The Adolescent HIV Communication Belief Scale: Preliminary Reliability and Validity

Globally, there are nearly 2 million HIV positive children, many of whom are adolescents. The majority have perinatally acquired HIV. A key challenge for this population is communicating about HIV to meet emotional and practical needs. Despite evidence of its benefits, HIV communication in adolescents with HIV is rare. To enhance HIV communication, individuals’ beliefs may need to be taken into account. There is no measure of beliefs about HIV communication for adolescents living with HIV. A seven-item measure of HIV communication beliefs was developed and administered to 66 adolescents with HIV in the UK (39 female; aged 12–16 years). Data were explored using principal component analysis. Preliminary criterion-related validity was assessed by examining relationships between the measure and communication occurrence, frequency and intention. Preliminary construct validity was assessed by examining relationships between the measure and HIV stigma, HIV disclosure cognition and affect, quality of life and self-perception. Two factors were revealed: communication self-efficacy and normative beliefs; and communication attitudes. The full scale and its subscales were internally consistent. The total score showed statistically significant positive relationships with HIV communication intention, HIV disclosure cognitions and affect, and HIV stigma but not with other variables. Preliminary evidence of the measure’s good psychometric properties suggests it may be helpful in outlining relationships between HIV communication beliefs and other constructs. It may also be useful in testing interventions that aim to enhance HIV communication in this population. Further work needs to be done to establish the scale’s psychometric properties.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

Correlates of perceived HIV-related stigma among HIV-positive pregnant women in rural Mpumalanga province,South Africa

The study investigated correlates of perceived HIV-related stigma among 673 HIV-positive women from rural Mpumalanga province, South Africa (mean age 28 years old, SD = 5.73 years). The women completed measures of HIV-related stigma experience and related personal factors. Following multivariable logistic regression, results showed that lack of male involvement during the ante-natal visits was significantly associated with all four perceived HIV-related stigma factors. Lower income, intimate partner violence (IPV), lower education, and experienced HIV-related stigma were associated with a combination of the four components of perceived HIV-related stigma. From these findings, we conclude that higher levels of education, income, and partner involvement are protective factors against perceived HIV-related stigma, at multiple layers. Improving on adult education and income generating activities can help in reducing HIV-related stigma. Male partner involvement in their partner’s pregnancy, the initiation of support groups for both women and men, as well as community-based IPV prevention interventions may help to reduce perceived HIV-related stigma among women living with HIV.     

HIV Testing Experience and Risk Behavior Among Sexually Active Black Young Adults: A CBPR-Based Study Using Respondent-Driven Sampling in Durham,North Carolina

African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community‐based participatory research study we assessed HIV testing experience among sexually active 18–30 year old Black men and women in Durham, NC. Of 508 participants, 173 (74 %) men and 236 (86 %; p = 0.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing—routine screening in clinical settings—was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women.     

A systematic review of interventions for anxiety in people with HIV

People with human immunodeficiency virus (HIV) show elevated anxiety levels compared to the general population. Anxiety can predate HIV infection or be triggered by HIV diagnosis and the many stresses that emerge during the course of HIV disease. Many psychological and pharmacological therapies have been shown to treat anxiety in the general population but a systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review examines all published intervention studies on anxiety and HIV from 1980 to 2009 covered by the databases MedLine (1980-2009) and PsycINFO (1980-2009) for a definitive account of effectiveness of interventions and an indication of prevalence of HIV-related anxiety and measurement within studies. Standard systematic research methods were used to gather quality published papers on HIV and anxiety, searching published data bases according to quality inclusion criteria. From the search, 492 papers were generated and hand searched resulting in 39 studies meeting adequacy inclusion criteria for analysis. Of these, 30 (76.9%) were implemented in North America (the USA and Canada), with little representation from developing countries. Thirty-three (84.6%) studies recruited only men or mostly men. A total of 50 interventions were investigated by the 39 studies; 13 targeted HIV, symptoms or associated outcomes/conditions, 20 directly targeted anxiety and another 17 indirectly targeted anxiety. Twenty-four (48%) interventions were effective in reducing anxiety (including 11 indirect interventions), 16 (32%) were ineffective and 10 (20%) had an unknown effect on anxiety. Sixty-five percent of interventions directly targeting anxiety were effective. Psychological interventions (especially cognitive behavioural stress management interventions and cognitive behavioural therapy) were generally more effective than pharmacological interventions. Only three studies provided prevalence rates - these ranged from 13% to 80%. Anxiety was measured using 16 different instruments. Our detailed data suggest that interventions are both effective and available, although further research into enhancing efficacy would be valuable. Also, the vast majority of studies were Western-based, no studies looked at children or adolescents and few looked specifically at women. An international effort to harmonise measurement of anxiety is also missing. There is a need to routinely log anxiety in those with HIV infection during the course of their disease, to provide specific data on women, young people and those in diverse geographic areas and incorporate management into care protocols.     

HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings

HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman–infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman–infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.     

HIV and depression--a systematic review of interventions

HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.     

Psychological trauma associated with AIDS and HIV infection in women

The growing numbers of women faced with HIV infection and AIDS has specific counselling implications. This paper analyses the psychological needs of all women patients seen by the psychology department (n = 33) over the past 12 months. The mean age was 32.3 years. Psychological crisis was high. Four women reported rapes (three accounting for their HIV infection). Two women had suicide attempts (one on two occasions), Death experiences were notable, including multiple bereavement. Conjidentiality was problematic for many of the women. Problems were reported around pre- and post-test counselling which was absent for three women, and often surrounded the diagnosis of a loved one (child, husband or partner). Most women were first seen as in-patients (when disease progression was extensive) or when their partners or children were in-patients. Despite offers of out-patients follow-up, only four HIV + ve women attended, three of which were irregular. A group of ten women were only seen indirectly when provision of care wasgiven to their children. A consistent group were seen with worries about HIV (either due to sexual contact with a known HZV+ ve or at risk individual) or to unfounded concerns often reflecting underlying psychological problems. This paper explores the counselling challenges of AIDS and HIV for women.     

An Intervention to Help Community-Based Organizations Implement an Evidence-Based HIV Prevention Intervention: The Mpowerment Project Technology Exchange System

Considerable resources have been spent developing and rigorously testing HIV prevention intervention models, but such models do not impact the AIDS pandemic unless they are implemented effectively by community-based organizations (CBOs) and health departments. The Mpowerment Project (MP) is being implemented by CBOs around the US. It is a multilevel, evidence-based HIV prevention program for young gay/bisexual men that targets individual, interpersonal, social, and structural issues by using empowerment and community mobilization methods. This paper discusses the development of an intervention to help CBOs implement the MP called the Mpowerment Project Technology Exchange System (MPTES); CBOs’ uptake, utilization and perceptions of the MPTES components; and issues that arose during technical assistance. The seven-component MPTES was provided to 49 CBOs implementing the MP that were followed longitudinally for up to two years. Except for the widely used program manual, other program materials were used early in implementing the MP and then their use declined. In contrast, once technical assistance was proactively provided, its usage remained constant over time, as did requests for technical assistance. CBOs expressed substantial positive feedback about the MPTES, but felt that it needs more focus on diversity issues, describing real world implementation approaches, and providing guidance on how to adapt the MP to diverse populations.     

‘They’ve invited me into their world’: a focus group with clinicians delivering a behaviour change intervention in a UK contraceptive service

Although teenage conceptions rates in the United Kingdom (UK) have seen a downward trend recently, it remains imperative that contraceptive services for young people continue to improve. To ensure that evidence-based interventions are sustained in clinical practice, it is useful to assess the experiences of those delivering them. This study explores the experiences of sexual health clinicians who were trained to deliver a one-to-one behaviour change intervention aiming to improve contraceptive use in young women. The intervention was set in a UK NHS contraceptive and sexual health service and involved clinicians’ facilitating (within one-to-one consultations) the formation of implementation intentions (or ‘if-then’ plans) that specified when, where and how young women would use contraception. A focus group was conducted with seven clinicians who had delivered the intervention. A thematic analysis of the focus group revealed three overall themes: (1) How the intervention worked in practice; (2) barriers and benefits to delivering the intervention; and (3) positive changes to individual consultation style and wider ‘best practice’ within the clinic. Our findings show that, with support, clinical staff would be in favour of incorporating if-then planning as a strategy to help promote contraceptive adherence in young women.     

Research Report: Antenatal HIV testing from the perspective of pregnant women and health clinic staff in South Africa—implications for pre- and post-test counselling

HIV testing is not routinely available at present in health clinics in Umtata, South Africa. However current statistics indicate that up to 25% of the population may be infected. Such findings imply that HIV testing and counselling should be introduced in health clinics as a means of promoting HIV prevention and reducing the risk of vertical transmission. However this would only be beneficial if staff are prepared to implement it and patients are willing to test. The issues are couched in a background of political activity surrounding HIV that may question approaches to HIV testing and a lack of availability of interventions to prevent mother to infant transmission. Furthermore the infrastructures of counselling training and provision may not be universally available, especially in pressured rural clinics. Therefore, a group of clinic staff and pregnant women, in rural and urban health centres in Umtata, were asked to participate in focus group discussions to elicit attitudes to HIV testing and counselling. In principal the majority of women, particularly in the rural clinic, were willing to have an HIV test, and strongly articulated the desire to test with their partners. Women who were reluctant to test emphasized their fear of receiving the result. The rural women appeared to be far more willing to disclose their HIV status to clinic staff, than urban women. Nevertheless, the discussions illustrated the impact of the stigma surrounding HIV, with clinic staff reporting cases where patients who were suspected to be positive were avoided by health workers. However staff in both clinics were willing to make the effort to implement HIV tests if they were to be made available. Despite the non-availability of rapid testing and interventions to reduce mother to child transmission most women saw advantages to HIV test provision. Pessimism and fear were underlying emotions associated with HIV for both staff and women. The implications for pre- and post-test counselling are discussed.     

HIV/AIDS and immigrant Cape Verdean women: Contextualized perspectives of Cape Verdean community advocates

This research explored Cape Verdean community advocates’ understandings of the structural and social realities that contribute to the increased HIV/AIDS risk of Northeastern U.S.-based immigrant Cape Verdean women. A community perspective informed the analysis of the multi-layered contextual barriers that these advocates identified as limiting the effectiveness of individual-level HIV/AIDS prevention and intervention models. Qualitative content analysis of interviews with nine community advocates revealed several thematic clusters including challenges to (1) perceived institutional and community realities; (2) traditional gender relations; and, (3) traditional ways of thinking. These findings challenge universalist cognitive-behavioral change models of HIV/AIDS prevention and intervention and are critically discussed to better understand the complex realities faced by Cape Verdean immigrant women. A liberatory community psychology perspective framed the research process and contributed to reconceptualizing HIV/AIDS risk as a community problem that requires interventions not simply at the individual and relational levels, but also at the structural level.     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. Four hundred eighty women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message.     

艾滋病揭示的性别不公正

贫困妇女人群中HIV新发感染不成比例上升的现象揭示了社会中的性别不公正,通过美国和肯尼亚的案例说明,预防艾滋病需要认可和促进妇女的人权,减少针对妇女的暴力,并保障妇女的教育,普及艾滋病相关知识.对女性主义进行了重新阐释,并以南非"和平与和解"运动为例指明了新的前进方向.     

Safer Sex Among HIV+ Women: The Role of Relationships

Among 230 HIV+ women in New York City, 105 had been heterosexually active in the last 90 days and 54% of these reported unsafe sex. Contrary to our hypotheses based on relational theory, respondents with steady partners were more likely to have unprotected sex than nonpartnered women. However, among respondents with steady partners, the degree of commitment to the relationship was positively associated with condom use. The only other correlate of unprotected sex was current drug use. Almost all steady partners were aware of the woman's HIV status, and, contrary to our hypothesis, respondents were not more likely to have protected sex with HIV– than HIV+ steady partners. The discussion considers self-in-relation theory, culture, power, and contextualistic behaviorism.     

UNDERSTANDING WOMEN'S RISK FOR HIV INFECTION USING SOCIAL DOMINANCE THEORY AND THE FOUR BASES OF GENDERED POWER

Theoretical models to date have fallen short of accounting for the alarming worldwide rates of HIV infection in women through heterosexual contact. In this article, social dominance theory and the four bases of gendered power—force, resource control, social obligations, and consensual ideologies—are used to organize and explain international research findings on women's risk of contracting HIV from male sexual partners. Research suggests that the four bases of gendered power contribute to women having less power than men in heterosexual relationships, resulting in challenges to preventing HIV transmission from male partners. Social dominance theory also recognizes the intersections among various group-based hierarchies, such as race and class, thereby helping explain why women of color and low-income women are disproportionately affected by HIV. The intergroup focus of social dominance theory points to gender inequality as increasing men's risk of HIV infection as well, and the construct of social dominance orientation helps to explain individual differences in HIV risk behavior. We discuss the ways the current theoretical framework can prove useful in helping to guide future research addressing the connections between power and HIV risk, including exploring mediators and links to other theoretical models. We also discuss the implications the framework has for intervention efforts aimed at reducing HIV rates worldwide, such as supporting efforts at increasing women's representation in hierarchy-enhancing positions, incorporating empowerment issues into current interventions, promoting use of female condoms, and targeting heterosexual men for interventions.     

HIV infection associated post-traumatic stress disorder and post-traumatic growth--a systematic review

The phenomenon of post-traumatic stress has been well documented in the literature as a lasting mental health condition associated with exposure to traumatic life events. The diagnosis and experience of human immunodeficiency virus (HIV) disease may be such a trauma. On the other hand, the phenomenon of post-traumatic growth (PTG) has been described, whereby people show positive mental health growth in the face of such trauma. This systematic review was set out to explore post-traumatic stress disorder (PTSD) and PTG in people with HIV to monitor prevalence, measurement and efficacy of interventions to reduce stress and/or promote growth. Standardised review techniques were used to track reports on both PTSD and PTG. A total of 206 papers were retrieved from the PTSD and HIV searches, and 13 from the PTG and HIV searches. After reviewing the papers for inclusion according to adequacy and relevance criteria and to remove duplicates, 33 PTSD papers and three PTG were available for full coding. Prevalence of PTSD in HIV ranged from 5% to 74%, which were much greater than the 7-10% in the general population. Seven studies showed a relation between trauma and PTSD, while six showed a link between PTSD diagnosis and reduced antiretroviral treatment adherence. Women were more likely to be diagnosed with PTSD. Only three intervention reports were identified that fitted our inclusion criteria. All of these reported on psychological interventions for HIV+?individuals with trauma. The interventions utilised HIV education, training in coping techniques and support groups. Only coping interventions were shown to be effective. PTG was under researched but showed a promising avenue of study. There needs to be harmonised measurement and the evidence base would need strengthening in order to build on the understanding of the impact of PTSD and PTG over the course of HIV disease. There is good evidence to associate HIV diagnosis and experiences during the course of illness as traumatic. PTSD has been shown to be prevalent and there seems to be good evidence to incorporate standardised measures to track the course of the disorder. There is extremely limited evidence that interventions may affect the course of symptom experience. The evidence and insight into PTG show promise but is currently inadequate.     

The effects of stressful life events,coping, and cortisol on HIV infection

What is the role of stress and coping in changes in immunologic and clinical indicators of human immunodeficiency virus disease progression? There is substantial evidence that stressful life events and passive coping strategies, such as denial, may have a detrimental effect on HIV disease progression. Given the harmful effects of stress and passive coping, the author reviews the limited research testing the efficacy of interventions, such as cognitive-behavioral therapies for HIV-infected persons. Finally, in trying to understand psychoimmune relationships in HIV, the evidence is examined for the mediating and direct effects of cortisol, a hormone associated with stress, on HIV disease progression. Delineating the role of psychosocial factors and cortisol on HIV disease progression may aid in the development of new interventions for this devastating disease.     

Offering Support Group Services for Lesbians Living with HIV

In this paper, the authors describe their clinical experiences offering support group services for lesbians living with HIV. Two different group models were used, allowing for comparison of their effectiveness and relevance for this population. One was a closed membership, time-limited group; the other was an open membership, ongoing group. It is hoped that by communicating about the structure, organization, membership, facilitation, process, and content of the support groups, the authors might make it easier for others to initiate supportive interventions for this invisible population of women affected by the HIV epidemic.