Perceptions of alcohol risk among people on antiretroviral treatment in South Africa: a qualitative study

This study explored perceptions of alcohol abuse risk among people on antiretroviral treatment (ART) who self-identified as alcohol users. Twenty six people receiving ART from an out-patient setting were interviewed on their alcohol abuse risk perception. Data were thematically analysed. Findings suggest participants developed routines to drink alcohol around the times they took their antiretroviral medications to reduce adverse impact. They also reported alcohol abuse risk reduction strategies such as reducing alcohol use because of the event of an HIV positive diagnosis and/or getting on antiretroviral treatment, and alcohol use reduction following health education or counselling by health care staff. These findings suggest a need for alcohol interventions tailored to ART patients.     

Effects of attitude action identification on congruence between attitudes and behavioral intentions toward social groups

Attitude Representation Theory (ART) holds that attitude-relevant responses are informed by mental representations of the attitude object, which include the individual's actions toward that object. Action Identification Theory (AIT) holds that the same action can be identified at multiple levels. Individuals who identify their actions at lower levels have less flexibility in how they perform the action, and thus enact the action less consistently. An integration of ART and AIT suggested that individuals who spontaneously (Experiment 1) or through manipulation (Experiments 2 and 3) identify their attitude-relevant actions toward a social group at lower levels might display less attitude-intention congruence than would individuals who identify their attitude-relevant actions at higher levels. ART and AIT are discussed as having links with each other and with other theories of attitude and judgment processes.     

Spirituality and Religion in Antiretroviral Therapy (ART) in Kwazulu-natal,South Africa: A Longitudinal Study

This study assesses the effects of spirituality and religion in health outcomes of patients on ART in KwaZulu-Natal, South Africa. Participants were 735 patients who attended three HIV clinics for ART over a period of 20 months as follows: 519 after 6 months on antiretroviral therapy (ART), 557 after 12 and 499 after 20 months on ART. They completed the Duke Religion Index each visit. Factors associated with spirituality/religiousness included fewer mental health problems (lower depressive symptoms, lower alcohol use), CD4 cell counts, adherence to ART, better certain health related quality of life outcomes (physical, psychological and environmental), social support and internalized HIV/AIDS stigma. Further research could examine the feasibility of including spirituality and religion in the assessment and providing support interventions for HIV patients.     

Margaret Atwood and Assisted Reproduction: From Fantasy to Reality

ABSTRACT

This article raises the bewildering impact of artificial reproduction techniques (ART) for analysts, for the family, for the couple, and for their children. It explores a number of concerns, some of which include: the dissociation of sex from reproduction; the relative absence of the usual time limits that people have traditionally taken into consideration to conceive; questions about generation and age; the risk of perceiving oneself as omnipotent; the need to renovate the story of how one came to be; the impact of ART on the way the primal scene and the Oedipal complex are worked through when there is no longer only a triangle, but more people involved in procreation; the children’s identity (Who are my real parents?) and the impact on the identity of the women involved in participating in the procreation such as the egg donor or surrogate. It also addresses the impact of ART on the analyst who has to deal with situations for which he or she is not prepared either personally or professionally. It begins by exploring Margaret Atwood’s 1985 novel, The Handmaid’s Tale, and its present day relevance to ART. Atwood’s vision was prescient. The similarity between the lives and experiences of her Handmaids and that of today’s commercial surrogates in India is often striking. It also presents some ways in which literature and media are predicting the challenges that ART will bring in the future. It explores how what was fiction a few decades ago has become reality and how what we presently think of as fiction will perhaps be a reality in the not-so-distant future. The second part of the article presents a clinical vignette in which a couple presents with infertility in the wife, whose infertility was the consequence of chemotherapy treatment she received as a young adult. She decided to look for a donor in a European country and succeeded at getting pregnant. However, though successful, the pregnancy proved to be extremely difficult. When a second pregnancy was desired, the same donor provided with her ova. To avoid the complications of the first pregnancies, the couple accepted the wife’s sister’s offer to carry the pregnancy. Their daughters are now two and four years old.     

Use of traditional medicine by HIV-infected individuals in South Africa in the era of antiretroviral therapy

As antiretroviral therapy (ART) becomes more available in African countries, the potential for interaction with traditional medicines becomes more important. We carried out a cross-sectional survey among individuals with moderate or advanced HIV disease attending a workplace clinic providing ART in South Africa to determine prevalence of traditional medicine use, source, recommended products and costs. Among 44 clinic attendees (100% male, median age 42 years, 30 taking ART), 37 (84%) reported ever using traditional medicines, 25 obtained from a healer or herbalist, eight from their own fields and four from a pharmacy. Fourteen of the 44 (32%) were currently using traditional medicines, most frequently African potato (9/14) and Aloe vera (3/14). Seven out of 30 persons taking ART (23%) reported currently using traditional medicines. Participants spent 4 - 27 pounds per month on traditional medicines. Traditional medicine use is common among individuals with moderate and advanced HIV disease. Concomitant use with ART has the potential for drug interactions and should be discussed routinely in ART counselling. Further work is warranted to investigate whether commonly used traditional medicines interact with ART in vivo.     

The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse,Racial/Ethnic Identity,and Medication Adherence in Women Living with HIV

Racial/ethnic minority status and physical abuse history are risk factors for higher mortality rates and lower adherence to antiretroviral therapy (ART) in women living with HIV (WLWH) in the United States. The current study tested the hypotheses that minority status and physical abuse history might lead women to silence the self (minimize and hide thoughts and feelings in order to avoid relational conflict, loss, and/or abuse) as measured by the Silencing the Self Scale (STSS), and that STSS might mediate and moderate relationships of physical abuse and racial/ethnic minority status with ART adherence. Divided Self (DS; acting in ways inconsistent with inner thoughts and feelings), an STSS subscale, was targeted for study along with the total STSS score. Participants were 513 women from the U.S. Women’s Interagency HIV Study (M_age?=?46; 387, 75%, Black; 66, 13%, Hispanic; 60, 12%, White). Multiple logistic regressions indicated that across all racial/ethnic groups, physical abuse history related to higher DS and lower adherence. DS significantly mediated relationships between abuse and adherence. Compared to White women, Black women demonstrated worse ART adherence, but had lower total STSS. Racial/ethnic minority women and women with a physical abuse history who had higher DS had lower adherence than other groups. Results indicate that being a racial/ethnic minority or having a history of physical abuse may increase vulnerability to the deleterious effects of DS on ART adherence, findings that can help inform interventions to decrease health disparities in WLWH.

     

Congruence of the Marital Relationship During Transition to Parenthood: A Study with Couples Who Conceived Spontaneously or Through Assisted Reproductive Technologies

In this study we examined the congruence between partners’ perceptions of their marital relationship during the transition to parenthood and the effect of depression during pregnancy on couples’ congruence during the early postpartum period. Thirty-one couples who conceived spontaneously, along with thirty-five who conceived through assisted reproductive technologies (ART), provided data on their marital relationship and depression at their 24th pregnancy week and four months after the partum. All couples reported a decrease in marital congruence. Couples who conceived through ART reported lower marital congruence. For these subjects, women’s depression was associated with lower congruence. Interventions that focus on strengthening the marital relationship across the transition to parenthood should assess and promote couples’ congruence.     

Effects of tobacco use on non-adherence to antiretroviral therapy among HIV-positive patients in South Africa

This study aimed to estimate the relationship between tobacco use and non-adherence to antiretroviral therapy (ART) in a South African sample. Participants were 1 963 HIV patients who attended a primary care clinic in Pretoria (female = 68.5%; black African = 99.5%; median age = 37.0 years; tobacco users only = 8.6%, problem drinkers only = 14.9%, and tobacco users and problem drinkers = 10.5%). In adjusted logistic regression analysis, tobacco use only was not significantly associated with non-adherence to ART. Alcohol use only (OR: 1.72; CI: 1.26, 2.36) and tobacco use and problem drinking (OR: 2.31; CI: 1.60, 3.33) were highly associated with non-adherence to ART.     

Hazardous Alcohol Use among Persons Living with Human Immunodeficiency Virus Infection in the Eastern Cape,South Africa

The study assessed the prevalence of hazardous alcohol use among people living with HIV (PLHIV) and its correlates with socio-economic characteristics, disease variables and ART adherence in South Africa. The sample included 607 PLHIV (males =475, females =132; age range =18–61), sampled by all districts in the Eastern Cape. Participants were recruited through a health facility in the community through key informants or a support group. Results indicate that male PLHIV were more often than female PLHIV “past month” (18.9% vs. 6.1%) and hazardous alcohol drinkers (6.1% vs. 2.7%); using a cut-off score of 8 and more on the Alcohol Use Disorders Identification Test (AUDIT). Not having a disability grant for HIV/AIDS and the disability grant terminated were both related to past month alcohol use, while having the “disability grant stopped” was also related with hazardous or harmful drinking. Not having an AIDS diagnosis and not being on ART were both associated with past month alcohol use and hazardous or harmful drinking. CD4 counts and non-adherence to ART were both not significantly related with alcohol use status. Brief health provider initiated alcohol interventions for PLHIV should be promoted, with emphasis on targeting men.     

ART知情同意的困境与对策

由于受到千百年来传统家庭观念及患者认知能力的影响,同时,由于辅助生殖技术(ART)的专业性、复杂性,ART技术应用的局限性、结果的不确定性以及诊治周期长、费用高等因素的存在,ART知情同意过程面临着困境。ART伦理管理落实真实知情同意的体现在对患者进行充分、全面、如实的信息告知,取得其配偶的同意和支持,完善的、个案化的文书签定,是ART伦理管理落实真实知情同意的体现。     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa

Neurodevelopmental delay has been documented in up to 97.5% of HIV-infected children in Soweto who were not yet on antiretroviral treatment (ART). With growing numbers of children in South Africa being successfully treated with ART, the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV-infected preschool children (aged five to six years) receiving ART and compare it to an apparently healthy (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for more than one year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised 30 well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunizations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were <-2 (indicating severe delay) in 27 (90%) children in the HIV-infected group compared to 23 (76%) in the comparison group (p?=?0.166). Mental handicap (overall GQ?相似文献   

Adherence to antiretroviral therapy: an empirical test of the information-motivation-behavioral skills model.

Consistent and nearly perfect adherence is considered an essential requirement for HIV-positive patients on antiretroviral therapy (ART) to fully realize its life-extending benefits. The current study evaluated a comprehensive model of ART adherence--the information-motivation-behavioral skills (IMB) model. This model views adherence behavior as a function of the interrelations between adherence-related information, motivation, and behavioral skills. It hypothesizes that adherence-related information and motivation work through adherence-related behavioral skills to affect the initiation and maintenance of optimal ART adherence. In a series of structural equation models, the IMB model's critical constructs and assumptions were evaluated with a sample of 100 HIV-positive patients in clinical care. Across all analyses, the authors found support for the assumptions of the IMB model of ART adherence. Consistent with the model, adherence-related information and motivation related significantly to adherence-related behavioral skills, and behavioral skills related significantly to self-reported optimal adherence. Further, as predicted, the effects of information and motivation on self-reported adherence were mediated by adherence-related behavioral skills. Current study results are explored, and implications for adherence promotion interventions based on the model are discussed.     

山东省人类辅助生殖技术服务利用人群特征调查研究

对山东省人类辅助生殖技术(Assisted Reproductive Techology,ART)服务利用人群特征进行了调查和评价研究.主要包括不孕症门诊病人社会学特征,知情权,不孕症患者意愿,满意度评价等;并建议进一步加大宣传教育的力度,普及ART健康知识,提高对ART的知晓率,树立正确的社会观念,达到充分有效的利用ART的目的.     

International comparison of parenting styles in ICSI,IVF and natural conception families: Results from a European study

In studies comparing ART children born in different countries cultural factors mediate outcomes on child development and parenting. The aim of the study was to investigate whether the variability between the parents living in different cultures is the same regardless of whether these parents conceived after ICSI–IVF or naturally. Questionnaires measuring parental wellbeing, attitudes to family life and parent–child relationships were distributed to parents of 5-year-old ICSI, IVF and natural conceived (NC) control children in the UK (n = 510), Belgium (n = 512), Denmark and Sweden (n = 400). Participation rates were not known for every conception group in each country. However, the participation rate was 45% in the ICSI and IVF conception groups in Belgium, 90% in the ICSI conception group in the UK and 82%, 76% and 56% in the ICSI, IVF and NC groups, respectively, in Denmark and Sweden. In the UK mothers and fathers experienced less marital satisfaction compared to their counterparts in the other countries. Compared to the mothers in Belgium and in the Nordic countries, the mothers in the UK who conceived after ICSI, IVF or naturally reported more stress from parenting. In Belgium ICSI, IVF and NC mothers were highly committed to work while Belgian fathers were least committed to parenting when compared to fathers in Nordic countries and the UK. Mothers in Nordic countries differed from other mothers in that they described fewer negative feelings towards their ICSI, IVF or NC offspring. Although international multi-centre ART follow-up studies help to investigate the wellbeing of ART children and parents the effect of living in a particular culture or nation needs to be taken into account.     

Adoption, ART, and a re-conception of the maternal body: toward embodied maternity

We criticize a view of maternity that equates the natural with the genetic and biological and show how such a practice overdetermines the maternal body and the maternal experience for women who are mothers through adoption and ART (Assisted Reproductive Technologies). As an alternative, we propose a new framework designed to rethink maternal bodies through the lens of feminist embodiment. Feminist embodied maternity, as we call it, stresses the particularity of experience through subjective embodiment. A feminist embodied maternity emphasizes the physical relations of the subjective lived-body rather than the genetic or biological connections. Instead of universalizing claims about the maternal body, embodied maternity looks to communicable experiences and empathetic understanding.     

“Where Did I Come From?” The Impact of ART on Families and Psychotherapists

ABSTRACT

This article focuses on the field of assisted reproductive technology (ART) and psychoanalysis as it relates to people who’ve struggled emotionally in pursuit of their wish to create a family. Recent medical advances have changed baby-making to the extent that infertility is no longer a terminal diagnosis (Ehrensaft, 2012). New opportunities exist to create a family through introduction of a third party in the process of conception via in vitro fertilization, the use of donor egg and/or sperm, intracytoplasmic sperm injection, and surrogacy. The realities raised by these new methods have challenged usual cultural ideas of what constitutes a family, as well as what it means to become a parent or give birth to a child (Ehrensaft, 2000; Notman, 2011; Samish, 2006). The subject of reproductive medicine has stimulated a wide range of emotions within the community of people who suffer infertility and among psychotherapists who become involved with them in analytic and psychotherapeutic relationships.     

Modeling developmental transitions in adaptive resonance theory

Neural networks are applied to a theoretical subject in developmental psychology: modeling developmental transitions. Two issues that are involved will be discussed: discontinuities and acquiring qualitatively new knowledge. We will argue that by the appearance of a bifurcation, a neural network can show discontinuities and may acquire qualitatively new knowledge. First, it is shown that biological principles of neurite outgrowth result in self-organization in a neural network, which is strongly dependent on a bifurcation in the activity dynamics. Second, the effect of a bifurcation due to morphological change is investigated in an Adaptive Resonance Theory (ART) network. Exact ART networks with quantitative differences in network structure at the category level show qualitatively different dynamical regimes, which are separated by bifurcations. These qualitative differences in dynamics affect the cognitive function of Exact ART: Representations of learned categories are local or distributed.