"You have to be your own doctor": sociocultural influences on alternative therapy use among gay men with AIDS in west Hollywood

Physician perceptions of HIV cure in China: A mixed methods review and implications for HIV cure research

There are over 100 clinical trials worldwide focused on developing an HIV cure. Research participants will assume substantial individual risks while receiving little or no individual benefit. Physicians will have important dual roles of leading HIV cure research studies and guiding patient expectations. Many low and middle-income nations have started HIV cure trials, including China. The goal of this study was to better understand physician attitudes, behaviors, and perceptions of HIV cure research within the context of China. We conducted a quantitative and qualitative evidence review of published literature on physician perceptions of HIV cure in China. Quantitative survey data revealed that physicians rarely believed HIV was curable, but this perception may be more common compared to other countries. Qualitative data showed that inconsistent terminology used among physicians may contribute to the perception of HIV as curable. The belief that HIV is curable among some physicians in China may be related to the influence of traditional Chinese medicine beliefs. Rather than seeking elimination of pathogens, traditional Chinese medicine aims to achieve harmony between organs and a vital life force. In this context, HIV infection can be seen as a temporary state of imbalance rather than an irreversible change. There is a wide range of physician perceptions about HIV cure in China. Conflicting information about HIV cure from physicians and other sources could thwart the progress of HIV cure research. Enhancing patient-physician communication about ongoing HIV cure research trials will be important for developing an HIV cure.

My body, my life, my choice: practices and meanings of complementary and alternative medicine among a sample of Australian people living with HIV/AIDS and their practitioners

In this study we examine the sociocultural meaning and use of complementary and alternative medicine (CAM) by nine people living with HIV/AIDS (PLWHA) and four CAM practitioners. Analysis revealed five themes: focus on health not illness; resistance to antiretroviral therapy and adherence; allopathic medicine as narrow; difficulty disclosing to doctors; and a continuum of CAM that sometimes included conventional medicine and sometimes excluded it entirely. Literature on PLWHA in the West commonly describes them as sophisticated health consumers. We explore the concepts of individual responsibility in relation to health, holism, control and well-being in the context of CAM. We also consider the meaning and significance of CAM and western medicine to comment on the contemporary experience of HIV, including the possible impact of stigma and the perceived limits of allopathic medicine among some PLWHA. Understanding this will enable better insight into the treatment choices of PLWHA, particularly those who may be described as sceptical of conventional medical science.

Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care

Use of complementary and alternative medicine (CAM) is prevalent among HIV-positive individuals despite the success of antiretroviral treatments and limited evidence of CAM's safety and efficacy. To characterize the potential impact of CAM use on HIV care, we conducted a systematic review of 40 studies of CAM use among HIV-positive people. The goals of this review are to: (1) describe the demographic, biomedical, psychosocial and health behavior correlates of CAM use; (2) characterize patient-reported reasons for CAM use; and (3) identify methodological and conceptual limitations of the reviewed studies. Findings confirm that a high proportion of HIV-positive individuals report CAM use (M=60%). Overall, CAM use is more common among HIV-positive individuals who are men who have sex with men (MSM), non-minority, better educated and less impoverished. The use of CAM is also associated with greater HIV-symptom severity and longer disease duration. HIV-positive CAM users commonly report that they use CAM to prevent or alleviate HIV-related symptoms, reduce treatment side-effects and improve quality of life. Findings regarding the association between CAM use, psychosocial adjustment and adherence to conventional HIV medications are mixed. While the reviewed studies are instrumental in describing the characteristics of HIV-positive CAM users, this literature lacks a conceptual framework to identify causal factors involved in the decision to use CAM or explain implications of CAM use for conventional HIV care. To address this concern, we propose the use of health behavior theory and discuss implications of review findings for HIV care providers.

American Acupuncture and Efficacy: Meanings and Their Points of Insertion

By its very definition, efficacy's meanings remain fluid, their particularities contingent on context. The change seen as significant may occur on a symbolic level or through the removal of physical symptoms. It may address conditions of a social body. Some discussions differentiate between "healing" and "curing." Many of these meanings surface when examining what efficacy means in the practice of acupuncture in the United States. This complex phenomenon is possible largely because acupuncture draws on the qi paradigm on the one hand, allowing for the most ephemeral dimensions of experience to be included in considerations of efficacy. On the other hand, in the most material sense, acupuncture is also susceptible to being conceptualized as a device, independent of that same paradigm, allowing for the insertion of biomedical models and criteria. Pluralism within acupuncture itself intersects with, and even embodies, the medical pluralism of U.S. culture.

Complementary and alternative medicine use and substitution for conventional therapy by HIV-infected patients

BACKGROUND

HIV-infected patients commonly use complementary and alternative medicine (CAM), but it is not known how often CAM is used as a complement or as a substitute for conventional HIV therapy.

OBJECTIVES

To evaluate the prevalence and factors associated with CAM use with potential for adverse effects and CAM substitution for conventional HIV medication.

DESIGN AND PARTICIPANTS

Cross-sectional survey of U.S. national probability sample of HIV-infected patients (2,466 adults) in care from December 1996 to July 1997.

MAIN OUTCOME VARIABLES

Any CAM use, CAM use with potential for adverse effects, and use of CAM as a substitute for conventional HIV therapy. Substitution was defined as replacement of some or all conventional HIV medications with CAM.

RESULTS

Fifty-three percent of patients had recently used at least one type of CAM. One quarter of patients used CAM with the potential for adverse effects, and one-third had not discussed such use with their health care provider. Patients with a greater desire for medical information and involvement in medical decision making and with a negative attitude toward antiretrovirals were more likely to use CAM. Three percent of patients substituted CAM for conventional HIV therapy. They were more likely to desire involvement in medical decision-making (odds ratio, 1.8; 95% confidence interval, 1.0-3.2) and to have a negative attitude toward antiretrovirals (odds ratio, 7.8; 95% confidence interval, 3.0-19.0).

CONCLUSIONS

Physicians should openly ask HIV-infected patients about CAM use to prevent adverse effects and to identify CAM substitution for conventional HIV therapy.

Use of alternative therapists among people in care for HIV in the United States

OBJECTIVES

This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV.

METHODS

Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted.

RESULTS

Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/lesbian, had incomes above 40,000 dollars, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count.

CONCLUSIONS

Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed.

Communities, citizens, and the perceived importance of AIDS-related services in West Hollywood, California

Successful strategies for prevention and treatment of human immuneodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the developed world are commonly described in terms of community mobilisation and involvement. While a broadly defined 'gay community' has been regarded as central in mobilising responses to HIV and AIDS, other kinds of communities are also relevant, including place-based communities of citizens constituted by their shared residential location, and interest or affinity-based communities of individuals constituted by their relationship to AIDS (e.g. as HIV-positive, as care-giver, as activist). These overlapping communities are identified in West Hollywood, a city with a relatively large gay and lesbian population, and with high rates of HIV infection and AIDS. Results are presented from a 1993 survey of city residents (N=832), comparing perceptions of the relative importance of HIV and AIDS services. How does the perception of the importance of these services vary among individuals defined in terms of their potential membership of these three communities? The findings show that although household HIV-status and gay self-identity were positively associated with relatively high ratings of importance for HIV and AIDS services, there was a strong consensus among all residents that AIDS was the top issue of concern for West Hollywood as a whole. In short, AIDS had emerged as a central issue for citizens of West Hollywood even though the majority of residents were not self-identified members of a gay community nor part of a narrowly-defined community of interest comprising households with a HIV-positive member.

Use of complementary and alternative therapies by patients with human immunodeficiency virus disease in the era of highly active antiretroviral therapy

BACKGROUND

Complementary and alternative medical therapies (CAM) are popular with patients who are human immunodeficiency virus (HIV) seropositive, despite effective drug treatments, potential drug interactions, and overlapping toxicities.

OBJECTIVE

To determine rates and correlates of ingested and noningested CAM use, and to examine temporal changes in the rates of ingested CAM use during the introduction of highly active antiretroviral therapy (HAART).

DESIGN

Cross-sectional analysis with repeated measures from a cohort study, with the study visit as the unit of analysis.

SETTING

Eastern Massachusetts and Rhode Island.

PARTICIPANTS

Adults who are HIV seropositive followed semiannually (n = 642) in Nutrition for Healthy Living (NFHL) study.

MEASUREMENTS

Rates of ingested and noningested CAM use were assessed by interview every 6 months between 1995 and 1999.

RESULTS

Ingested CAM use was reported at 60% of visits. Between 1995 and 1999, HAART use increased from 0% to 70%, and ingested CAM use decreased from 71% to 52%. In multivariate analyses, users of ingested complementary therapies were more likely to be gay men (prevalence ratio [PR] 1.40, 95% confidence interval [CI] 1.23-1.58; p < 0.0001), at least high school educated (PR 1.37, 95% CI 1.12-1.68, p = 0.002), and with secure housing (PR 0.75, 95% CI 0.61-0.92; p = 0.007). Even in the lowest risk group (less educated, nongay males with insecure housing), CAM use rates were 27% (95% CI 21%-34%). There was no association between HAART and CAM use.

CONCLUSIONS

CAM therapies complement, rather than replace, HAART. Even among poorly educated, nongay male patients with insecure housing, rates of ingested CAM use were substantial. Physicians should routinely ask about ingested CAM therapy use and become knowledgeable about potential hazards.

How people with HIV/AIDS manage and assess their use of complementary therapies: a qualitative analysis

The objective of this article is to provide a qualitative analysis of the practical concerns that people with HIV/AIDS have with regard to their use of complementary therapies. In-depth semistructured interviews were conducted with a diverse range of people with HIV/AIDS (N = 46). An inductive grounded approach was used to collect and analyze the data. There were five central concerns: (a) selecting which therapies to use, (b) judging which therapies work, (c) combining Western medicine with complementary therapies, (d) assessing the safety of complementary therapies, and (e) dealing with the barriers to the use of complementary therapies. A better understanding of the practical dimensions of complementary therapy use highlights the treatment and care issues that people with HIV/AIDS face and offers insights into the role that nurses might play in addressing some of these issues.