Counseling Caregivers of Families Affected by HIV/AIDS: The Use of Narrative Therapy

This article proposes the use of Narrative Therapy with family caregivers of family members diagnosed with HIV/AIDS. The authors identify the reasons for using Narrative Therapy with African family caregivers who have relocated to the United States of America. The tenets of Narrative Therapy are outlined, and a case illustration is provided to show how Narrative Therapy can be implemented. In this case study, the client moves from a state of helplessness and hopelessness to being able to regain control of her life and improve the care of her sister. She was able to re-write her story: from feeling incompetent to a position of strength. Although Narrative Therapy was used successfully with an African family caregiver within the USA, the authors assert that the interventions have the potential to be used as effectively with those clients living in Africa, provided counselors are sensitive to cultural differences that will affect their practice.     

Parentification and Maternal HIV Infection: Beneficial Role or Pathological Burden?

Parentification, along with parenting and child adjustment, were examined in 23 9-through 16-year-old youth from families affected by maternal HIV infection and 20 same-age peers whose mothers were not infected. Children whose mothers were HIV-positive reported to more often engage in parental role behaviors, relative to children of HIV-negative mothers. This difference remained even after controlling for the effects of current drug use, number of adults per child in the household, and marital status. Findings revealed a beneficial relationship between parentification and both child adjustment and parenting, particularly among families affected by maternal HIV infection. When relationships were examined separately by HIV status, the pattern of results suggested that parentification, which involves increased emotional closeness, rather than role-related tasks, which may involve increased responsibility of household maintenance, seems to foster an association with concurrent positive parenting and child adjustment among families coping with HIV/AIDS. Directions for future research, including the need for methodological advances in the field are discussed.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Psychosocial Well-being of Children in HIV/AIDS-Affected Families in Southwest China: A Qualitative Study

We investigated the psychosocial well-being of children in HIV/AIDS-affected families in rural China from the child’s and caregiver’s perspectives. Semi-structured interviews were conducted among children living in HIV/AIDS-affected families (n = 16), their caregivers (n = 16) and key community informants (n = 5). Our findings showed that all of the children relied heavily on caregivers and peers to gain psychological support. Children’s psychosocial problems included fear, anxiety, grief, and loss of self-esteem and confidence. Stigma towards children existed, including isolation, ignorance and rejection. Our study illustrates that HIV/AIDS has impacted negatively on the psychosocial well-being of children. These findings can be used as preliminary data supporting more researches to profoundly explore the psychosocial impact of HIV/AIDS on children and appropriately indicate the need for interventions.     

大学生对艾滋病的乐观偏差

研究采用问卷法,以北京6所高校的278名被试为样本,考察了大学生对艾滋病的乐观偏差。结果表明,被试对艾滋病的感染和治愈存在着双重乐观偏差;艾滋病知识掌握程度既与感染艾滋病的乐观偏差无显著相关,也与治愈艾滋病的乐观偏差无显著相关。     

护理扩展培训在艾滋病干预模式中的探讨

新疆艾滋病形势严峻,艾滋病重点疫区的护理人员普遍存在着对艾滋病知识的缺乏,对艾滋病患者持有歧视、恐惧的心理及缺乏基本的防护知识等现状,艾滋病护理扩展培训项目的实施,通过对护理人员进行的艾滋病知识培训,对艾滋病干预模式进行了有益的探索和实践。     

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.     

Maternal Distress and Parenting in the Context of Cumulative Disadvantage

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This article presents an emergent conceptual model of the features and links between cumulative disadvantage, maternal distress, and parenting practices in low‐income families in which parental incarceration has occurred. The model emerged from the integration of extant conceptual and empirical research with grounded theory analysis of longitudinal ethnographic data from Welfare, Children, and Families: A Three‐City Study. Fourteen exemplar family cases were used in the analysis. Results indicated that mothers in these families experienced life in the context of cumulative disadvantage, reporting a cascade of difficulties characterized by neighborhood worries, provider concerns, bureaucratic difficulties, violent intimate relationships, and the inability to meet children's needs. Mothers, however, also had an intense desire to protect their children, and to make up for past mistakes. Although, in response to high levels of maternal distress and disadvantage, most mothers exhibited harsh discipline of their children, some mothers transformed their distress by advocating for their children under difficult circumstances. Women's use of harsh discipline and advocacy was not necessarily an “either/or” phenomenon as half of the mothers included in our analysis exhibited both harsh discipline and care/advocacy behaviors. Maternal distress characterized by substance use, while connected to harsh disciplinary behavior, did not preclude mothers engaging in positive parenting behaviors.     

Researching HIV/AIDS,Education & Childhood in the African Context

This article offers a reflective review of 12 articles and 4 brief reports included in this special issue of the International Journal of Psychology in Africa with the theme, ‘HIV/AIDS, education and childhood in the African context’. Muthukrishna and Ramsuran (2007) have emphasised that the consequences of HIV/AIDS can be far-reaching for children and young people resulting in unequal life chances. It is thus fitting that this special issue should be edited by them in KwaZulu-Natal, South Africa, in the country (and province) with the highest levels of incidence of HIV/AIDS in Africa. In this article I offer a commentary on how the interpretive lenses of the authors who are located in various disciplines provide a theorised understanding of what shapes knowledge constructions in situated African contexts.     

山西省艾滋病防治政策分析

阐述了艾滋病在山西省流行的现状,探讨了艾滋病引发的社会问题,分析了艾滋病防治条例、四免一关怀政策以及艾滋病自愿咨询与检测制度的执行情况以及在执行过程中所存在的主要问题,研究了山西省艾滋病防治工作相关基金的来源和使用情况,针对山西省在艾滋病防治工作中存在的问题,提出了艾滋病防治工作与社区工作相结合的建议。     

特殊人群艾滋病行为干预的思考

艾滋病直接危害人类的健康,也对社会、政治、经济及人文伦理道德产生重大的负面影响。对艾滋病病人犯罪的监管问题,公安干警的职业暴露问题,都是目前司法实践中遇到的新课题。加强艾滋病患者违法监管,对特殊群体进行行为干预,是司法结构急待解决问题。     

An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.     

Subverting Culture: Promoting HIV/AIDS Prevention Among Puerto Rican and Dominican Women

This article discusses the challenges faced by researchers and interventionists when attempting to promote change in social norms and normative beliefs that promote HIV/AIDS risk-related behaviors among Puerto Rican and Dominican women. The article focuses on the role of culture in HIV/AIDS prevention with women by analyzing the sociohistorical context of some cultural beliefs and by illustrating the tension between risk-related and protective cultural beliefs in research conducted by the authors with women in both New York and Puerto Rico. The authors propose that promoting changes in sex-related social norms and normative beliefs might be constructed as a subversive act and present the challenge this analysis poses for community psychology. They conclude that this conceptualization might be construed as subversive because rather than idealizing culture, it promotes changes that respect diversity within the culture and foster participation in the development of new cultural values, beliefs and norms.     

The Relation of Social Capital to Child Psychosocial Adjustment Difficulties: The Role of Positive Parenting and Neighborhood Dangerousness

Substantial research attention has focused on the psychosocial adjustment problems of children and adolescents residing in disadvantaged neighborhoods. However, less attention has been directed to neighborhood factors within disadvantaged neighborhoods that may facilitate child psychosocial adjustment. An expanded model, assessing how social capital, neighborhood dangerousness, and positive parenting relate to child psychosocial adjustment difficulties, was estimated using structural equation modeling (Lisrel 8.3). Participants included 130 African American mothers and their children (mean age = 12.9 years) residing in inner city New Orleans, LA. The model examined 3 avenues through which social capital (e.g., support, neighborhood cohesion) may relate to fewer child psychosocial adjustment difficulties: a direct relation; through its relation to positive parenting; and through its relation to neighborhood dangerousness. Results indicate that social capital related to child psychosocial adjustment difficulties through positive parenting and neighborhood dangerousness, but not directly. Overall, the proposed model fit the observed data reasonably well. The results suggest that social capital in disadvantaged neighborhoods is important in indirectly facilitating child psychosocial adjustment and should be incorporated into assessment and intervention practices.     

HIV/AIDS in scottish prisons: Attitudes of staff and prisoners

Abstract

Prison is commonly regarded as a high risk environment for the transmission of HIV/AIDS. Five hundred and fifty-nine prisoners and 591 prison staff sampled from 8 Scottish prisons completed questionnaires concerning attitudes towards various issues of HIVIAIDS. A majority of prisoners and prison staff expressed liberal attitudes with respect to HIV/AIDS. For both staff and prisoners, the most liberal responses were to items dealing with personal and social contact with people with HIVIAIDS. A majority of prisoners and prison staff expressed conservative attitudes in relation to screening of individuals for HIV. With regard to differences between prisoners and prison staff, prisoners were more supportive than prison staff of the provision of free condoms to homosexuals and free condoms and syringes to intravenous drug users, and the provision of free medical care to both groups in the case of AIDS. Among the prisoner sample, intravenous drug users, in comparison to non-users, were found to be more positive in their attitudes toward HIVIAIDS on a wide range of issues. The implications of the study for health psychology are discussed with regard to prisoner and prison staff educational needs and prisoner management.     

School adjustment of adolescents affected by HIV and AIDS: A case study

The study examined the school adjustment of South African adolescents affected by HIV and AIDS . Participants were a convenient sample of 60 adolescents from a secondary school in a major South African city (females = 73 .33%, 50% affected by HIV and AIDS, grade 8 = 40%, grade 9 = 30%, grade 10 = 30%, age range = 16–18 years) . Data on their personal functioning were gathered using the Beck Youth Inventory^TM and the Enhanced School Support Inventory (ESSI) . The data analysis comprised between-group and within-group comparisons, using the t-test statistic . Findings suggest that adolescents affected by HIV and AIDS had significantly lower psychological and behavioural functioning than their typical other peers . Results also show that these affected learners had lower school adjustment than their typical peers . The schools environment can support comprehensive interventions to addresses psychosocial vulnerability among adolescents affected by HIV and AIDS .     

Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders

SUMMARY

Social discourses regarding gender are responsible for molding people's cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender socialization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people.

This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area.

Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis confirmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies.

Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities.