. Data were collected through in-depth interviews with the children and staff members. The children received disclosure about their status from healthcare workers rather than caregivers. Several children were asked by their caregivers to keep their status secret, some chose to do so themselves, largely to avoid experienced or perceived stigma from the community. Secrecy had an impact on potentially supportive relationships. Children tend to mimic adult responses, including partial disclosure and lying to others.
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Affiliation(s)
- Marguerite Daniel
- a Department of Health Promotion and Development , University of Bergen , Box 7807, 5020 Bergen , Norway
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11
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Kapetanovic S, Dass-Brailsford P, Nora D, Talisman N. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav 2014; 18:1152-73. [PMID: 24584458 DOI: 10.1007/s10461-014-0728-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With growing numbers of HIV-seropositive (HIV+) women of child-bearing age and increased access to effective clinical protocols for preventing mother-to-child transmission (MTCT) of HIV, mental health-related factors have become increasingly relevant due to their potential to affect the women's quality of life, obstetric outcomes and risk of MTCT. This review synthesizes evidence from 53 peer-reviewed publications examining mental health-related variables in pregnant and postpartum HIV+ women. The presentation of results is organized by the level of socioeconomic resources in the countries where studies were conducted (i.e., high-, middle-, and low-income countries). It is concluded that psychiatric symptoms, particularly depression, and mental health vulnerabilities (e.g., inadequate coping skills) are widespread among pregnant HIV+ women globally and have a potential to affect psychological well-being, quality of life and salient clinical outcomes. The current body of evidence provides rationale for developing and evaluating clinical and structural interventions aimed at improving mental health outcomes and their clinical correlates in pregnant HIV+ women.
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Affiliation(s)
- Suad Kapetanovic
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, USA,
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12
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Dow A, Dube Q, Pence BW, Van Rie A. Postpartum depression and HIV infection among women in Malawi. J Acquir Immune Defic Syndr 2014; 65:359-65. [PMID: 24189149 PMCID: PMC4009700 DOI: 10.1097/qai.0000000000000050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND HIV-infected women face several risk factors related to postpartum depression (PPD). We aimed to describe the prevalence and cumulative incidence of PPD in the low-income setting of Malawi and to determine the association between maternal and infant HIV and PPD. METHODS This longitudinal cohort study included 156 HIV-uninfected and 373 HIV-infected Malawian women enrolled 10-14 weeks after delivery who returned at 6, 9, 12, 15, and 18 months for follow-up visits. PPD was assessed at all visits. The prevalence of PPD at all visits was estimated using the Edinburgh Postnatal Depression Scale (EPDS). Association between PPD at 10-14 weeks and maternal and infant HIV status was assessed using log binomial regression. Cumulative incidence of PPD was assessed using Kaplan-Meier curves. RESULTS Prevalence of PPD was highest (11%) at 10-14 weeks postpartum and decreased to 2.9% at 18 months. There was no association between maternal HIV status and PPD (prevalence ratio, 1.18; 95% confidence interval: 0.68 to 2.08). Among HIV-infected women, prevalence of PPD was higher among women whose infants had acquired HIV (prevalence ratio, 2.0; 95% confidence interval: 1.1 to 3.6). The cumulative probability of experiencing PPD over the first 12 months postpartum was estimated to be 33.5% for HIV-infected mothers with HIV-infected infants vs. 22.5% for HIV-infected mothers with uninfected infants and 23.2% for HIV-uninfected mothers. CONCLUSIONS PPD prevalence did not differ between HIV-infected and -uninfected mothers but increased among women with an HIV-infected infant. Our findings suggest that it may be important to monitor PPD among women with HIV-infected infants.
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Affiliation(s)
- Anna Dow
- *Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; and †Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
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13
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Abstract
To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of 2 years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women's ability to cope and enhance their health and that of their infants.
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14
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Evaluation of a Brief Intervention to Improve the Nursing Care of Young Children in a High HIV and AIDS Setting. Nurs Res Pract 2012; 2012:647182. [PMID: 22530114 PMCID: PMC3316944 DOI: 10.1155/2012/647182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022] Open
Abstract
The HIV epidemic in South Africa is putting great strain on health services, including the inpatient care of young children. Caregivers and young children (107 pairs) and 17 nurses participated in an intervention to improve the care of young children in hospital in a high HIV and AIDS setting. The intervention addressed caregiver expectations about admission and treatment, responsive feeding, coping with infant pain and distress, assistance with medical procedures, and preparation for discharge and home care. Following a preparatory and piloting phase, measures of nurse burnout, caregiver physical and emotional well-being, and caregiver-child interaction were made before and after intervention. No changes were found between before and after intervention on assessments of caregiver wellbeing. However, mothers in the postintervention phase rated nurses as more supportive; mother-child interaction during feeding was more relaxed and engaged, and babies were less socially withdrawn. While the intervention proved useful in improving certain outcomes for children and their caregivers, it did not address challenging hospital and ward administration or support needed by caregivers at home following discharge. To address the latter need, the intervention has been extended into the community through home-based palliative care and support.
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Donahue MC, Dube Q, Dow A, Umar E, Van Rie A. "They have already thrown away their chicken": barriers affecting participation by HIV-infected women in care and treatment programs for their infants in Blantyre, Malawi. AIDS Care 2012; 24:1233-9. [PMID: 22348314 PMCID: PMC3395765 DOI: 10.1080/09540121.2012.656570] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV-infected infants and young children are at high risk of serious illness and death. Morbidity and mortality can be greatly reduced through early infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy (ART). Despite global efforts to scale-up of EID and infant ART, uptake of these services in resource poor, high HIV burden countries remain low. We conducted a qualitative study of 59 HIV-infected women to identify and explore barriers women face in accessing HIV testing and care for their infants. To capture different perspectives, we included mothers whose infants were known positive (n=9) or known negative (n=14), mothers of infants with unknown HIV status (n=13), and pregnant HIV-infected women (n=20). Five important themes emerged: lack of knowledge regarding EID and infant ART, the perception of health care workers as authority figures, fear of disclosure of own and/or child's HIV status, lack of psychosocial support, and intent to shorten the life of the child. A complex array of cultural, economic, and psychosocial factors creates barriers for HIV-infected women to participate in early infant HIV testing and care programs. For optimal impact of EID and infant ART, reasons for poor uptake should be better understood and addressed in a culturally sensitive manner.
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Affiliation(s)
- Marie Collins Donahue
- University of North Carolina Gillings School of Global Public Health, Department of Health Behavior Health Education
| | | | - Anna Dow
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology
| | | | - Annelies Van Rie
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology
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Rochat TJ, Bland R, Coovadia H, Stein A, Newell ML. Towards a family-centered approach to HIV treatment and care for HIV-exposed children, their mothers and their families in poorly resourced settings. Future Virol 2011; 6:687-696. [PMID: 22003360 DOI: 10.2217/fvl.11.45] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article provides a summary of emerging psychosocial evidence relevant to the success of comprehensive family-centered approaches to HIV prevention, treatment, care and support programs in poorly resourced settings. This report synthesizes current evidence on maternal, paternal and family experiences of HIV prevention, diagnosis, treatment, adherence and disclosure, with special focus on HIV-infected mothers and HIV-exposed children. Taking a developmental approach, we explore the current challenges and opportunities towards a family-centered approach within the continuum of HIV treatment and care, beginning in pregnancy and following the course of childhood. The discussion is limited to early and middle childhood and excludes discussion of special issues emergent in adolescence, which would warrant discussion outside the scope of this article. Attention is drawn to the complexity of problems arising within the family context and the need for improvements in the integration of aspects of treatment, care and support. While this article focuses on examples from sub-Saharan Africa, the lessons learnt and future challenges outlined are applicable to most low- and middle-income countries, and to poorly resourced contexts in higher-income countries.
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Affiliation(s)
- Tamsen Jean Rochat
- Africa Centre for Health & Population Studies, University of KwaZulu-Natal, South Africa
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Starting HIV-positive babies on antiretroviral treatment: perspectives of mothers in Soweto, South Africa. J Pediatr Health Care 2010; 24:176-83. [PMID: 20417889 DOI: 10.1016/j.pedhc.2009.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Timely and effective initiation of antiretroviral treatment for babies infected with the human immunodeficiency virus (HIV) is critical. Mothers' perspectives on the health care and treatment of their HIV-positive babies could affect how they engage with health care. METHOD A convenience sample of HIV-positive mothers was interviewed using qualitative methods. Thematic analysis was used to identify themes significant for participants as well as those relevant to health service provision. RESULTS These mothers seemed relatively well-informed and positive regarding their baby's care and treatment, but their understanding and practice was influenced by their own experience, observations, and fears, as well as the views of others. Having a baby on antiretroviral treatment improved their own health care motivation, but the daily reminder that it provided of the baby's status and still possible death and the prospect of their own death constituted a heavy emotional burden. DISCUSSION The study highlights the complexity, ambiguity, and interlocking nature of the mothers' understandings, attitudes, and concerns. This contrasts with the often fairly one-dimensional nature of communication by health care providers and highlights the need to engage more comprehensively with mothers.
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Abstract
AIM The aim of this study was to investigate factors determining HIV viral testing of infants in the context of Prevention of Mother-to-Child Transmission of HIV (PMTCT). METHODS Post-delivery HIV infected mothers 18 years and above with babies aged 3-6 months were interviewed on HIV viral testing of infants and factors associated with it. RESULTS Among 311 HIV infected women 61.7% had their infant tested for HIV between 4 and 8 weeks. Bivariate analyses found that older age of the mothers, lower depression scores, higher PMTCT knowledge, low PMTCT risk behaviour (maternal and infant nevirapine adherence, health facility delivery and exclusive formula feeding), HIV status disclosure and attending a support group were associated with PCR test participation. In multivariate analyses higher PMTCT knowledge, infant nevirapine adherence, and not exclusive breast feeding were associated with polymerase chain reaction test participation. CONCLUSION Various determinants of acceptance of participation in HIV viral testing of infants in the context of PMTCT were identified that can guide infant testing and diagnosis counselling and support services of PMTCT programmes.
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Affiliation(s)
- K Peltzer
- Human Sciences Research Council, Pretoria, South Africa.
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Kuhn L, Sinkala M, Thea DM, Kankasa C, Aldrovandi GM. HIV prevention is not enough: child survival in the context of prevention of mother to child HIV transmission. J Int AIDS Soc 2009; 12:36. [PMID: 20015345 PMCID: PMC2796993 DOI: 10.1186/1758-2652-12-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/11/2009] [Indexed: 11/10/2022] Open
Abstract
Clinical and epidemiologic research has identified increasingly effective interventions to reduce mother to child HIV transmission in resource-limited settings These scientific breakthroughs have been implemented in some programmes, although much remains to be done to improve coverage and quality of these programmes. But prevention of HIV transmission is not enough. It is necessary also to consider ways to improve maternal health and protect child survival. A win-win approach is to ensure that all pregnant and lactating women with CD4 counts of <350 cells/mm3 have access to antiretroviral therapy. On its own, this approach will substantially improve maternal health and markedly reduce mother to child HIV transmission during pregnancy and delivery and through breastfeeding. This approach can be combined with additional interventions for women with higher CD4 counts, either extended prophylaxis to infants or extended regimens of antiretroviral drugs to women, to reduce transmission even further. Attempts to encourage women to abstain from all breastfeeding or to shorten the optimal duration of breastfeeding have led to increases in mortality among both uninfected and infected children. A better approach is to support breastfeeding while strengthening programmes to provide antiretroviral therapy for pregnant and lactating women who need it and offering antiretroviral drug interventions through the duration of breastfeeding. This will lead to reduced HIV transmission and will protect the health of women without compromising the health and well-being of infants and young children.
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Affiliation(s)
- Louise Kuhn
- Gertrude H, Sergievsky Center, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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