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.     

Stigmatizing attitudes of the community towards people living with HIV/AIDS

This research involved an exploratory study in which a questionnaire was used to investigate the personal stigma and perceived community stigma regarding HIV/AIDS in a South African community. Student fieldworkers interviewed a convenient sample of 901 respondents from different races, gender and age groups, and found that respondents tended towards stigmatizing persons with HIV/AIDS. Yet, this degree of stigmatization was significantly less severe than the degree of stigmatization that respondents attributed to the community at large. Altogether 17% of the respondents had high stigmatizing attitudes, while 42% perceived the stigmatization by others in the community to be high. Race group, personal knowledge of someone with HIV, area of residence, gender and age group impacted on the respondents' personal tendency to stigmatize those with HIV/AIDS. The article discusses the difference between the level of personal stigma attached by the respondents and that perceived by them to be attached by the community. Attention is also paid to the possible implications of stigmatizing behaviour patterns and interventions on a community level. Copyright © 2006 John Wiley & Sons, Ltd.     

HIV/AIDS Awareness of In—School Adolescents in Nigeria: Implications for Adolescence Sexuality

This study investigated HIV/AIDS awareness of in-school adolescents in Nigeria to determine their risk for contracting HIV/AIDS. A total of 892 purposively selected adolescents (mean age = 16. 5 years; SD = 5. 2; males = 492; females = 400) participated in the study. The participants responded to the HIV/AIDS Awareness Inventory (HAAI). The questions on the survey included the following aspects: meaning of HIV/AIDS; prevalence; mode of transmission; consequences and prevention. Differences in gender, age, school location and father's educational background in understanding HIV risk were examined. A group means comparison procedure revealed a significant difference in HIV awareness by gender, age, school location and father's educational background. Female adolescents, the older adolescents, those living in urban centres and those whose fathers are literate had higher HIV/AIDS awareness than their counterparts from rural areas. Nigerian adolescents need education regarding HIV/AIDS awareness.     

Culture at the Heart of Coping with HIV/AIDS

This study explored the manner in which a South African informal community coped with living with HIV/AIDS by relying on existing assets and local resources. A case study research design applying participatory reflection and action principles was used. Focus group/workshop sessions were conducted with ten selected female educators from the community. In addition, individual interviews with stakeholders and other members of the community (n=31, males=6, females=25) were also carried out. Supplemental data collection methods included observation, visual techniques, field notes and a reflective journal. The study found that community members coped with HIV/AIDS by relying on culture and family, faith in God, religiosity and prayer. Inner strength, hope, optimism and expectancy appeared to be key resources for informal settlement residents.     

Thai Women: Meditation as a Way to Cope with AIDS

Mental-health professionals often ignore the spirituality and religious beliefs that can aid a person's ability to cope with a life-threatening illness such as HIV/AIDS. As the physical body succumbs to the disease, people with HIV/AIDS search for ways to lower their stress, regain control of their health, attain some peace of mind, and hope to prolong their survival. This sense of personal control is important when dealing with chronic or terminal illness. The purpose of this study was to explore the role of meditation in Thai Buddhist women who are infected with HIV/AIDS. Interviews were conducted with 26 Thai women living in the northern part of Thailand known as Chiang Mai, where the incidence of AIDS is the highest in Southeast Asia. Although the scope of this study is limited and not generalizable, it supports the idea that a spiritual approach to healing, in conjunction with conventional medical treatment, is a source of great comfort to persons living with HIV/AIDS and may influence immune functioning.     

HIV-related stigma among market workers in China.

HIV-related stigma was examined among 209 employees and owners of stalls in 5 markets in an eastern coastal city in China. Of the participants 53% were women and 47% were men; 100% were Han. Ages ranged from 18 to 49 years (M=35, SD=8.1). Half of the participants believed that punishment was an appropriate response toward those living with HIV (50%). Over half (56%) were unwilling to be friends with infected individuals. The majority thought that those living with HIV should be isolated (73%). They agreed that persons living with HIV should not take care of other people's children (85%). Punishing beliefs toward persons living with HIV were related to being male, older, married, less educated, and unwilling to be tested for HIV.     

Daily life with early orphanhood from HIV/AIDS: An exploratory study

This study explored the everyday lived life by South African early adolescents orphaned by HIV/AIDS. Informants were ten early adolescents (age range 12 to 14 years; females?=?6; males?=?4) from a low socioeconomic status neighbourhood of Johannesburg. The adolescents completed autobiographical essays and in-depth individual interviews on their quality of life in the school, home, and community. Thematic analysis of the data revealed the early adolescents, orphaned due to HIV/AIDS, to experience extreme sadness, anxiety, and fear. Their sense of emotional distress was compounded by living in material and relational poverty, with frequent exposure to bullying at school, and crime in their neighbourhood. Integrated psycho-social interventions addressing both material and relational poverty might enhance the physical and psycho-social well-being of adolescents with orphanhood from HIV/AIDS.     

Spiritual Wellness for Clients With HIV/AIDS: Review of Counseling Issues

The epidemic of HIV/AIDS has resulted in an increasing population of individuals in need of counseling services: persons living with AIDS, as well as family, friends, and caregivers. The relationship between HIV/AIDS clients' counseling and spiritual issues is demonstrated by a review of salient literature. Three broad themes are used: terminal illness issues such as post-death existence and existential meaning of life, religious disenfranchisement from society or families of origin, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included.     

Attitudes Toward People Living With HIV/AIDS: A Model of Attitudes to Illness1

This study examined attitudes toward people living with HIV/AIDS within a sample of 220 young men and women. As predicted, a multiple regression analysis revealed that the fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. Attitudes toward homosexuality were also a significant predictor of attitudes toward people living with HIV/AIDS among women, who generally have a low risk of contracting the disease in Western societies. These results indicate that attitudes toward people with a serious illness may be strongly related to the perceived risk of contracting the disease.     

Health-related quality of life among people living with hiv disease in small communities and rural areas

Abstract

While many studies have examined the life quality of HIV-infected persons in large metropolitan areas, few studies have investigated quality of life issues among persons living with HIV disease in America's small and rural communities. In the present study, 78 people living with HIV/AIDS in small and rural communities (i.e., populations <25,000) reported on their health-related quality of life. Many respondents reported decreased social, emotional, functional, and physical well-being. Results revealed that participants' emotional well-being and the quality of their relationship with their doctor were related to their overall quality of life. The majority of participants (73%) expressed interest in participating in a telephone-linked support group involving other people living with HIV designed to improve quality of life.     

Responsibility judgments and responses to people living with AIDS in China: testing an attributional perspective

With one in five individuals in the world living in China, there is an urgent need for HIV prevention and understanding HIV/AIDS stigma in China. This study applies an attributional analysis to Chinese students' responses to AIDS, examining effects of attributions of causal controllability for HIV infection on reactions to people living with HIV/AIDS. Students (n = 309) read one of two scenarios describing an AIDS patient and manipulating controllability of AIDS onset. Controllability of AIDS onset contributed to responsibility judgments, less positive affect, and lower desires to personally interact with the patient. Responsibility judgments predicted interaction wishes directly and indirectly through positive affect. Results provide support for Weiner's interpersonal attributional model. Implications for responses to AIDS in China are discussed.     

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.     

Perceived importance of services for persons with AIDS: recipient, family, caregiver, and public differences

596 adults from a moderately sized community in central California were divided into four groups (person with HIV or AIDS, friend or relative, caregiver or service provider for such a person, or member of the general public) and completed a schedule assessing their perceptions of the importance of 36 items related to potential services for persons with HIV or AIDS. Factor analysis of these items yielded in six constructs (Counseling, Medical, Assistance, Homecare, Adjunct/Auxiliary, and Nontraditional), accounting for 65.0% of the variance. Over-all, regardless of group membership, Medical Services were perceived as of highest importance, but differences were found across all groups regarding Assistance Services and Nontraditional Services for persons with AIDS. Implications and suggestions for research are discussed.     

Finding Voice: The Photovoice Method of Data Collection in HIV and AIDS-Related Research

This study examined the efficacy of photovoice as a research technique to explore the lives of children and families living in the context of HIV and AIDS. Participants were volunteers at a Day Care and Support Centre (n=18), and members of a community support group consisting of People Living with AIDS (n=5). The findings revealed that the photovoice method is particularly useful for dealing with the ‘unspoken’ lived experience of children and families.     

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.     

Older Adolescents’ Self-Determined Motivations to Disclose Their HIV Status

Disclosure of HIV status is an important topic for youth living with HIV/AIDS, yet theoretical frameworks for understanding HIV disclosure motivations have been poorly applied. Self-determination theory (SDT) proposes that people are at optimal functioning when they are engaging in activities that are interesting and enlivening. This study utilized SDT to understand young adults’ motivations to disclose their HIV status. Interviews and observations were conducted with nine youth aged 17–19 and two adult staff. Results indicate that SDT is useful for understanding types of motivation (i.e., amotivation, controlled, and autonomous motivation) to disclose. Amotivation was the most common type of motivation, and came from two recursive sources: fear of stigma and previous experiences of others disclosing without their consent. Controlled motivation to disclose occurred when participants were motivated to disclose because of reasons related to other people, rather than internal or personal reasons, and included the reasons of wanting to gain a closer relationship, reciprocate a shared secret, for psychological or emotional relief, and for attention. Autonomous motivation included two themes: the life perspective that “Having HIV is just part of who I am,” and valuing educating others because education was perceived as important and beneficial to others. This study extends SDT into the domain of HIV disclosure in older adolescents. People providing guidance and support to older adolescents with HIV/AIDS can use SDT to understand different motivations to disclose.     

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.     

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.