Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda

The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. 

Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. 

The majority were managing their condition well across three broad domains of self-management. 

• First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. 
• Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. 
• Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. 

Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage.

Below:  Adjusting to life with HIV on ART

Full article at:   http://goo.gl/VqWsp6

By:  Russell S1, Martin F2, Zalwango F3, Namukwaya S3, Nalugya R3, Muhumuza R3, Katongole J3, Seeley J3,4.

• 1School of International Development, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
• 2External Research Associate, School of International Development, University of East Anglia, Norwich, United Kingdom.
• 3Medical Research Council / Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
• 4London School of Hygiene and Tropical Medicine, London, United Kingdom.
• PLoS One. 2016 Jan 25;11(1):e0147896. doi: 10.1371/journal.pone.0147896. eCollection 2016. 

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“I Spent a Full Month Bleeding, I Thought I Was Going to Die…” A Qualitative Study of Experiences of Women Using Modern Contraception in Wakiso District, Uganda

There is high unmet need for family planning (FP) in Uganda as well as high contraceptive discontinuation rates. These contribute to the high fertility rates that in part are due to unplanned pregnancies. There are gaps in knowledge about experiences that couples go through while using contraceptives in their lives. This study explored women’s experiences during the course of their contraceptive use.

We conducted a qualitative study involving 30 women who had used modern contraception for at least one year in Wakiso district, central Uganda. We used in-depth interviews to obtain their personal accounts. Index women were approached through health officers at four health centres in the district. All ethical approvals and informed consent were obtained. We used conventional content analysis; identifying codes through open coding, on which basis categories were developed and grouped into overarching themes.

Women’s accounts were summarised in the following themes: negative experiences with modern contraceptive use, motivation to continue using FP in spite of these negative experiences, the role of influential people, and discontinuation of use. Negative accounts dominated the experiences of most women but they expressed strong desire to continue using modern contraception even amidst all challenges. Health workers emerged as the most influential people that played a vital role in women’s decisions.

Varied negative experiences with modern contraception and misperceptions exist amidst a determination to continue use. Partner engagement, health service strengthening to improve side effects management and health worker skills, and engaging older women that have successfully used contraception as community champions, are potential strategies to support women’s contraceptive decisions.

Below:  Example of the coding Framework used to arrive at themes

Full article at: http://goo.gl/qbjz5u

By: 

Simon P. S. Kibira, Justine N. Bukenya, Lynn M. Atuyambe

Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Simon P. S. Kibira

Centre for International Health, Department of Global Public Health and Primary care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

Christine Muhumuza

Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

  

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Antiretroviral Therapy & Changing Patterns of HIV Stigmatisation in Entebbe, Uganda

Antiretroviral therapy (ART) has the potential to change processes of HIV stigmatisation. In this article, changing processes of stigmatisation among a group of people living with HIV (PLWH) on ART in Wakiso District, Uganda, are analysed using qualitative data from a study of PLWH's self-management of HIV on ART. 

There were 38 respondents (20 women, 18 men) who had been taking ART for at least 1 year. They were purposefully selected from government and non-government ART providers. Two in-depth interviews were held with each participant. 

Processes of reduced self-stigmatisation were clearly evident, caused by the recovery of their physical appearance and support from health workers. However most participants continued to conceal their status because they anticipated stigma; for example, they feared gossip, rejection and their status being used against them. 

Anticipated stigma was gendered: women expressed greater fear of enacted forms of stigma such as rejection by their partner; in contrast men's fears focused on gossip, loss of dignity and self-stigmatisation. 

The evidence indicates that ART has not reduced underlying structural drivers of stigmatisation, notably gender identities and inequalities, and that interventions are still required to mitigate and tackle stigmatisation, such as counselling, peer-led education and support groups that can help PLWH reconstruct alternative and more positive identities. 

A video abstract of this article, via: https://youtu.be/WtIaZJQ3Y_8

Via:   http://ht.ly/Ss7A5 

By:  Russell S1, Zalwango F2, Namukwaya S2, Katongole J2, Muhumuza R2, Nalugya R2, Seeley J2.

• 1School of International Development, University of East Anglia, Norwich, Norfolk.
• 2Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.