Predictors of Disclosure of Maternal HIV Status by Caregivers to their Children in an Inner-City Community in the United States

Disclosure of HIV status to children is a challenge parents living with HIV face. To evaluate predictors of maternal HIV disclosure in a low-income clinic in the U.S. that serves an African American, Hispanic and immigrant population with high HIV prevalence, 172 caregivers with 608 children completed a standardized survey. 

Caregivers were 93% female, 84% biological mothers, and 34% foreign born. Sixty-two (36 %) caregivers had at least one disclosed child, 42 of whom also had other nondisclosed children. Of all children, 581 (96%) were uninfected and 181 (30 %) were disclosed. Caregiver's U.S. birth, child's age, and increased HIV-stigma perception by caregiver predicted disclosure. Children were more often disclosed if their caregiver was born in the U.S. or reported higher HIV-related stigma. 

These findings suggest that complex family context may complicate disclosure, particularly among immigrants.

Purchase full article at:   http://goo.gl/eh7v2d

By:  Abdulrahman R1, Stuard E2, Vachon ME2, Nicholas C2, Neugebauer R3, Hagmann SH2, Purswani MU2.

• 1Columbia University, Mailman School of Public Health, Environmental Health Department, New York, NY, USA. rozanabdul@gmail.com.
• 2Bronx-Lebanon Hospital Center, Department of Pediatrics, Bronx, NY, USA.
• 3Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA. 
• AIDS Behav. 2016 Mar 24. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Prevention & Care of Pediatric HIV Infection in Ouagadougou, Burkina Faso: Knowledge, Attitudes & Practices of the Caregivers

Background

The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso.

Methods

We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows:

those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment.

Results

A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done.

Conclusions

This study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care.

Caregivers’ knowledge, attitudes and perceptions in Ouagadougou, Burkina Faso, 2011

	Total N = 37 100 %	Group 1 N = 11 100 %	Group 2 N = 4 100 %	Group 3 N = 5 100 %	Group 4 N = 17 100 %	Groups 1 + 2 + 3 N = 20 100 %	P-value (Group 1 + 2 + 3 vs Group 4)
Caregiver’s knowledge of existing interventions to prevent MTCT of HIV
Yes	30 (81)	7 (64)	4 (100)	3 (60)	16 (94)	14 (70)	0.16
No	1 (3)	0 (0)	0 (0)	1 (20)	0 (0)	1 (5)
No response	6 (16)	4 (36)	0 (0)	1 (20)	1 (6)	5 (25)
Caregiver’s knowledge regarding existing methods of infant HIV diagnosis
Yes	32 (86)	8 (73)	4 (100)	5 (100)	15 (88)	17 (85)	0.77
No	5 (14)	3 (27)	0 (0)	0 (0)	2 (12)	3 (15)
Caregiver’s knowledge regarding existing treatment of HIV-infected infants
Yes	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)		Not applicable
No	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Caregiver’s attitude regarding the practice of their child systematic HIV testing
For	31 (84)	11 (100)	3 (75)	4 (80)	13 (76)	18 (90)	0.26
Against	6 (16)	0 (0)	1 (25)	1 (20)	4 (24)	2 (10)
Caregiver’s attitude regarding the antiretroviral treatment of HIV-infected children
For	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)	20 (100)	Not applicable
Against	0 (0)	0 (0)	0 (0)	0 (0.0)	0 (0.0)	0 (0)
Parent’s consent needed for child HIV-test
Yes	24 (65)	8 (73)	3 (75)	4 (80)	9 (53)	15 (75)	0.16
No	13 (35)	3 (27)	1 (25)	1 (20)	8 (47)	5 (25)
Parent’s consent needed for child treatment
Yes	11 (30)	6 (55)	0 (0)	1 (20)	4 (24)	7 (35)	0.25
No	24 (65)	4 (36)	3 (75)	4 (80)	13 (76)	11 (55)
No response	2 (5)	1 (9)	1 (25)	0 (0)	0 (0)	2 (10)

Group 1: caregivers of HIV-infected child currently treated with antiretroviral therapy

Group 2: caregivers of HIV-infected child not yet initiated on antiretroviral therapy

Group 3: caregivers waiting for their child’s HIV post-test result

Group 4: caregivers attending paediatric ward, with an unknown HIV child status

Vs versus

Full article at:   http://goo.gl/1Dwg43

By:  Malik Coulibaly, Elisabeth Thio, Caroline Yonaba, Sylvie Ouédraogo, Nicolas Meda, Fla Kouéta, Désiré Lucien Dahourou, Angèle Kalmogho, Mady Gansonré, Diarra Yé, Ludovic Kam, Valériane Leroy, and for the MONOD Study Group*

Projet MONOD, ANRS 12206, Centre de Recherche Internationale pour la Santé, 09 BP 168 Ouagadougou, Burkina Faso

Centre Muraz, Bobo Dioulasso, Burkina Faso

CHU Charles De Gaules, Service de Pédiatrie médicale, Ouagadougou, Burkina Faso

CHU Yalgado Ouédraogo, Service de Pédiatrie, Ouagadougou, Burkina Faso

Inserm U1219, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France

Inserm U1027 Université Paul Sabatier, Toulouse 3, Toulouse, France

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

'When You Visit a Man You Should Prepare Yourself': Male Community Care Worker Approaches to Working with Men Living with HIV in Cape Town, South Africa

Caring is typically constructed as a feminised practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regards to gendered constructions of caring. 

Using semi-structured interviews and observational home visits, this study explored the techniques that community care workers employ when working with male clients. The empirical analysis draws on the perspectives of eight care workers and three of their male clients from the Cape Town area. 

Interviews reveal how care workers and clients perform and negotiate masculinities as they navigate hegemonic masculine norms that require men to act tough, suppress emotions and deny weakness and sickness. Both parties bump up against ideals of what it means to be a man as they strive to provide care and receive support. Community care workers avoid rupturing client performances of hegemonic masculinities which inhibit confession and support. To do this, they use techniques of indirectly broaching sensitive subjects, acting in a friendly way and being clear about the intention of their work.

Purchase full article at:   http://goo.gl/9OQKL2

By:  Gittings L1.

• 1 AIDS and Society Research Unit (ASRU), Centre for Social Science Research , The University of Cape Town , Cape Town , South Africa. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Tensions in Communication between Children on Antiretroviral Therapy and Their Caregivers: A Qualitative Study in Jinja District, Uganda

Introduction

HIV treatment and disclosure guidelines emphasize the importance of communicating diagnosis and treatment to infected children in ways that are appropriate to children’s developmental stage and age. Minimal attention, however, has been given to communication challenges confronted by HIV-infected children and their caregivers. This study examined the tensions between children and their caregivers arising from differing perspectives regarding when and what to communicate about antiretroviral therapy (ART).

Methods

This qualitative study was conducted between November 2011 and December 2012 and involved 29 HIV-infected children aged 8–17 years on ART and their caregivers. Data were collected through observations and in-depth interviews, which took place in homes, treatment centres and post-test clubs. Children and caregivers were sampled from among the 394 HIV-infected children and (their) 393 caregivers who participated in the cross-sectional survey that preceded the qualitative study. ATLAS.ti. Version 7 was used in the management of the qualitative data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis.

Results

While the children felt that they were mature enough to know what they were suffering and what the medications were for, the caregivers wanted to delay discussions relating to the children’s HIV diagnosis and medication until they felt that the children were mature enough to deal with the information and keep it a secret and this caused a lot of tension. The children employed different tactics including refusing to take the medicines, to find out what they were suffering from and what the medications were for. Children also had their own ideas about when, where and with whom to discuss their HIV condition, ideas that did not necessarily coincide with those of their caregivers, resulting in tensions.

Conclusions

Guidelines should take into consideration differing perceptions of maturity when recommending ages at which caregivers should communicate with their children about diagnosis and ART. Health care providers should also encourage caregivers to recognize and respect children’s efforts to learn about and manage their condition. Children’s questions and expressions of feelings should be treated as openings for communication on these issues.

Summary of the topics in the in-depth interview guide.

TOPICS	SUB-TOPICS
Experiences considered most important in the life of the child	Schooling/lack of schooling experiences; a typical week of schooling; vacation/holiday-what they do, who they visit; involvement in social events e.g. sports, drama, post-test clubs, relations with peers; whom they confide in when they have good or bad news.
Socio-demographic information	Age, birth/parents, education status, residence i.e. who the child lives with/family relations, relationship to caregiver, employment of caregiver, living conditions, number of siblings.
Health & medicine experiences	Why and how often they go to the treatment centres; who escorts them; what takes place when they go; what medicines they are given and how often they take them; how long they have been taking the medicines; where they keep the medicines; who helps them to take the medicine; who they talk to about the medicine at home, school, neighbourhood; what they talk about; who else at home takes similar medicines; what they understand by the need to be on lifelong/daily medication
Learning about status/experiences of disclosure	Reasons they had been given for taking daily medicines; who told them; their experiences and reactions when they learnt reasons for taking daily medicines; how they came to know the illness/health condition for which they took daily medicines; who told them; what exactly they were told; how they were told; age at which they were told; their experiences/reactions when they were told about their illness; what they understand by having illness.
Communication about illness and treatment in different social spaces	People who knew about their illness/health and medicines at home, school, in the neighborhood, and how they came to know; people they had told about their health and medicines; reasons for telling such people; people’s reactions when they were told; who they normally communicated with about their illness and treatment and where; who they think deserved to know about their illness and why; what they liked/disliked to hear about their health and medicines; questions/challenges of being on daily medicines; whom they talk to about these challenges; how they could be supported to live on daily medicines.

Full article at:   http://goo.gl/0ZWizF

By:  Phoebe Kajubi,1,* Susan Reynolds Whyte,#2 David Kyaddondo,#1 and Anne Ruhweza Katahoire#1

David Joseph Diemert, Editor

¹Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda

²Department of Anthropology, University of Copenhagen, Copenhagen, Denmark

The George Washington University School of Medicine and Health Sciences, UNITED STATES

^#Contributed equally.

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: PK SRW DK ARK. Performed the experiments: PK. Analyzed the data: PK. Contributed reagents/materials/analysis tools: PK SRW DK ARK. Wrote the paper: PK SRW DK ARK. Participated in analysis and interpretation of data: SRW DK ARK. Drafted the manuscript: PK. Reviewed the manuscript: SRW DK ARK. Read and approved the final manuscript: PK SRW DK ARK.

* E-mail: moc.oohay@ibujakebeohp

Published online 2016 Jan 19. doi:  10.1371/journal.pone.0147119

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Caregiving to Persons Living with HIV/AIDS: Experiences of Vietnamese Family Members

AIMS AND OBJECTIVES:

To examine the experiences of care giving among Vietnamese family members of persons living with HIV/AIDS.

BACKGROUND:

As the number of persons living with HIV/AIDS increases, the need of family caregivers who can take responsibility for the home care of these persons increases. Vietnam has one of the fastest growing HIV epidemics in Asia.

DESIGN:

A descriptive cross-sectional study with quantitative and qualitative methods was used.

METHODS:

A purposive sample of 104 family caregivers, both male and female, participated voluntarily by answering a questionnaire of caregiver burden, and 20 of them participated in in-depth interview.

RESULTS:

Female caregivers were mainly mothers and wives while male caregivers were mainly husbands, fathers and siblings. The largest group of family caregivers reported moderate to severe burden. There was no difference between genders in total caregiver burden, but there were several differences between older and younger caregivers in some items of caregiver burden. Five categories of experiences emerged: Different types of care giving to persons living with HIV/AIDS, cultural and religious issues associated with care giving, keeping secret to avoid stigma and discrimination, lack of knowledge about disease and provision of care, and fear, anxiety and frustration.

CONCLUSIONS:

Stigma and discrimination should be decreased by providing knowledge to the general public about HIV/AIDS, in particular about ways of transmission and protection. Special knowledge should be given to family caregivers to enable them to give care to persons living with HIV/AIDS at home. This could be done through culturally appropriate training/intervention programs in which coping methods should be included. Support group interventions should also be carried through. The results obtained can be used as baseline information.

RELEVANCE TO CLINICAL PRACTICE:

Health care providers should consider gender, age and culture of family members of persons living with HIV/AIDS. Knowledge about HIV/AIDS, provision of care at home and in hospital, and support groups should be developed and implemented.

Purchase full article at:   http://goo.gl/mwYpYU

By:  Lundberg PC1, Doan TT2, Dinh TT3, Oach NK3, Le PH4.

• 1Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
• 2Department of Nursing, Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.
• 3Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
• 4Medicine and Pharmacy University Hospital, Ho Chi Minh City, Vietnam. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Quality of HIV Care and Mortality Rates in HIV-Infected Patients

BACKGROUND:

The Patient Protection and Affordable Care Act encourages healthcare systems to track quality-of-care measures; little is known about their impact on mortality rates. The objective of this study was to assess associations between HIV quality of care and mortality rates.

METHODS:

A longitudinal survival analysis of the Veterans Aging Cohort Study included 3038 human immunodeficiency virus (HIV)-infected patients enrolled between June 2002 and July 2008. The independent variable was receipt of ≥80% of 9 HIV quality indicators (QIs) abstracted from medical records in the 12 months after enrollment. Overall mortality rates through 2014 were assessed from the Veterans Health Administration, Medicare, and Social Security National Death Index records. We assessed associations between receiving ≥80% of HIV QIs and mortality rates using Kaplan-Meier survival analysis and adjusted Cox proportional hazards models. Results were stratified by unhealthy alcohol and illicit drug use.

RESULTS:

The majority of participants were male (97.5%) and black (66.8%), with a mean (standard deviation) age of 49.0 (8.8) years. Overall, 25.9% reported past-year unhealthy alcohol use and 28.4% reported past-year illicit drug use. During 24 805 person-years of follow-up (mean [standard deviation], 8.2 [3.3] years), those who received ≥80% of QIs experienced lower age-adjusted mortality rates (adjusted hazard ratio, 0.75; 95% confidence interval, .65-.86). Adjustment for disease severity attenuated the association.

CONCLUSIONS:

Receipt of ≥80% of select HIV QIs is associated with improved survival in a sample of predominantly male, black, HIV-infected patients but was insufficient to overcome adjustment for disease severity. Interventions to ensure high-quality care and address underlying chronic illness may improve survival in HIV-infected patients.

Purchase full article at:   http://goo.gl/NIGMkr

By:  Korthuis PT¹, McGinnis KA², Kraemer KL², Gordon AJ³, Skanderson M², Justice AC⁴, Crystal S⁵, Goetz MB⁶, Gibert CL⁷, Rimland D⁸, Fiellin LE⁹, Gaither JR¹⁰,Wang K⁹, Asch SM¹¹, McInnes DK¹², Ohl ME¹³, Bryant K¹⁴, Tate JP⁴, Duggal M¹⁵, Fiellin DA⁹; Veterans Aging Cohort Study.

¹Oregon Health & Science University, Portland.

²VA Pittsburgh Healthcare System.

³Center for Health Equity Research and Promotion Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania.

⁴Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine Veterans Aging Cohort Study Coordinating Center.

⁵The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.

⁶VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA.

⁷VA Medical Center and George Washington University Medical Center, Washington D.C.

⁸VA Medical Center and Emory University School of Medicine, Atlanta, Georgia.

⁹Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine.

¹⁰Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven.

¹¹VA Greater Palo Alto Healthcare System and Stanford University, California.

¹²Boston University, Massachusetts.

¹³University of Iowa Carver College of Medicine, Iowa City.

¹⁴HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland.

¹⁵VA Connecticut Care System, West Haven, Connecticut Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Clin Infect Dis. 2016 Jan 15;62(2):233-9. doi: 10.1093/cid/civ762. Epub 2015 Sep 3.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Attitudes, Knowledge, and Correlates of Self-Efficacy for the Provision of Safer Conception Counseling among Ugandan HIV Providers

High rates of childbearing desires (59%) and serodiscordant partnerships (50%) among people living with HIV (PHLA) in Uganda highlight the need for safer conception counseling (SCC). Provider attitudes about counseling PLHA on the use of safer conception methods (SCM) have been explored in qualitative studies, but published quantitative investigations are scarce. 

Data from 57 Ugandan providers were collected to examine providers' attitudes about childbearing among PLHA and engagement in discussions about childbearing, as well as their knowledge, interest, self-efficacy, and intentions to provide SCC. Correlates of self-efficacy for the provision of SCC were explored to inform the development of training programs. 

Providers reported a general awareness of most SCM, especially timed unprotected intercourse (TUI); but just over half felt they knew enough to counsel clients in the future and all wanted more training. Childbearing was discussed with less than a third of reproductive aged patients and was mostly initiated by patients. Most providers saw value in providing SCC and believed that most aspects of SCM would be acceptable to their clients, but numerous barriers were endorsed. 

Self-efficacy was greatest among providers who had had more childbearing conversations, greater SCM awareness, perceived fewer barriers and greater intentions to counsel on TUI. Providers evidence fewer stigmatizing attitudes than in the past. However, those who endorsed more stigmatizing attitudes evidenced a trend for reporting lower self-efficacy for providing SCC. 

Training will need to simultaneously focus on increasing providers' SCC knowledge and skills while instilling a more realistic appraisal of the risks of assisting couples to employ SCM versus doing nothing.

Full article at:   http://goo.gl/Hjoqdw

By:   Kathy Goggin, PhD,^1,,2 Sarah Finocchario-Kessler, PhD, MPH,³ Vincent Staggs, PhD,^1,,4 Mahlet Atakilt Woldetsadik, MPH,⁵ Rhoda K. Wanyenze, MBChB, MPH,⁶ Jolly Beyeza-Kashesya, MBChB, MMed Ob/Gyn, PhD,^7,,8 Deborah Mindry, PhD,⁹ Sarah Khanakwa,¹⁰ and Glenn J. Wagner, PhD⁵

¹Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.

²Schools of Medicine and Pharmacy, University of Missouri – Kansas City, Missouri.

³Department of Family Medicine, University of Kansas Medical Center, Kansas City, Missouri.

⁴School of Medicine, University of Missouri – Kansas City, Missouri.

⁵RAND Corporation, Santa Monica, California.

⁶Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.

⁷Mulago Hospital Department of Obstetrics and Gynaecology, Kampala, Uganda.

⁸College of Health Sciences, Makerere University, Kampala, Uganda.

⁹University of California, Los Angeles Center for Culture and Health, Los Angeles, California.

¹⁰The AIDS Support Organization, Kampala, Uganda.

Corresponding author.

Address correspondence to:, Kathy Goggin, PhD, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, E-mail:Email: ude.hmc@niggogk

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health