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Nabunya P, Ssewamala FM, Bahar OS, Michalopoulos LTM, Mugisha J, Neilands TB, Trani JF, McKay MM. Suubi4Stigma study protocol: a pilot cluster randomized controlled trial to address HIV-associated stigma among adolescents living with HIV in Uganda. Pilot Feasibility Stud 2022; 8:95. [PMID: 35488323 PMCID: PMC9052650 DOI: 10.1186/s40814-022-01055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) is heavily burdened by HIV, with 85% of the global new infections among adolescents happening in the region. With advances in medication and national policies promoting antiretroviral therapy (ART), children < 15 years living with HIV (CLWH) continue to grow with a chronic, highly stigmatized disease. Unfortunately, the stigma they experience results in much lower quality of life, including poor mental health and treatment outcomes. Family members also experience stigma and shame by virtue of their association with an HIV-infected family member. Yet, stigma-reduction interventions targeting CLWH and their families are very limited. The goal of this study is to address HIV-associated stigma among CLWH and their caregivers in Uganda. METHODS This three-arm cluster randomized control trial, known as Suubi4Stigma, will evaluate the feasibility, acceptability, and preliminary impact of two evidence-based interventions: (1) group cognitive behavioral therapy (G-CBT) focused on cognitive restructuring and strengthening coping skills at the individual level and (2) a multiple family group (MFG) intervention that strengthens family relationships to address stigma among CLWH (N = 90, 10-14 years) and their families (dyads) in Uganda. Nine clinics will be randomized to one of three study arms (n = 3 clinics, 30 child-caregiver dyads each): (1) usual care; (2) G-CBT + usual care; and (3) MFG + usual care. Both treatment and control conditions will be delivered over a 3-month period. Data will be collected at baseline (pre-intervention) and at 3 months and 6 months post-intervention initiation. CONCLUSION The primary aim of the proposed project is to address the urgent need for theoretically and empirically informed interventions that seek to reduce HIV-associated stigma and its negative impact on adolescent health and psychosocial well-being. As several countries in SSA grapple with care and support for CLWH, this study will lay the foundation for a larger intervention study investigating how HIV-associated stigma can be reduced to foster healthy child development-especially for CLWH as they transition through adolescence. TRIAL REGISTRATION ClinicalTrials.gov: NCT04528732 ; Registered August 27, 2020.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), St. Louis, USA.
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), St. Louis, USA
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), St. Louis, USA
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Lynn T M Michalopoulos
- The Moving Well Project International, Inc., Silver Spring, USA
- School of Social Work, Columbia University, New York City, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Torsten B Neilands
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, USA
| | - Jean-Francois Trani
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Mary M McKay
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
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Wowolo G, Cao W, Bosomtwe D, Enimil A, Tarantino N, Barker DH, Galárraga O. The Impact of Different Parental Figures of Adolescents Living With HIV: An Evaluation of Family Structures, Perceived HIV Related Stigma, and Opportunities for Social Support. Front Public Health 2022; 10:647960. [PMID: 35400055 PMCID: PMC8987121 DOI: 10.3389/fpubh.2022.647960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/17/2022] [Indexed: 12/05/2022] Open
Abstract
Although antiretroviral therapy (ART) has changed the expected health outcomes for HIV, there are still issues related to stigma, how people living with HIV are perceived, and the availability of social support. The purpose of this study was to explore the associations between family structure and psychosocial wellbeing reflected by perceived HIV stigma and social support among adolescents living with HIV in Kumasi, Ghana. This article used baseline data from two mixed methods studies that evaluated the safety and preliminary efficacy of group-based support programs for ART adherence improvement among adolescents living in Kumasi, Ghana (N = 70, aged 12–18 years). A multivariate linear regression analysis was employed to examine the associations between family structure and the outcomes of stigma and social support. The main variables for family structure were single mothers and female caregivers. We found that single motherhood was a significant determinant of stigma. When compared to other categories of caregiver types, adolescents being raised by their single mothers was associated with a 0.259 decrease in the mean internal HIV stigma score (p = 0.029). Also, for female adolescents, being raised by a female guardian (e.g., mother, aunt, grandmother, and sister) was associated with a 20.92 point increase in the overall support index (p = 0.005). This study shows that the type of parent or guardian, and their gender, influences the perceived stigma and available social support among adolescents living with HIV in Ghana. Vulnerable subgroups of adolescents living with HIV, particularly those raised up by male caregivers, should be provided with additional support.
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Affiliation(s)
- Gloria Wowolo
- Brown University School of Public Health, Providence, RI, United States
- *Correspondence: Gloria Wowolo
| | - Wangnan Cao
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Dennis Bosomtwe
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Anthony Enimil
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nicholas Tarantino
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States
| | - David H. Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
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Doat A, Navab E, Sadat Hoseini AS. Lived Experiences of Adolescent Living with human immunodeficiency virus in Ghana: A Phenomenology Study. Nurs Open 2021; 8:299-307. [PMID: 33318837 PMCID: PMC7729801 DOI: 10.1002/nop2.630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
Aim and objectives To explore the meaning of living with HIV positive in Ghanaian adolescents. Design Hermeneutic phenomenological approach developed by Van Manen methodology (1990). Method A purposive sampling of 12 adolescents living with HIV was recruited. Data were collected between September 2019-January 2020 using semi-structured interviews and analysed using thematic analysis. Results Two main themes emerged: Stigmatization and HIV disclosure and Living with a heavy burden. Seven subthemes were also found. Adolescents living with HIV in Ghana face discrimination, rejection and go through psychological distress such as suicidal thoughts, fear of death and hopelessness. Conclusion The problems faced by adolescents living with HIV are a result of the inherent beliefs of the Ghanaian society about HIV. Nurses working with ADLHIV should concentrate on identifying challenges and provide support and care, in addition to their treatment.
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Affiliation(s)
- Abdul‐Razak Doat
- Department of Pediatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Elham Navab
- Department of Critical Care NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Akram Sadat Sadat Hoseini
- Department of Pediatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
- Department of Pediatric NursingSchool of Nursing and MidwiferyResearch center of QuranHadith and MedicineTehran University of Medical sciencesTehranIran
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Agyemang-Duah W, Abdullah A, Mensah CM, Arthur-Holmes F, Addai B. Caring for older persons in rural and urban communities: perspectives of Ghanaian informal caregivers on their coping mechanisms. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01082-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
OBJECTIVE The negative effects of HIV stigma may extend beyond those who are HIV-positive, to people who are perceived to be at risk of HIV. This article examines HIV stigma by association among Australian gay and bisexual men (GBM). DESIGN Cross-sectional, online survey of 1280 Australian gay and bisexual men. This article focuses on HIV stigma from within a larger study that investigated stigma related to sexual identity. METHODS Bivariate and multivariable comparisons were made between men who experienced HIV stigma by association and those who did not. A serial mediation model was tested to investigate relationships between GBM community attachment, sexual identity stigma, HIV testing frequency, HIV stigma by association, psychological distress, and rejection of sex partners. RESULTS Results found that 5% of participants were HIV-positive, yet over 70% reported that they had been stigmatized by others for their perceived risk of acquiring HIV. Multivariable analysis indicated that HIV stigma by association was associated with more frequent HIV testing, greater GBM community attachment, experiencing stigma related to sexual identity and psychological distress. Our results suggest flow-on effects of HIV stigma by association, such as being more likely to reject other GBM on the basis of their HIV status or not testing for HIV. CONCLUSION Our results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations. There is a need to address HIV stigma within GBM communities and society more broadly in order to encourage HIV testing and prevention among GBM.
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Ehiri JE, Alaofè HS, Yesufu V, Balogun M, Iwelunmor J, Kram NAZ, Lott BE, Abosede O. AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria. BMJ Open 2019; 9:e026322. [PMID: 31110094 PMCID: PMC6530297 DOI: 10.1136/bmjopen-2018-026322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria. DESIGN Cross-sectional survey. SETTING Thirty-eight primary healthcare centres in Lagos, Nigeria. PARTICIPANTS One hundred and sixty-one PMTCT service providers. OUTCOME MEASURES PMTCT service providers' discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies). RESULTS Reported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p<0.01), fear of HIV infection (r=0.16, p<0.05) and professional resistance (r=0.32, p<0.001). Those who underwent HIV training had less fear of contagion. CONCLUSIONS This study documented generally low levels of reported AIDS-related stigmatisation by PMTCT service providers in primary healthcare centres in Lagos. Policies that reduce stigmatisation against PLWHA in the healthcare setting should be supported by the provision of basic resources for infection control. This may reassure healthcare workers of their safety, thus reducing their fear of contagion and professional resistance to care for individuals who are perceived to be at high risk of HIV.
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Affiliation(s)
- John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Halimatou S Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Victoria Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, School of Public Health, University of St. Louis, St. Louis, Missouri, USA
| | - Nidal A-Z Kram
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Breanne E Lott
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Olayinka Abosede
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
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Small J, Aldwin C, Kowal P, Chatterji S. Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach. THE GERONTOLOGIST 2019; 59:e223-e240. [PMID: 29045750 PMCID: PMC6524476 DOI: 10.1093/geront/gnx159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories. RESEARCH DESIGN AND METHODS A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites. RESULTS The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies. DISCUSSION AND IMPLICATIONS The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities.
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Affiliation(s)
- Jeon Small
- School of Social and Behavioral Sciences, Oregon State University
| | - Carolyn Aldwin
- Center for Healthy Aging Research, Oregon State University
| | - Paul Kowal
- SAGE, World Health Organization, Geneva, Switzerland
- Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
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Van Deventer C, Wright A. The psychosocial impact of caregiving on the family caregivers of chronically ill AIDS and/or HIV patients in home-based care: A qualitative study in Zimbabwe. South Afr J HIV Med 2017. [DOI: 10.4102/sajhivmed.v18i1.718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The family caregiver has a pivotal role to play in the management of the chronically ill HIV and/or AIDS patients. The wellbeing of caregivers is therefore crucial because impairment of their physical or mental health could impact negatively on the management of their HIV-positive family member. The purpose of this qualitative study was to explore the psychosocial impact of caregiving on the family caregiver of the chronically ill HIV and/or AIDS patients in home-based care.Method: Unstructured interviews were conducted with 11 caregivers recruited at an adult HIV clinic at United Bulawayo Hospitals, Bulawayo, Zimbabwe. Relevant demographic information was collected from each participant. The interviews were then transcribed and analysed.Results: Caregivers’ biggest challenge was meeting care costs such as food, transport and medical costs. Certain conditions relating to the care-recipient’s health and family issues, such as abandonment of the ill patient as well as that of orphans, added to the burden of care. Carers also had to deal with their own health and physical problems. All the above resulted in a spectrum of emotions such as helplessness, sadness, anxiety and anger. Despite this, caregivers also reported on the positive aspects regarding their caregiving role.Conclusion: There were both negative and positive psychosocial experiences by caregivers of HIV and/or AIDS patients. The study highlighted practical areas where support could be provided.
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Lambert SD, Bowe SJ, Livingston PM, Heckel L, Cook S, Kowal P, Orellana L. Impact of informal caregiving on older adults' physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO's Study on global AGEing and adult health (SAGE). BMJ Open 2017; 7:e017236. [PMID: 29146639 PMCID: PMC5695345 DOI: 10.1136/bmjopen-2017-017236] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/15/2017] [Accepted: 08/17/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES A high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the level of burden experienced by these caregivers, explore associated factors and assess whether caregivers' and non-caregivers' health differed. DESIGN AND SETTING This cross-sectional study was a secondary analysis of data on caregivers' burden, health and health risk factors in Ghana, India and the Russian Federation collected as part of the WHO's Study on global AGEing and adult health (SAGE) Wave 1. PARTICIPANTS Caregivers in Ghana (n=143), India (n=490) and Russia (n=270) completed the measures. OUTCOME MEASURES Factors associated (ie, demographics and caregiving profile variables) with burden were explored among caregivers. Then, quality of life (QOL), perceived stress, depression, self-rated health (SRH) and health risk factors were compared between caregivers and matched non-caregivers (1:2). RESULTS The largest caregiving subgroups were spouses and adult children. Caregivers mostly cared for one person and provided financial, social/emotional and/or physical support, but received little support themselves. Burden level ranged from 17.37 to 20.03. Variables associated with burden were mostly country-specific; however, some commonality for wealth, type of care and caregiving duration was noted. Caregivers with a moderate or high level of burden reported lower QOL and higher perceived stress than those experiencing low burden. Caregivers reported lower QOL and SRH than non-caregivers. CONCLUSION Given the lack of support received and consequences of the burden endured by caregivers, policy and programme initiatives are needed to ensure that caregivers in low- and middle-income countries can fulfil their role without compromising their own health.
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Affiliation(s)
- Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
- St. Mary's Research Centre, St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Steven J Bowe
- Faculty of Health, Deakin University, Geelong, Australia
| | | | - Leila Heckel
- Faculty of Health, Deakin University, Geelong, Australia
| | - Selina Cook
- Faculty of Health, Deakin University, Geelong, Australia
| | - Paul Kowal
- Department of Anthropology, University of Oregon, Geneva, Switzerland
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
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Kushwaha S, Lalani Y, Maina G, Ogunbajo A, Wilton L, Agyarko-Poku T, Adu-Sarkodie Y, Boakye F, Zhang N, Nelson LE. "But the moment they find out that you are MSM…": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system. BMC Public Health 2017; 17:770. [PMID: 28974257 PMCID: PMC5627492 DOI: 10.1186/s12889-017-4799-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM’s experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM’s use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities. Methods We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM. Results There were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana. Conclusion MSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM’s autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.
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Affiliation(s)
| | | | - Geoffrey Maina
- University of Saskatchewan, College of Nursing, 214-1301 Central Avenue, Prince Albert, SK, Canada.
| | | | - Leo Wilton
- State University of New York at Binghamton, Binghamton, NY, USA.,University of Johannesburg, Johannesburg, South Africa
| | | | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science & Technology, Kumasi, Ashanti, Ghana
| | | | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - LaRon E Nelson
- University of Toronto, Toronto, ON, Canada.,University of Rochester, Rochester, NY, USA.,St. Michael's Hospital, Centre for Urban Health Solutions, Toronto, ON, Canada
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Mafune RV, Lebese RT, Nemathaga LH. Challenges faced by caregivers of children on antiretroviral therapy at Mutale Municipality selected healthcare facilities, Vhembe District, Limpopo Province. Curationis 2017; 40:e1-e9. [PMID: 28893073 PMCID: PMC6091811 DOI: 10.4102/curationis.v40i1.1541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Children depend solely on caregivers who can be either parents or guardians for drug administration to enhance adherence to antiretroviral treatment (ART), which might pose any number of challenges. PURPOSE The purpose of this study was to explore and describe the challenges faced by caregivers of children on ART at Mutale Municipality, Vhembe District, Limpopo Province. RESEARCH DESIGN AND METHOD The research design was qualitative, explorative, descriptive and contextual in nature. The population consisted of 16 caregivers who were 18 years of age and above, and mentally capable, irrespective of educational qualifications, caring for children aged between 0 and 15 years who were on ART between April 2013 and October 2014. Non-probability, purposive sampling was used to select the 16 caregivers. Required permission, approval and ethical clearance were obtained from the University of Venda Higher Degree Committee, Limpopo Provincial Health Department and relevant institutions. An in-depth, individual, unstructured interview method was used to collect data. One central question was asked: 'What are the challenges you experience when caring for a child on antiretroviral treatment?' Subsequent questions were based on the participants' responses to the central question. Qualitative data were analysed by means of Tesch's open-coding method. RESULTS The findings of this study revealed that participants, that is, caregivers of children on ART, experienced financial burdens because of transport costs needed to comply with follow-up dates and insufficient of money for food, clothing the child in need of care, pocket money for lunch boxes during school hours and time lost while waiting for consultations. Participants reported some level of stigmatisation against children on ART by family members, especially the husbands or in-laws of the secondary caregivers. Many primary and secondary caregivers seemed to have given up seeking support from government and community structures. CONCLUSION The conclusions drawn from this research are that caregivers hardly receive any support from family members or the community. Fear of disclosing the HIV-positive status of children resulted in the delay of financial support from the government, thus leading to serious financial burden on the caregivers.
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Affiliation(s)
| | - Rachel T Lebese
- Department of Advanced Nursing, School of Health, University of Venda.
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Doku PN, Minnis H. Multi-informant perspective on psychological distress among Ghanaian orphans and vulnerable children within the context of HIV/AIDS. Psychol Med 2016; 46:2329-2336. [PMID: 27270076 DOI: 10.1017/s0033291716000829] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is little knowledge about the psychosocial distress of children affected by human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) in Ghana, to aid the planning of services. This study investigated mental health problems among children affected by HIV/AIDS, compared with control groups of children orphaned by other causes, and non-orphans. METHOD The study employed a cross-sectional survey that interviewed 291 children and their caregivers. Both children and caregivers completed the Strengths and Difficulties Questionnaire that measured children's psychosocial wellbeing. Verbal autopsy was used to identify whether children lost one or both parents from AIDS. RESULTS The results indicated that controlling for relevant sociodemographic factors, both children's self-reports and caregivers' reports indicate that both children living with HIV/AIDS-infected caregivers and children orphaned by AIDS were at heightened risk for mental health problems than both children orphaned by other causes and non-orphans. The findings further indicated that a significant proportion of orphaned and vulnerable children exhibited symptoms for depression and other psychiatric disorders (approximately 63%) compared with 7% among the non-orphaned group. Caregivers gave higher ratings for children on externalizing problems and lower on internalizing problems, and vice versa when the children's self-reports were analysed. CONCLUSIONS The findings suggest that both children and their informants have diverse yet complementary perspectives on psychological outcomes. The study discusses the theoretical and practical implications of these findings and urgently calls for necessary intervention programmes that target all children affected by HIV/AIDS to effectively alleviate psychological distress and enhance the mental health of these children.
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Affiliation(s)
- P N Doku
- Department of Psychology,University of Ghana,Box LG 84, Legon, Accra,Ghana
| | - H Minnis
- University of Glasgow, Institute of Mental Health and Wellbeing,Glasgow G12 0XH,UK
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Ashraf M, Sitwat A. Personality dimensions, positive emotions and coping strategies in the caregivers of people living with HIV in Lahore, Pakistan. Int J Nurs Pract 2016; 22:364-74. [PMID: 27166621 DOI: 10.1111/ijn.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/27/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
The aim of this research was to study the relationship between personality dimensions, positive emotions and coping mechanisms of caregivers of patients living with HIV. This study used a cross-sectional research design. A sample comprising 56 caregivers was recruited from HIV/AIDS clinics in three teaching hospitals in Lahore, Pakistan. Data were collected between February and July 2010. Most caregivers were men, and of low socio-economic status. Individuals with both high and low extraversion used problem-focused coping, self-control and accepting responsibility, but those with low extraversion used more escape-avoidance coping, and they had also high levels of negative emotions. Those high in neuroticism used more tension-reduction coping than problem-focused coping, and experienced fewer positive emotions. Regression analysis findings revealed neuroticism as a significant predictor of negative emotions as well as emotion-focused coping, and only extraversion significantly predicted negative emotions. This research could help in devising psychological management plans for caregivers of patients living with HIV in order to assist them in coping with the burden of care.
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Affiliation(s)
- Mujeeba Ashraf
- Department of Applied Psychology, University of Punjab, Lahore, Pakistan
| | - Aisha Sitwat
- Centre for Clinical Psychology, University of Punjab, Lahore, Pakistan
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Owusu-Ansah FE. Sharing in the life of the person with disability: A Ghanaian perspective. Afr J Disabil 2015; 4:185. [PMID: 28730035 PMCID: PMC5433484 DOI: 10.4102/ajod.v4i1.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/02/2015] [Indexed: 11/24/2022] Open
Abstract
This thought article was a hermeneutic inquiry into the experiences of informal caregivers of the elderly who are also physically disabled. The experiences of some Ghanaian informal caregivers were examined in three clinical cases and laced with the lived experiences of the author as an informal caregiver and clinician. Two processes were explored. The first relates to how a caregiver is changed through the experience of caregiving by examining the intrapersonal and interpersonal dynamics affecting caregiving. Secondly, the positive 'shifts' that occurred in therapy were explored. In the present Ghanaian society it appears that care for the elderly disabled is compounded by the rapid migration of many Ghanaians to 'greener pastures' in search of a brighter future, with consequent empty homesteads and fragmentation of the socio-cultural practices that hitherto buttressed informal care for the aged. In the absence of well-established professional care facilities, informal caregiving with its numerous challenges has become the norm for many. This article posited that caregiver self-care is the most important, and yet often forgotten, aspect of informal caregiving. When this is neglected, caregiver burnout is sure to occur, which results in poor physical, mental and emotional health for the caregiver. In this state caregivers may injure both themselves and the care recipients.
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Affiliation(s)
- Frances E Owusu-Ansah
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Ghana
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Caregiver profiles and determinants of caregiving burden in Ghana. Public Health 2015; 129:941-7. [PMID: 26115592 DOI: 10.1016/j.puhe.2015.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/24/2014] [Accepted: 05/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Due to the growing elderly population, the high cost of care in Ghana and low coverage of the National Health Insurance Scheme, demands for family caregiving have become more imperative in Ghana than ever before. Many caregivers experience high burdens, yet literature on caregiving in Ghana is lacking. This study examined caregiver profiles and determinants of the burden of caregiving in Ghana. STUDY DESIGN Cross-sectional study. METHODS This study used data from Wave 1 of the World Health Organization (WHO) Study on Global Ageing and Adult Health (2007-2008). In total, 238 caregivers were analysed in the study. The burden of caregiving was measured using the WHO Impact of Caregiving Scale. Independent sample t-tests, correlations and analysis of variance were used to investigate associations between background characteristics and the burden of caregiving. Linear regression was used to examine determinants of the burden of caregiving. RESULTS The mean age of caregivers was 61 years (standard deviation 14.5), and the male:female ratio was approximately equal. On average, approximately two adults per household required care. Less than five percent of caregivers received financial, emotional, health, physical and personal care support. Place of residence, provision of financial, health and physical support to care recipients, and receipt of financial, physical and health support were significant determinants of the burden of caregiving. CONCLUSIONS This study found a mismatch between the number of people needing care and the number of people providing care. In order to improve the health of caregivers and care recipients, there is a need to provide financial support for caregivers. In addition, pro-caregiving government programmes and policies should be established.
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Mbonu NC, Van den Borne B, De Vries NK. A model for understanding the relationship between stigma and healthcare-seeking behaviour among people living with HIV/AIDS in sub-Saharan Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 8:201-12. [PMID: 25875571 DOI: 10.2989/ajar.2009.8.2.8.860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People living with HIV or AIDS (PLHIV) in sub-Saharan Africa sometimes have care-seeking behaviours that result in a suboptimal quality of life. This paper seeks to examine the role of stigma in the care-seeking behaviour of PLHIV. We hypothesise that stigma relates to the behaviour of PLHIV themselves and with societal reactions, including those of healthcare professionals. From a literature review, we identified the following as important correlates of care-seeking behavior: beliefs about pathways of HIV infection and people infected with HIV, social reactions, coping strategies, knowledge of HIV and AIDS, and self-efficacy in finding care and treatment in addition to coping with the disease. Poverty, gender, age, religion and policy were found to be moderating variables. The Precede-Proceed model was adapted to build an explanatory model of healthcare-seeking behaviour among PLHIV and particularly to explore the role of stigma in the non-utilisation of healthcare institutions.
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Affiliation(s)
- Ngozi C Mbonu
- a Department of Health Promotion, The School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences , Maastricht University , PO Box 616 , Maastricht , 6200 MD , The Netherlands
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Patterson AS. Church mobilisation and HIV/AIDS treatment in Ghana and Zambia:a comparative analysis. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 9:407-18. [PMID: 25875889 DOI: 10.2989/16085906.2010.545653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article compares Ghanaian and Zambian church mobilisation on HIV and AIDS. It analyses why long-term interest in HIV and AIDS has declined in Ghana but increased in Zambia, and why church involvement in promoting access to HIV/AIDS treatment has been less apparent in Ghana than in Zambia. The article uses three levels of analysis - society, state, and international - to explicate these different patterns. The analysis finds that continued HIV/AIDS stigma hampered Ghanaian church activities, while a decline in stigma opened up space for church-related HIV/AIDS responses in Zambia. The elite and professional nature of Ghana's churches promoted early HIV/ AIDS activities, but may have prevented these activities from responding to the needs of people with HIV or AIDS. Overlapping personal networks between civil society and state elites in Ghana urged early HIV/AIDS church-related actions, while state co-optation and civil-society divisions in Zambia limited early HIV/AIDS activities. As Zambian churches built ties to external actors, however, they gained autonomy in their HIV/AIDS responses. In contrast, the fact that Ghana was less incorporated into global HIV/AIDS responses (particularly, the global treatment movement) weakened the long-term interest in HIV and AIDS among the country's churches. The article is based on more than 50 semi-structured interviews with a range of participants affiliated with HIV/AIDS organisations (e.g. church, secular, government, donor) in Zambia and Ghana.
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Affiliation(s)
- Amy S Patterson
- a Calvin College , Department of Political Science , 1810 East Beltline SE , Grand Rapids , Michigan , 49546 , United States
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Abrefa-Gyan T, Cornelius LJ, Okundaye J. Socio-Demographic Factors, Social Support, Quality of Life, and HIV/AIDS in Ghana. ACTA ACUST UNITED AC 2015; 13:206-16. [PMID: 25844820 DOI: 10.1080/23761407.2015.1018033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The increase in the access to biomedical interventions for people living with HIV/AIDS in the developing world has not been adequately matched with the requisite psychosocial treatments to help improve the effectiveness of biomedical interventions. Therefore, in this study the author seeks to determine whether socio-demographic characteristics and social support are associated with quality of life in individuals diagnosed with HIV/AIDS in Ghana. A convenience sample of 300 HIV/AIDS support group members was obtained via cross-sectional design survey. The Medical Outcome Studies (MOS) HIV Health Survey, the MOS Social Support Survey (MOS-SSS), and demographic questionnaire instruments were used to assess quality of life, social support, and demographic information respectively. Multiple regression analysis showed that there was a positive association between overall social support and overall quality of life (r = .51). It also showed that being younger, male, attending support group meetings for over a year, and having ≥ 13 years of schooling related to higher quality of life. Implications of the findings for practice, policy, and research in Ghana and the rest of the developing world are discussed.
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Affiliation(s)
- Tina Abrefa-Gyan
- a Ethelyn R. Strong School of Social Work, Norfolk State University , Norfolk , Virginia , USA
| | | | - Joshua Okundaye
- c School of Social Work, University of Maryland , Baltimore County , Maryland , USA
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Nelson LE, Wilton L, Agyarko-Poku T, Zhang N, Aluoch M, Thach CT, Owiredu Hanson S, Adu-Sarkodie Y. The Association of HIV Stigma and HIV/STD Knowledge With Sexual Risk Behaviors Among Adolescent and Adult Men Who Have Sex With Men in Ghana, West Africa. Res Nurs Health 2015; 38:194-206. [PMID: 25809638 DOI: 10.1002/nur.21650] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
Ghanaian men who have sex with men (MSM) have a high HIV seroprevalence, but despite a critical need to address this public health concern, research evidence has been extremely limited on influences on sexual risk behavior among MSM in Ghana. To investigate associations between HIV/STD knowledge, HIV stigma, and sexual behaviors in a sample of MSM in Ghana, we conducted a secondary data analysis of cross-sectional survey data from a non-probability sample of Ghanaian MSM (N = 137). Nearly all the men (93%) had more than one current sex partner (M = 5.11, SD = 7.4). Of those reported partners, the average number of current female sexual partners was 1.1 (SD = 2.6). Overall, knowledge levels about HIV and STDs were low, and HIV stigma was high. There was no age-related difference in HIV stigma. Younger MSM (≤25 years) used condoms less often for anal and vaginal sex than did those over 25. Relative frequency of condom use for oral sex was lower in younger men who had higher STD knowledge and also was lower in older men who reported high HIV stigma. Knowledge and stigma were not associated with condom use for anal or vaginal sex in either age group. These descriptive data highlight the need for the development of intervention programs that address HIV/STD prevention knowledge gaps and reduce HIV stigma in Ghanaian communities. Intervention research in Ghana should address age-group-specific HIV prevention needs of MSM youth.
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Affiliation(s)
- LaRon E Nelson
- Dean's Endowed Fellow in Health Disparities & Assistant Professor, School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY, 14642
| | - Leo Wilton
- Associate Professor, Department of Human Development, State University of New York at Binghamton, Binghamton, NY.,Lecturer, Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | - Thomas Agyarko-Poku
- Lecturer, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Nanhua Zhang
- Assistant Professor, Department of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marilyn Aluoch
- Doctoral Student & US Fulbright Scholar, College of Nursing, University of South Florida, Tampa, FL
| | - Chia T Thach
- Postdoctoral Fellow, College of Nursing, University of South Florida, Tampa, FL
| | | | - Yaw Adu-Sarkodie
- Dean and Professor, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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Nelson LE, Wilton L, Agyarko-Poku T, Zhang N, Zou Y, Aluoch M, Apea V, Hanson SO, Adu-Sarkodie Y. Predictors of condom use among peer social networks of men who have sex with men in Ghana, West Africa. PLoS One 2015; 10:e0115504. [PMID: 25635774 PMCID: PMC4312093 DOI: 10.1371/journal.pone.0115504] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
Ghanaian men who have sex with men (MSM) have high rates of HIV infection. A first step in designing culturally relevant prevention interventions for MSM in Ghana is to understand the influence that peer social networks have on their attitudes and behaviors. We aimed to examine whether, in a sample of Ghanaian MSM, mean scores on psychosocial variables theorized to influence HIV/STI risk differed between peer social networks and to examine whether these variables were associated with condom use. We conducted a formative, cross-sectional survey with 22 peer social networks of MSM (n = 137) in Ghana. We assessed basic psychological-needs satisfaction, HIV/STI knowledge, sense of community, HIV and gender non-conformity stigmas, gender equitable norms, sexual behavior and condom use. Data were analyzed using analysis of variance, generalized estimating equations, and Wilcoxon two sample tests. All models were adjusted for age and income, ethnicity, education, housing and community of residence. Mean scores for all psychosocial variables differed significantly by social network. Men who reported experiencing more autonomy support by their healthcare providers had higher odds of condom use for anal (AOR = 3.29, p<0.01), oral (AOR = 5.06, p<0.01) and vaginal (AOR = 1.8, p<0.05) sex. Those with a stronger sense of community also had higher odds of condom use for anal sex (AOR = 1.26, p<0.001). Compared to networks with low prevalence of consistent condom users, networks with higher prevalence of consistent condom users had higher STD and HIV knowledge, had norms that were more supportive of gender equity, and experienced more autonomy support in their healthcare encounters. Healthcare providers and peer social networks can have an important influence on safer-sex behaviors in Ghanaian MSM. More research with Ghanaian MSM is needed that considers knowledge, attitudes, and norms of their social networks in the development and implementation of culturally relevant HIV/STI prevention intervention strategies.
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Affiliation(s)
- LaRon E. Nelson
- School of Nursing, University of Rochester, Rochester, NY, United States of America
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Leo Wilton
- State University of New York at Binghamton, College of Community and Public Affairs, Department of Human Development, Binghamton, NY, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | | | - Nanhua Zhang
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America
| | - Yuanshu Zou
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, United States of America
| | - Marilyn Aluoch
- University of South Florida, College of Nursing, Tampa, FL, United States of America
| | - Vanessa Apea
- Department of Genitourinary Medicine, Barts & the Royal London Hospital, London, United Kingdom
| | | | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science & Technology, School of Medical Sciences, Kumasi, Ghana
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Kanamori MJ, Carter-Pokras OD, Madhavan S, Lee S, He X, Feldman RH. Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys. Matern Child Health J 2015; 19:1662-71. [PMID: 25630405 DOI: 10.1007/s10995-015-1680-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.
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Affiliation(s)
- Mariano J Kanamori
- Center for Research on U.S. Latinos HIV/AIDS and Drug Use, Florida International University, 11200 SW 8th ST PCA 353A, Miami, FL, 33199, USA,
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Drah BB. 'Older women', customary obligations and orphan foster caregiving: the case of queen mothers in Manya Klo, Ghana. J Cross Cult Gerontol 2015; 29:211-29. [PMID: 24737050 DOI: 10.1007/s10823-014-9232-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Female orphan caregivers in countries heavily affected by HIV in sub-Saharan Africa are often presented as a homogenous group of vulnerable 'older women' that struggles to support orphans. There is a dearth of data on the different kinds of women and how their social characteristics impact their survival strategies and caregiving responsibilities. This study examines the link between the social characteristics of queen mothers in Manya Klo in Ghana and their roles as caregivers. The research findings suggest that queen mothers have become the primary caregivers of orphans, even though they do not have the wherewithal to provide for these orphans. The lack of kin support to queen mothers exacerbates their physical and economic vulnerabilities. They engage in less dignifying economic activities and pay less attention to their own needs in order to meet their customary obligations as orphan caregivers. The growing influence of queen mothers as caregivers for orphans, however, is a reflection of some of the changes that are occurring in customary foster care arrangements. Policy makers and interventionists require in depth understanding of queen mothers and their peculiar circumstances in order to strengthen their roles as leaders and caregivers.
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Affiliation(s)
- Bright B Drah
- Alberta Health, Workforce Strategy Branch, Education & Collaborative Practice Unit, 10th Floor, ATB Place North Tower, 10025 Jasper Avenue NW, Edmonton, Alberta, T5J 1S6, Canada,
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Sulstarova B, Poglia Mileti F, Mellini L, Villani M, Singy P. HIV disclosure and nondisclosure among migrant women from sub-Saharan Africa living in Switzerland. AIDS Care 2014; 27:451-7. [PMID: 25297928 DOI: 10.1080/09540121.2014.963497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
No study to date has focused specifically on the reasons for and against disclosure of HIV-positive status among sub-Saharan migrant women. Thirty HIV-positive women from 11 sub-Saharan countries living in French-speaking Switzerland participated in semi-structured individual interviews. The reasons women reported for disclosure or nondisclosure of their HIV serostatus were classified into three categories: social, medical, and ethical. The women identified the stigma associated with HIV as a major social reason for nondisclosure. However, this study identifies new trends related to disclosure for medical and ethical reasons. Being undetectable played an important role in the life of sub-Saharan migrant women, and analysis revealed their medical reasons for both disclosure and nondisclosure. Disclosure to new sexual partners occurred when women had a more positive perception about HIV and when they believed themselves to be in a long-term relationship. Women reported nondisclosure to family members when they did not need help outside the support provided by the medical and social fields. The results on ethical reasons suggested that challenging stigma was a reason for disclosure. Since the women' perceptions on HIV changed when they came to see it as a chronic disease, disclosure occurred in an attempt to normalize life with HIV in their communities in migration and to challenge racism and discrimination. Our findings can help health providers better understand the communication needs of sub-Saharan migrant women with respect to HIV/AIDS and sexuality and offer them adequate disclosure advice that takes into account migration and gender issues.
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Affiliation(s)
- Brikela Sulstarova
- a Psychiatric Liaison Service , Lausanne University Hospital , Lausanne , Switzerland
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Ngazimbi EE, Hagedorn WB, Shillingford MA. Counseling Caregivers of Families Affected by HIV/AIDS: The Use of Narrative Therapy. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2008.10820204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Liu H, Xu Y, Sun Y, Dumenci L. Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs). PLoS One 2014; 9:e92855. [PMID: 24658364 PMCID: PMC3962465 DOI: 10.1371/journal.pone.0092855] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors (“public stigma” and “self-perceived stigma”) had high internal consistency reliability (Cronbach's alpha coefficient between 0.83–0.90) and good construct validity (standardized factor loading range: 0.37–0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- * E-mail:
| | - Yongfang Xu
- Department of HIV/AIDS Control, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yehuan Sun
- Department of Epidemiology, Anhui Medical University, Hefei, Anhui, China
| | - Levent Dumenci
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Mwini-Nyaledzigbor PP, Agana AA, Pilkington FB. Lived Experiences of Ghanaian Women With Obstetric Fistula. Health Care Women Int 2013; 34:440-60. [DOI: 10.1080/07399332.2012.755981] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Akintola O, Hlengwa WM, Dageid W. Perceived stress and burnout among volunteer caregivers working in AIDS care in South Africa. J Adv Nurs 2013; 69:2738-49. [PMID: 23683176 DOI: 10.1111/jan.12166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Abstract
AIMS To conduct a quantitative investigation of stress and the relationship with burnout among AIDS care volunteers. BACKGROUND Volunteer caregivers experience stress that could lead to burnout. Yet, very few studies quantify stress and its relationship with burnout among AIDS care volunteers. DESIGN This study uses a cross-sectional, exploratory survey design. METHODS Face-to-face interviews were conducted with 126 volunteer caregivers working in 13 semi-rural communities (townships) in Durban, South Africa in April 2009. All participants were women, Christian and with low levels of education. A 22-item instrument was drawn from Pearlin et al.'s role overload and role captivity scales, Van Dyk's stress factor scale and the Maslach Burnout Inventory. RESULTS Most of the volunteers had moderate-to-high levels of stress. 'Role/work overload' 'lack of support' and 'overwhelming nature of the disease' explained most of the variance in stress. Volunteers' age and number of patients in their care were predictors of stress. Caring for only AIDS patients, lack of support, stress emanating from perceived stigma and lack of training; and the overwhelming nature of AIDS were predictors of burnout. CONCLUSION High levels of stress could negatively impact volunteers' health and well-being and on-the-job performance. Policy makers must develop and fund home-based care models that take into account the stressors associated with AIDS care, by reducing the work load, providing ongoing psychosocial support and recruiting nurses to assist volunteers. The small non-probability sample used in this study highlights the need to treat the findings with caution.
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Affiliation(s)
- Olagoke Akintola
- School of Applied Human Sciences, University of KwaZuluNatal, Durban, South Africa; Program in Policy Decision-making, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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Singh D, Chaudoir SR, Escobar MC, Kalichman S. Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home-based care in South Africa. AIDS Care 2011; 23:839-45. [PMID: 21400316 DOI: 10.1080/09540121.2010.542122] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite its benefits for people living with HIV/AIDS (PLWHA), home-based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV-related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7%) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HIV stigma scale. Eighty-eight percent had low to moderate levels of caregiver burden. People with higher level of burden and higher income were more likely to hold stigmatizing beliefs. Caregivers with the following characteristics: support from a nurse, support from community careworker, HIV stigmatizing beliefs, and personal experience of discrimination as result of caring for PLWHA and low caregiver burden, had more than twice the odds of wanting to care for another PLWA in the future. Overall, caregivers in HBC experience low level of severe caregiver burden. The support offered to caregivers from the hospice and relatively low levels of discrimination encourage expansion of HBC programs for PLWHA.
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Affiliation(s)
- Dinesh Singh
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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Cianelli R, Ferrer L, Norr KF, McCreary L, Irarrázabal L, Bernales M, Miner S. Stigma Related to HIV among Community Health Workers in Chile. ACTA ACUST UNITED AC 2011; 1:3-10. [PMID: 21687824 DOI: 10.5463/sra.v1i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: When healthcare workers have stigmatizing attitudes toward people living with HIV it may lead to discriminatory behavior that interferes with prevention, treatment, and care. This research examined the HIV-related stigmatizing attitudes reported by health workers in Santiago, Chile. METHODS: The study used focus group data from the first phase of a larger study to develop and test a HIV prevention intervention for Chilean health workers. Ten focus groups were conducted with Health workers in two communities in Santiago, Chile. Content analysis was used to analyze the data. RESULTS: Two central themes emerged: Societal stigma and discrimination towards people living with HIV and healthcare system's policies related to HIV. Both inaccurate fears of transmission among the general public and Chilean Health workers and societal prejudices against homosexuals contributed to stigmatization and discrimination. CONCLUSIONS: Health workers did not recognize their own stigmatizing attitudes or discriminatory behaviors, but their discussion indicated that these behaviors and attitudes did exist. Healthcare system issues identified included problems with confidentiality due to the desire to inform other health workers about client HIV status. Health workers must be sensitized to the current stigmatization and misinformation associated with HIV and its negative impacts on persons living with HIV and the general community. IMPLICATIONS: All clinical and non-clinical workers at community clinics need mandatory education for HIV prevention that focuses on changing attitudes as well as sharing knowledge. Also, the Chilean law protecting people living with HIV and the confidentiality of their medical care needs to be publicized, along with guidelines for its enactment in clinics and other health facilities.
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Affiliation(s)
- Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Mill JE, Edwards N, Jackson RC, MacLean L, Chaw-Kant J. Stigmatization as a social control mechanism for persons living with HIV and AIDS. QUALITATIVE HEALTH RESEARCH 2010; 20:1469-1483. [PMID: 20663937 DOI: 10.1177/1049732310375436] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Stigmatization contributes to inequity by marginalizing persons living with HIV and AIDS (PHAs). In this study we examined the stigmatizing practices in health care settings from the perspectives of PHAs and health care providers (HCPs). A qualitative design, using a participatory action research approach, was used. Interviews and focus groups were completed with 16 aboriginal and 17 nonaboriginal individuals living with HIV (APHAs and PHAs) and 27 HCPs in Ottawa and Edmonton, Canada. We present findings to support the premise that stigmatization can be used as a social control mechanism with PHAs. Participants described both active and passive social control mechanisms: shunning and ostracizing, labeling, and disempowering health care practices. Forgiving behavior, balancing disclosure, practicing universal precautions, bending the rules, shifting services, and reducing labeling were strategies to manage, resist, and mitigate social control. The findings illustrate the urgent need for multilevel interventions to manage, resist, and mitigate stigma.
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Affiliation(s)
- Judy E Mill
- Faculty of Nursing, University of Alberta, 7-90 UniversityTerrace, Edmonton, AB, Canada.
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Akintola O. Perceptions of rewards among volunteer caregivers of people living with AIDS working in faith-based organizations in South Africa: a qualitative study. J Int AIDS Soc 2010; 13:22. [PMID: 20546580 PMCID: PMC2901349 DOI: 10.1186/1758-2652-13-22] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 06/14/2010] [Indexed: 11/24/2022] Open
Abstract
Background Volunteer caregivers are a critical source of support for the majority of people living with HIV and AIDS in southern Africa, which has extremely high HIV/AIDS prevalence rates. While studies have shown that volunteer caregiving is associated with negative health and socio-economic outcomes, little is known about the positive experiences of volunteers in the home-based care context in South Africa. The purpose of this study is to explore the perception of rewards among volunteers working in home-based care settings. Methods This study uses a qualitative design. Qualitative interviews were conducted with a purposively selected sample of 55 volunteer caregivers using an interview schedule containing open-ended questions. Results Volunteer caregivers derived intrinsic rewards related to self-growth and personal (emotional and psychological) development on the job; they also derived satisfaction from community members taking a liking for them and expressing a need for their services. Volunteers felt gratified by the improvements in their health behaviours, which were a direct consequence of the experiences of caring for terminally ill patients with AIDS. Extrinsic rewards came from appreciation and recognition shown by patients and community members. Extrinsic rewards also accrued to volunteers when the services they rendered made their patients happy. Perhaps the greatest sources of extrinsic rewards are skills and competencies acquired from training and experience while caring for their patients, and volunteers' ability to make a difference in the community. Conclusions Insights into volunteer caregiver rewards provide opportunities for policy makers and programme managers to develop a model of home-based care that facilitates the accrual of rewards to volunteers alongside volunteers' traditional duties of patient care. Programme managers could employ these insights in recruiting and assisting volunteers to identify and reflect on rewards in the caregiving situation as a means of reducing the burden of care and sustaining volunteer interest in caregiving.
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Boon H, James S, Ruiter RA, van den Borne B, Williams E, Reddy P. Explaining perceived ability among older people to provide care as a result of HIV and AIDS in South Africa. AIDS Care 2010; 22:399-408. [DOI: 10.1080/09540120903202921] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hermien Boon
- a Health Promotion Research and Development Unit , Medical Research Council , Cape Town , South Africa
- b Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Shegs James
- a Health Promotion Research and Development Unit , Medical Research Council , Cape Town , South Africa
| | - Robert A.C. Ruiter
- b Department of Work and Social Psychology , Maastricht University , Maastricht , The Netherlands
| | - Bart van den Borne
- c Department of Health Education and Health Promotion , Maastricht University , Maastricht , The Netherlands
| | - Eka Williams
- d Horizons, Population Council , Johannesburg , South Africa
| | - Priscilla Reddy
- a Health Promotion Research and Development Unit , Medical Research Council , Cape Town , South Africa
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Harrowing JN, Mill J. Moral distress among Ugandan nurses providing HIV care: a critical ethnography. Int J Nurs Stud 2009; 47:723-31. [PMID: 20004395 DOI: 10.1016/j.ijnurstu.2009.11.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 10/29/2009] [Accepted: 11/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa. AIM To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people. METHOD A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions. RESULTS Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients' wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues. CONCLUSIONS The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.
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Affiliation(s)
- Jean N Harrowing
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive West, Lethbridge, Alberta, Canada.
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Boon H, Ruiter RAC, James S, van den Borne B, Williams E, Reddy P. Correlates of grief among older adults caring for children and grandchildren as a consequence of HIV and AIDS in South Africa. J Aging Health 2009; 22:48-67. [PMID: 19923634 DOI: 10.1177/0898264309349165] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Over the past few years, older people have become the main caregivers for their sick adult children and orphaned grandchildren due to HIV/AIDS in South Africa. This article aims to investigate the scope of care provided by older people, with a specific focus on the experience of grief due to multiple losses and its correlates. METHODS Quantitative interviews were conducted among 820 isiXhosa speaking caregivers of 60 years and older in the Eastern Cape of South Africa. RESULTS Older persons are involved in a wide range of care activities with several dependents to care for. Grief among older adults is most strongly predicted by perceived stigma around HIV and AIDS and worries about providing the care. DISCUSSION This study provides insight into correlates of grief among older caregivers and results in useful information to inform the development of interventions to assist older persons in coping with their responsibilities as caregivers.
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Affiliation(s)
- Hermien Boon
- Health Promotion Research and Development Unit, Medical Research Council, South Africa.
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Pallangyo E, Mayers P. Experiences of Informal Female Caregivers Providing Care for People Living With HIV in Dar es Salaam, Tanzania. J Assoc Nurses AIDS Care 2009; 20:481-93. [DOI: 10.1016/j.jana.2009.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 05/25/2009] [Indexed: 11/16/2022]
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Chimango JL, Kaponda CN, Jere DL, Chimwaza A, Crittenden KS, Kachingwe SI, Norr KF, Norr JL. Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi. J Assoc Nurses AIDS Care 2009; 20:293-307. [PMID: 19576546 PMCID: PMC2763430 DOI: 10.1016/j.jana.2009.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 03/16/2009] [Indexed: 11/30/2022]
Abstract
Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.
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Affiliation(s)
- Jane L Chimango
- Nursing, Midwifery and Health Sciences Research Centre, Kamuzu College of Nursing, University of Malawi, Lilongwe
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Abstract
In this ethnography, I explored the impact of an HIV/AIDS education program on the lives of 24 Ugandan nurses and nurse-midwives. Nurses who previously had viewed themselves simply as providers of advice and sympathy now saw themselves as more holistic, collaborative caregivers. They voiced an increased awareness of their role as leaders and advocates in the community with respect to policy. The education program had positive and synergistic effects on the nurses' professional practice, communication and problem-solving skills, confidence, and engagement in political and social change activities.
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Akintola O. Defying all odds: coping with the challenges of volunteer caregiving for patients with AIDS in South Africa. J Adv Nurs 2008; 63:357-65. [PMID: 18727763 DOI: 10.1111/j.1365-2648.2008.04704.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore the challenges experienced by volunteer caregivers of people living with HIV/AIDS and the strategies employed in coping with these challenges. BACKGROUND Informal caregiving is associated with stresses that often results in poor health outcomes for caregivers. In South Africa, volunteers play a major role in the provision of care for people living with HIV/AIDS and have been shown to experience burdens as a result of caring. However, little is known about stress and coping among volunteer caregivers. METHODS An ethnographic study was conducted, using observation and in-depth interviews, to collect data with 20 volunteers and other stakeholders in two semi-rural communities in South Africa over a 19-month period in 2002/2003. FINDINGS 'Defying all odds' emerged as the central theme that encompassed the various ways in which volunteer caregivers dealt with the many practical challenges confronting them. These challenges initially posed a threat to volunteering work but were gradually appraised by volunteers as challenges that could be dealt with using various strategies in order to continue providing care. Eight themes highlighting these challenges and the coping strategies employed by volunteers were identified. CONCLUSION A clear understanding of how volunteers deal with challenges of caring for people living with HIV/AIDS can give insight into their weaknesses and strengths and can inform the design of interventions aimed at providing support. Studies are needed to facilitate better understanding of the processes of appraisal of challenges by volunteers and the effectiveness of coping strategies, and to track coping strategies over time.
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Affiliation(s)
- Olagoke Akintola
- School of Psychology, University of KwaZuluNatal, Glenwood, Durban, Kwazulu-Natal, South Africa.
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Mak WWS, Cheung RYM. Affiliate Stigma Among Caregivers of People with Intellectual Disability or Mental Illness. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2008. [DOI: 10.1111/j.1468-3148.2008.00426.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tarimo EAM, Kohi TW, Outwater A, Blystad A. Gender roles and informal care for patients with AIDS: a qualitative study from an urban area in Tanzania. J Transcult Nurs 2008; 20:61-8. [PMID: 18852478 DOI: 10.1177/1043659608325843] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As HIV/AIDS imposes an overwhelming pressure on the capacity of an already overburdened health care system in many African countries, families have increasingly been noted to supplement hospital care services for patients with AIDS. The aim of the present study is to generate knowledge on the experiences of family caregivers to the patients with AIDS at the household level in Dar es Salaam, Tanzania. Data were collected through in-depth interviews with 20 family caregivers and were analyzed using thematic content analysis. The article provides the reader increased insight on the obligations that AIDS caregiving has imposed on women within the close kin group of the patient. The study indicates that caregiving has increased the workload and in the same vein the economic marginality of women, who themselves are increasingly widowed heads of households. The study findings demonstrate strong gendered implications for community and policy makers.
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Ulasi CI, Preko PO, Baidoo JA, Bayard B, Ehiri JE, Jolly CM, Jolly PE. HIV/AIDS-related stigma in Kumasi, Ghana. Health Place 2008; 15:255-62. [PMID: 18632302 DOI: 10.1016/j.healthplace.2008.05.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 05/15/2008] [Accepted: 05/20/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess HIV/AIDS-related stigma and discrimination of people living with HIV/AIDS (PLWHA) in Kumasi, Ghana. METHODS A cross-sectional survey of 104 adults from the four sub-districts in Kumasi was conducted. RESULTS Four stigma constructs, employment-based discrimination, screening and identification of HIV positive people, revelation of HIV status and social contact stigma were determined based on reliability measures from responses to the questionnaire. Regression analysis showed that participants with higher educational attainment were more likely to favor policies denying employment to PLWHA (p<0.05), but disapproved of revealing HIV sero-status (p<0.05). Muslims were more likely than Christians to agree with identifying PLWHA (p<0.05) and more likely to advocate revealing HIV sero-status (p<0.05). Males were more likely to favor revealing HIV status (p<0.05). Employed persons were more likely to have social contact with PLWHA (p<0.05). CONCLUSIONS These findings are useful in guiding the design of interventions against HIV/AIDS-related stigma in Kumasi.
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Affiliation(s)
- Chijioke I Ulasi
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Wiig K, Smith C. An exploratory investigation of dietary intake and weight in human immunodeficiency virus-seropositive individuals in Accra, Ghana. ACTA ACUST UNITED AC 2007; 107:1008-13. [PMID: 17524722 DOI: 10.1016/j.jada.2007.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Indexed: 11/29/2022]
Abstract
In Africa, the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) complex is commonly referred to as "slim disease" because, as the disease progresses, food intake and metabolism are altered, leading to visible body weight loss. In this descriptive, cross-sectional pilot study, 50 HIV-seropositive adults attending the Korle Bu Teaching Hospital in Accra, Ghana, were interviewed during the late spring of 2003. Demographics, medical HIV history and current status of their HIV disease, food safety, and food security information were collected. One 24-hour dietary recall was completed, height and weight were measured, and body mass index (BMI) was calculated for each participant. Results show that women participants had a higher mean BMI and maintained it through disease progression compared with men (P<0.02). The majority of the participants cited cost as a barrier in purchasing adequate amounts of food (92%). Fruit and vegetable intake was low overall (<three servings/day). The foods contributing most to daily energy intake were fried fish, white rice, kenkey, white bread, and fufu. In fighting the global HIV/AIDS epidemic, registered dietitians must consider barriers to achieving optimal nutritional status in a cultural context to enhance feasibility and ensure the effectiveness of dietary interventions.
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Affiliation(s)
- Kristen Wiig
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN 55108, USA
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