Receiving a positive HIV test result: the experience of patients in Europe

Testing HIV positive in pregnancy: A phenomenological study of women's experiences

OBJECTIVE

globally women receive HIV testing in pregnancy; however, limited information is available on their experiences of this potentially life-changing event. This study aims to explore women's experiences of receiving a positive HIV test result following antenatal screening.

DESIGN

a qualitative, phenomenological approach.

SETTING

two public National Health Service (NHS) hospitals and HIV support organisations.

PARTICIPANTS

a purposive sampling strategy was used. Thirteen black African women with a positive HIV result, in England, participated.

METHODS

data were collected using in-depth semi-structured interviews. An interpretive phenomenological approach to data analysis was used.

FINDINGS

the emergent phenomenon was transition and transformation of 'being,' as women accepted HIV as part of their lives. Paired themes support the phenomenon: shock and disbelief; anger and turmoil; stigma and confidentiality issues; acceptance and resilience. Women had extreme reactions to their positive HIV diagnosis, compounded by the cultural belief that they would die. Initial disbelief of the unexpected result developed into sadness at the loss of their old self. Turmoil was evident, as women considered termination of pregnancy, self-harm and suicide. Women felt isolated from others and relationship breakdowns often occurred. Most reported the pervasiveness of stigma, and how this was managed alongside living with HIV. Coping strategies included keeping HIV 'secret' and making their child(ren) the prime focus of life. Growing resilience was apparent with time.

KEY CONCLUSIONS

this study gives midwives unique understanding of the complexities and major implications for women who tested positive for HIV. Women's experiences resonated with processes of bereavement, providing useful insight into a transitional and transformational period, during which appropriate support can be targeted.

IMPLICATIONS

midwives are crucial in improving the experience of women when they test HIV positive and to do this they need to be appropriately trained. Midwives need to acknowledge the social and psychological impact of HIV and pathways should be developed to support early referral for appropriate support.

Health service barriers to HIV testing and counseling among pregnant women attending Antenatal Clinic; a cross-sectional study

BACKGROUND

HIV testing and counseling (HTC) remains critical in the global efforts to reach a goal of universal access to prevention and timely human immunodeficiency virus (HIV) treatment and health care. Routine HIV testing has been shown to be cost-effective and life-saving by prolonging the life expectancy of HIV patients and reducing the annual HIV transmission rate. However, these benefits of routine HIV testing may not be seen among pregnant women attending antenatal clinic (ANC) due to health facility related factors. This paper presents the influence of health facility related factors on HTC to inform HTC implementation.

METHODS

The study was cross-sectional in design and used structured questionnaire and interview guides to gather information from 300 pregnant women aged 18 to 49 years and had attended ANC for more than twice at the time of the study. Twelve health workers were interviewed as key informants. Respondents were selected from the five sub metro health facilities in the Kumasi Metropolis through systematic random sampling from August to November 2011. Pregnant women who had not tested after two or more ANC visits were classified as not utilizing HTC. Data was analyzed with STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level.

RESULTS

Twenty-four percent of the pregnant women had not undergone HTC, with "never been told" emerging as the most cited reason as reported by 29.5% of respondents. Decisions by pregnant women to take up HTC were mostly influenced by factors such as lack of information, perceptions of privacy and confidentiality, waiting time, poor relationship with health staff and fear of being positive.

CONCLUSIONS

Access to HTC health facility alone does not translate into utilization of HTC service. Improving health facility related factors such as health education and information, confidentiality, health staff turnaround time and health staff-client relationship related to HTC will improve implementation.

The utilization of testing and counseling for HIV: a review of the social and behavioral evidence

Against the background of debates about expanding HIV testing and counseling, we summarize the evidence on the social and behavioral dimension of testing and its implications for programs. The discrepancy between acceptance of testing and returning for results and the difficulties of disclosure are examined in light of research on risk perceptions and the influence of gender and stigma. We also summarize the evidence on the provision of testing and counseling, the implementation of practices regarding confidentiality and consent, and the results of interventions. We demonstrate that social factors have a considerable impact on testing, show that the services linked to testing are key determinants of utilization, and consider the implications of these findings for HIV testing programs.

Diagnosis and management of acute HIV infection

HIV infection starts as an acute, systemic infection, followed by a chronic period of clinical latency, usually lasting 3 to 10 years, which precedes the eventual collapse of the immune system. It is increasingly recognized that events occurring during acute HIV infection may determine the natural course of the disease. The very dynamic events of acute HIV infection provide multiple opportunities for biologic interventions, such as anti-retroviral or immune-based therapies. Similarly, the implementation of public health measures during acute HIV infection could help control epidemics or outbreaks. Many of the dramatic possibilities for intervention in acute HIV infection remain unproved, not the least because of traditional difficulty of diagnosing patients during this early period. This article reviews the natural history, pathogenesis and clinical presentation of acute HIV infection, and suggests a diagnostic and therapeutic approach to guide clinicians dealing with patients with suspected or confirmed acute HIV infection.

Assessing and achieving readiness to initiate HIV medication

OBJECTIVE

To summarise published HIV-specific research on readiness theories, factors influencing readiness, instruments to measure readiness and interventions to increase readiness for treatment.

METHODS

Medline and PsychInfo were searched until August 2004.

RESULTS

Two HIV-specific readiness theories were identified. Fear of side effects, emotions emerging from the diagnosis and lack of trust in the physician were some barriers to overcome in order to reach readiness. Of the three measurement instruments found, the index of readiness showed the most promise. Multi-step intervention programs to increase readiness for HIV treatment had been investigated.

CONCLUSION

Readiness instruments may be useful tools in clinical practice but the predictive validity of the instruments needs to be further established in the HIV-infected population.

PRACTICE IMPLICATIONS

Readiness instruments and practice placebo trials may serve as complements to routine care, since health care providers currently have no better than chance probability in identifying those patients who are ready to adhere.

Ethics and communication between physicians and their patients with cancer, HIV/AIDS, and rheumatoid arthritis in Mexico

BACKGROUND

Despite evidence that open communication concerning diagnosis of a disease substantially improves the doctor-patient relationship, in developing countries physicians often provide partial information.

METHODS

We carried out a cross-sectional study with 379 physicians practicing at 11 hospitals in Mexico City and in the central Mexican state of Morelos to quantify their communication patterns with patients with cancer, HIV/AIDS, and rheumatoid arthritis. Communication patterns were defined as physician self-reported communication with patients with regard to their diagnosis, prognosis, and treatment. Logistic, ordinal, multivariate models were constructed for analysis.

RESULTS

Assigning a high level of value to communication (odds ratio [OR] 5.5, 95% confidence interval [95% CI] 2.1-14.8), and bioethics training (OR 1.5, 95% CI 1.0-2.3) were principal predictors of explicit communication with cancer patients. We found a very strong association between explicit communication with HIV/AIDS patients and an accepting attitude of the physician toward death (OR 34.6, 95% CI 8.5-141.0). As for communication with rheumatoid arthritis patients, we observed an association between a very paternalistic attitude on the part of the physician (OR 6.8, 95% CI 1.9-24.1) and complete communication.

CONCLUSIONS

In Mexico, physicians exercise power and authority over patients in an effort that they perceive as beneficial or preventing harm. In most cases, physicians do not seem to recognize or respect their patients' autonomy; therefore, communication is generally partial and vague. Our study established the need among physicians for bioethics and communication training. A discussion of this topic is necessary to transform the doctor-patient relationship and to establish a consensus for policies and norms for communication that benefits patients.