The Impacts of the HIV/AIDS Pandemic and Socioeconomic Development on the Living Arrangements of Older Persons in Sub-Saharan Africa: A Country-Level Analysis

This study investigates whether socioeconomic development and the HIV/AIDS pandemic are associated with living arrangement patterns in older persons in 23 sub-Saharan African countries. Country-level aggregate data were taken from previous household surveys and information provided by the United Nations, the World Bank, and the World Health Organization. Results showed that 13.5% of older persons (aged 60 years or over) were living with grandchildren but not adult children (i.e., skipped generation households). Countries higher in HIV/AIDS prevalence had more skipped generation households, and also more older persons living with spouse only and fewer older persons living with other relatives. Countries with higher socioeconomic development had fewer older persons living with children younger than 25 years old and more living with spouse only or with other relatives and unrelated persons. The pandemic and socioeconomic development combine to accelerate the breakdown of the extended family structure so that older persons are less and less likely to reside with, and to receive support from, their children.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.     

Correlates of household smoking bans in low-income families of children with and without asthma

Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

CONSIDERATIONS FOR PREVENTION OF HIV INFECTION AMONG HISPANIC WOMEN

Data on the characteristics of individuals diagnosed with AIDS show that Hispanic women, men, and children are overrepresented. In order to effectively reduce the risk of HIV infection in Hispanic communities, prevention programs must take into account characteristics of Hispanic populations that differentiate them from the general population and that reflect the social and economic contexts that shape the realities of Hispanic women's lives.
This article presents an analysis of the AIDS epidemic, taking into consideration the major factors that will need to be addressed in designing programs to prevent HIV infection in Hispanic communities. First, characteristics of the AIDS epidemic among Hispanics are discussed. Second, demographic and psychological characteristics of Hispanic women and their relevance to AIDS prevention efforts are presented. Third, recommendations for research and prevention programs are made. While the specific topic of concern here is AIDS risk reduction, the approach illustrates the types of questions and factors that need to be considered in developing prevention approaches for any health problem in any ethnic and racial minority communities.     

Predictors of Depressive Symptoms Among Children Affected by HIV in Rural China: A 3-Year Longitudinal Study

The current study was designed to examine the trend of depression among children affected by HIV (n = 1,221) in rural China over a period of 3 years and to explore baseline psychosocial factors that can predict depressive symptoms at 1- and 2-year follow-ups. Baseline depression score, trusting relationship with caregivers, perceived public stigma against children affected by HIV, and future expectation at baseline positively predicted the 1-year follow-up depression, while children’ self-report health status, self-esteem, and perceived social support negatively predicted depression at 1-year follow-up survey. Depression and self-report health status at baseline significantly predicted depression at the 2-year follow-up. The data in the current study suggested that depressive symptoms were chronic or recurring among some children affected by HIV/AIDS. The findings also underscore the importance of early identification, early intervention, and ongoing counseling for mental health problems among children affected by HIV/AIDS. Future psychological support programs need to target both mental health symptoms and resilient factors that will help these children to cope with adverse life events associated with HIV/AIDS.     

Structural and Community Change Outcomes of the Connect‐to‐Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention,Testing, and Medical Care

Connect to Protect (C2P), a 10‐year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV‐related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions’ context and operation that facilitated and undermined their ability to achieve structural change and build communities’ capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS‐competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV‐risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions’ ability to successfully implement HIV‐related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS‐competent community.     

Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV

Youth living with HIV (YLH) experience multiple disease‐related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual‐ and neighborhood‐level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood‐specific data were compiled from the 2010 U.S. Census Bureau and matched with individual‐level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non‐Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross‐level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.     

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.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey.

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.     

The association between body image and smoking cessation among individuals living with HIV/AIDS

Lower smoking cessation rates are associated with body image concerns in the general population. This relationship is particularly important to study in individuals living with HIV/AIDS due to alarmingly high smoking rates and considerable bodily changes experienced with HIV disease progression and treatment. The association between body image and smoking cessation rates was examined among individuals living with HIV/AIDS participating in a smoking cessation intervention. Body image concerns were significantly associated with depression, anxiety, stress, and social support, all variables known to affect cessation rates. However, reduced quit rates were found among individuals reporting elevated and low levels of body image concerns at the end of treatment. These findings suggest a unique relationship between smoking and body image among individuals living with HIV/AIDS. Further research is needed to examine these effects and whether moderate levels of body image concerns in this population reflect realistic body perceptions associated with positive mental health.     

Cross-sectional and Longitudinal associations in coping strategies and physical health outcomes among HIV-Positive youth

This study assessed whether coping styles had an influence on physical health outcomes either concurrently or longitudinally in a sample of HIV-positive youth. Coping styles were characterized as positive, passive, depressive withdrawal, and escapist. A cross-sectional latent variable analysis (N = 279) assessed associations among environmental stress, self-esteem, social support, coping styles, AIDS symptoms, and CD4 count. A more restricted longitudinal analysis (N = 174) tested associations among earlier environmental stress, self-esteem, coping styles, and AIDS symptoms at follow-up. CD4 count was not associated with coping styles in the cross-sectional analysis. Concurrent AIDS symptoms were significantly predicted by depressive withdrawal and environmental stress. A passive coping style modestly predicted more AIDS symptoms longitudinally. Correlates of perceived health and well-being of persons with HIV/AIDS are important to investigate in addition to more objective measures such as CD4 count that may not be amenable to change through coping style interventions alone.     

Impact of a Father Figure’s Presence in the Household on Children’s Psychiatric Diagnoses and Functioning in Families at High Risk for Depression

The consequences of living in single-parent households on children’s wellbeing are well documented, but less is known about the impact of living in single-mother households among children with high familial risk for depression. Utilizing data from an ongoing three-generation study of high-risk families, this preliminary study examined a sample of 161 grandchildren of probands diagnosed with major depressive disorder, comparing those in single-parent households to those in dual-parent households with household status defined as the full-time presence of a resident male in the home. High-risk children were compared across households in terms of psychiatric diagnoses (measured by Schedule for Affective Disorders and Schizophrenia for School-Age Children; K-SADS-PL) and global functioning (assessed by Global Assessment Scale, child version; C-GAS). Results indicated that high-risk children in single-parent households had 4.7 times greater odds for developing a mood disorder and had significantly lower mean C-GAS scores (p = 0.01) compared to those in dual-parent households. Differences remained significant when controlling for household income, child’s age, and either parent’s depression status. There were no significant differences between high-risk children across households when household status was instead defined as legal marital status. This study has several limitations: sample size was small, probands were recruited from a clinical population, and participants had not passed completely through the period of risk for adult psychiatric disorders. These findings point towards the importance of identifying and closely monitoring children at risk for depression, particularly if they reside in households without a resident father figure.     

Parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China

The objective of this study was to examine the relationship between parental loss, trusting relationship with current caregivers, and psychosocial adjustment among children affected by AIDS in China. In this study, cross-sectional data were collected from 755 AIDS orphans (296 double orphans and 459 single orphans), 466 vulnerable children living with HIV-infected parents, and 404 comparison children in China. The trusting relationship with current caregivers was measured with a 15-item scale (Cronbach's α?=?0.84) modified from the Trusting Relationship Questionnaire developed by Mustillo et al. in 2005 (Quality of relationships between youth and community service providers: Reliability and validity of the trusting relationship questionnaire. Journal of Child and Family Studies, 14, 577-590). The psychosocial measures include rule compliance/acting out, anxiety/withdrawal, peer social skills, school interest, depressive symptoms, loneliness, self-esteem, future expectation, hopefulness about future, and perceived control over the future. Group mean comparisons using analysis of variance suggested a significant association (p?相似文献   

Community-Based Collaboration in Support of Older Persons

This study describes the processes for community-based collaboration in support of the older person living in the world of HIV/AIDS in South Africa. Secondary data from study from 333 older persons (> 60 years) and 28 leaders of community agencies of and for health and wellbeing were thematically analyzed. Findings suggest that older persons are resources in community partnership for ameliorating the impact of HIV and AIDS. This would be the case even as the older people may be living with HIV or AIDS.     

Predictors of the International HIV–AIDS INGO Network Over Time

The HIV–AIDS epidemic is one of the most challenging and significant health crises facing the world today. In order to cope with its complexities, the United Nations and World Health Organization have increasingly relied upon the resources offered by networks of HIV–AIDS nongovernmental organizations (NGOs). The research reported here uses evolutionary theory to predict the patterns of alliances and collaborations within the HIV–AIDS International Nongovernmental Organizations (INGO) network. The hypotheses are tested using 8 years of data from the Yearbook of International Organizations. The results showed that geographic proximity and common ties with intergovernmental organizations (IGOs) predict the pattern of alliances among HIV–AIDS INGOs. The best predictor of such alliances, however, is past relationships among these organizations.     

“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.     

The Complexity of Women’s Lives: Decision-making about Maternal HIV Disclosure

HIV/AIDS has reached epidemic levels in Washington, D.C. and mothers living with HIV increasingly have to make difficult decisions about whether or not to disclose their HIV status to their children. Focus groups were conducted with a sample of women (N = 15) living in Washington, D.C. to investigate maternal decision-making about HIV disclosure, the factors that influenced disclosure, challenges to disclosure, and children’s reactions to disclosure. This was a first step towards the larger goal of developing a culturally sensitive disclosure decision-making intervention. Participants were asked to identify elements to include in such an intervention. We also quantitatively examined participants’ psychosocial outcomes of depression, perceived social support, quality of life, and parenting challenges. Our preliminary findings showed that most participants experienced intense emotional distress after receiving an HIV diagnosis and this distress prevented them from disclosing their HIV status to family members and children. Several specific parenting concerns (e.g., age and gender of child, relationship to child, and number of children) influenced their decisions to disclose. All participants reported that HIV related stigma and discrimination as significant disclosure-related challenges. Health providers were not always perceived as being able to support participants in making a decision about whether or not to disclose their HIV status to their children.