Stigma in HIV-Positive Women

Purpose: To present a metasynthesis of qualitative findings on stigma in HIV-positive women.

Method: Metasummary and metasynthesis technique were used for integrate findings on stigma in 93
reports of qualitative studies conducted between 1991 and 2002 with a total of 1780 women, mostly
from minority groups.

Findings: Both perceived and enacted stigma were pervasive in the lives of HIV-positive women. HIV-
related stigma was intensified in women because they were women. Stigma management largely
involved efforts to control information in the service of preserving social relations and maintaining
moral identity.

Discussion: This metasynthesis reprises and clarifies the connections between recurring themes in
primary quantitative studies and metastudies of HIV-positive people and of stigmatizing diseases and
conditions. This work also shows how affected peoples location on key axes of difference can both
facilitate and complicate efforts to manage stigma.

Conclusions: HIV-positive women experience stigmatization in relationships with others. HIV-related

stigma is as much a reflection of these others as it is central to the experience of HIV-positive people
themselves. Even those not infected with HIV are still affected by it and are thus appropriate targets for
interventions to reduce its negative effects.

Key words: disclosure, HIV-positive women, qualitative metasynthesis, qualitative research, stigma

HIV Knowledge and Practices Among Rural South Africans

Purpose: To explore the knowledge and practices related to HIV/AIDS by rural South Africans in Limpopo
Province.

Design and Methods: Qualitative research methods were used. Twenty-eight key and general
informants participated in individual interview in summer 2001. The setting was a hospital based HIV
clinic in rural Limpopo Province.

Findings: All participants were members of support group, and they had basic knowledge about
HIV/AIDS until they joined the support group.

Conclusions: Support groups were effective in educating people about HIV/AIDS.

Key words: HIV/AIDS, South Africa, support groups)

 Self-Esteem and Optimism in Men and Women Infected with HIV

Background: Self-esteem and optimism have been associated with appraisal and outcomes in a variety
of situations. The degree to which the contribution of self-esteem and optimism to outcomes over time
is accounted for by the differences in threat (primary) or resource (secondary) appraisal has not been
established in persons with human immunodeficiency virus (HIV).

Objectives: To examine the longitudinal relationship of personality (self-esteem and optimism) on

primary and secondary appraisal and outcomes of well-being, mood, CD4 + T-lymphocyte count, and
selected activities.

Methods: Men (n=56) and women (n=42) infected with HIV completed eight self-report measures twice
over 18 months. Hierarchical Multiple Regressions were used to examine the relationship of personality
variables on appraisals and outcomes. The mediating effects of primary and secondary appraisals were
explored.

Results: Self-esteem uniquely accounted for 6% of the variance in primary appraisal 5% in secondary
appraisal. Optimism accounted for 8% of the unique variance in secondary appraisal. Primary and
secondary appraisal mediated differently between personality and outcome variables. A strong
predictor of well-being, mood disturbance, and activity disruption at Time 2 was participants initial level
of these variables. Socioeconomic status was a strong predictor of mood.

Conclusions: Self-esteem and optimism are important but different resources for adapting to HIV
disease. Strategies for reducing threats and increasing resources associated with HIV may improve an
individuals mood and sense of well-being.

Key words: primary and secondary appraisal, well-being, mood disturbances

Reproductive Decision-Making Among HIV-Positive Couples in Taiwan

Purpose: To explore the gender-based power relationships and social and cultural influences on
reproductive decision-making processes among HIV-positive couples in Taiwan.

Methods: The study sample consisted of 14 HIV-positive couples in Southern Taiwan. Data were
analyzed using feminist ethnography to explore reproductive decisions made by these couples within
the context of Taiwanese society.

Findings: Self-knowledge of HIV status had a limited influence on decisions about childbearing. More
important was the Confucian values of filial piety and familial obligation, a powerful norm that still
dictates procreation decisions in Taiwan. The process by which the couples made reproductive decisions
consisted of four stages: initial reproductive decisions between partners, their search for information,
their encounters with medical systems, and their weighing risks and benefits. Male and female partners
expressed different concerns, and gender-based power relationships were exercised during the
decision-making process.

Conclusions: HIV status was not the sole determinant of reproductive decisions made by HIV-positive
couples. Rather, the Confucian value of filial piety drove the couples reproductive decisions.

Key words; reproductive decision making, gender-based power relationships, couples with HIV, feminist
ethnography)

Quality of Life and the Concept of Living Well With HIV/AIDS in Sub-Saharan Africa

Purpose: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in
four countries in sub-Saharan Africa: Botswana, Lesotho, South Africa, and Swaziland.

Methods: Using a cross-sectional design and convenience simple, we administered a survey and
collected data on demographic characteristics, measures of severity of illness, and perceptions of quality
of life. The purposefully selected sample (N=743) consisted of community-based people living with
HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality
of life, a hierarchical multiple regression was conducted with quality of life as the dependent variable.

Results: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62%
of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2% of
the variance in life satisfaction. Those participants with higher life satisfaction scores were less
educated, had worries about disclosure and finances, did not have an AIDS diagnosis or other comorbid
conditions, had lower symptom intensity, had greater functioning, and had fewer health worries. None
of these participants was taking antiretroviral medications at the time of this study.

Conclusions: Several dimensions of the Wilson and Cleary model of quality of life were significantly
related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this
sample was primarily defined as overall functional ability and control over symptom intensity. These
findings are similar to studies in developed countries that have shown the significant relationships
among functional abilities, symptom control, and perceived quality of life. As antiretroviral medications
become more available in these areas, community members and care providers can help clients realize
the possibility of living well with HIV/AIDS, and can work with clients to improve functional ability and
control symptom intensity to make living well a reality.

Key words: HIV/AIDS, quality of life, sub-Saharan Africa, living well, life satisfaction
 Quality of a Standardized Nursing Terminology to Evaluate Dosage and Tailoring of an
HIV/AIDS Adherence Intervention

Purpose: To illustrate the utility of a standardized nursing terminology to calculate the dosage of the
Client Adherence Profiling-Intervention Tailoring (CAP-IT) and to determine the extent to which a
tailored intervention was delivered to 117 persons with HIV/AIDS who participated in the experimental
arm of a randomized controlled trial (RCT).

Methods: The intervention nurse assigned nursing diagnoses from the Home Health Care Classification
(HHCC) based upon CAP scores. During the IT phase the CAP-IT, the nurse delivered and documented a
tailored set of nursing interventions associated with the CAP and nursing diagnoses. Hierarchical linear
regression was used to evaluate the extent to which the number of interventions and intervention ties
were tailored to client needs.

Results: Linear regression models that includes CAP scores and nursing diagnoses as predictor variables
explained 53.2% of the variance in total number of interventions and 58.9% of the variance in
intervention time.

Conclusions: The use of the standardized nursing terminology enabled calculation of the intervention
dose and documentation that a tailored intervention was delivered.

Key words: nursing diagnosis, nursing intervention, adherence, HIV/AIDS, standardized terminology

HIV: The changing epidemic

SINCE ITS EMERGENCE in the early 1980s, HIV infection in the United States has evolved from an acute
debilitating condition to a chronic, treatable illness. Patients with HIV infection are at risk for various
comorbidities and adverse reactions associated with long-term medication administration, as well as
disorders associated with normal aging and chronic HIV infection. Because HIV infection is seen in every
age group and can cause multisystem disease, youre likely to care for patients with HIV infection across
all settings. This article provides an update on HIV infection assessment and treatment, and discusses
how can you help your patients manage this chronic disease.

Non occupational Post exposure Human Immunodeficiency Virus Prophylaxis

Acceptance Following Sexual Assault

Background: Non occupational postexposure prophylaxis (nPEP) for HIV following sexual assault may
decrease the likelihood of HIV transmission.

Objective: The purpose of this exploratory chart review study was to examine factors associated with
patients accepting post sexual assault nPEP at three forensic nurse examiner programs in urban settings.

Methods: Forensic nursing charts of patients presenting for acute sexual assault care were received as
part of a mixed-methods study.
Results: Patients assaulted by more than one or an unknown number of assailants were over 12 times
more likely to accept the offer of nPEP (adjusted odds ratio[aOR]= 12. 66. 95% Cl [2. 77. 57. 82]). In
case where no condom was used (aOR = 8. 57. 95% Cl[1. 59. 46. 10]) or when any injury to the anus or
genitalia was noted (aOR= 4. 10. 95% Cl [1. 57. 10. 75]), patients were more likely to accept nPEP.
Patients with any injury to the face or head were less likely to initiate nPEP (aOR= 0. 32, 95% Cl[0. 11, 0.
97]).

Discussion: This study is an important first step in understanding factors associated with nPEP
acceptance after sexual assault.

Key Words: forensic nursing. HIV. Post exposure prophylaxis. Rape

Nursing Research January/ February 2016 Vol 65 No 1. 47-54.

Self Care Strategies and Sources of Information for HIV/AIDS Symptom Management

Background: Self Care is one of the challenges that people with HIV/AIDS face in the long term symptom
management of the disease.

Objective: To identify the category schemes of self care strategies and sources of information for
symptom management of the disease.

Methods: A secondary analysis was conducted in a large dataset of an HIV/AIDS symptom management
study. Narrative data of symptom self care management strategies and sources of information for
symptom management were analyzed by a content analysis technique to identify category schemes.
The 359 participants in the study reported 776 symptom self care strategies and 526 sources of
information for three strategies.

Results: The symptom self care management strategies were summarized into eight categories:
medications (23. 45%), self comforting (15. 21%), complementary treatments (14. 69%), daily thoughts
and activities (12. 89%), diet changing (10. 95%) , help seeking (9. 28%) , spiritual care (6. 83%) and
exercise (6. 70 %). There were four categories of information sources: self (34. 41%), healthcare
provider (27.95%), personal network (19. 20%)and community (18. 44%). The category schemes had
moderate to high interrater reliability (Cohen's kappa: . 49-1. 00 for self care strategy and . 70-. 87 for
source of information). Most of the self care strategies were perceived as helpful. Except for
complementary treatments, self care strategies were used differently among people with the six most
frequently occurring symptoms (x^2[5, n=286]=28. 53-79. 89).

Discussion: The eight categories of self care strategies identified in this study showed that people with
HIV/AIDS not only seek the help of medications, but also follow a wide array of other self developed or
self taught nonpharmaceutical startegies to allay their symptoms.

Key Words: HIV/AIDS. Nursing. Self care. Symptom management.

A Randomized Clinical Trial of an HIV Risk Reduction Intervention Among Low Income Latina
Women

Background: HIV infection has increased within the Latina community more than in any other ethnic or
racial group within the United States. Latinas comprise only 13% of the U. S population, yet they
account for 20% of the cumulative reported cases of AIDS.

Objectives: The purpose of the study was to evaluate a randomized culturally tailored intervention to
prevent high HIV risk sexual behaviors for Latina women residing in urban areas.

Methods: Mexican and Puerto Rican Women (16-44 years of age; N=657) who were sexually active
during the previous 3 months were recruited and randomized into intervention and control groups. The
intervention, facilitated by bilingual, bicultural, trained Latina women consisted of culturally tailored
sessions on understanding their bodies. HIV/AIDS and negotiating safer sex practices, violence,
prevention, and partner communication. Bivariate and multivariate analyses assessed changes from
baseline.

Results: The interventions improved HIV knowledge, partner communication, risk reduction behavioral
intentions, and condom use, and decreased perceived barriers to condom use.

Discussions: The efficacy of culturally- sensitive intervention to reduce HIV/AIDS risk behaviors in Latina
women was demonstrated in the current study.

Key Words: HIV. Latina. Prevention.

Keepin' It R. E. A. L!

Results of a Mother- Adolescent HIV prevention program

Background: The concern that adolescents may be placing themselves at risk for contracting HIV has led
to widespread public and parental support for HIV prevention programs. Several programs on
increasing communication between parents and teenagers have been tested, but the study of the
impact of these programs on resulting sexual behaviors is lacking.

Objective: To test the efficacy of two interventions for mothers and their adolescents in delaying
initiation of sexual intercourse for youth who are not sexually active and encouraging the use of
condoms among sexually active youth.

Methods: Employed were a control group and two treatment groups: one based on social cognitive
theory (SCT) and behavior theory. Assessments were conducted before the intervention (baseline) and
at 4, 12, and 24 months after the baseline assessment.
Result: Adolescents and their mothers (total N=582) enrolled in the final. At baseline, the adolescents
ranged in age 11-14 years and were mostly male and African Americans. The mean age of the mothers
was 37. 9 years, and most were African American and single. The primary analyses showed to difference
among groups in abstinence rates for adolescents. However, adolescents in the LSK group
demonstrated an increase in the condom use rate, and those in the SCT and control groups scored
higher on human Immunodeficiency virus (HIV) knowledge than those in the SLK group. Mothers
showed substantial increases over time in comfort talking about sex and self efficacy. For HIV
knowledge, mothers in the SCT group scored significantly higher than those in the SLK and control
groups.

Conclusions: The results of this study are comparable to previous studies that have included mothers in
the HIV education of their adolescents. Although the program did nit demonstrate a substantial effect
on abstinence rates, increases were observed in condom use among adolescents and in mothers sex
based discussions and comfort in taking sexual issues.

Key Words: adolescents. HIV prevention. Sex based communication.

Desire for Children Among Black Women With and Without HIV infection

Purpose: to determine the relationship among self esteem, self efficacy and desire for children and to
contrast these concepts between Black women with and without HIV infection.

Design: Correlational analysis.

Method: A randomized sample of 98bBlavk women, 52 HIV positive and 46 HIV negative, recruited
from an American owner city health center, completed four questionnaire: the Rosenberg Self Esteem
Scale, the General Self Efficacy Subscale, a modified index of Parenthood Motivation and background
information sheet. Data were analyzed using descriptive statistics, zero order correlations, and
multiple regression techniques.

Findings: Increased self esteem and self efficacy were positively correlated with desire for children in
both HIV infected and uninfected Black women. No significant difference in the intensity of desire for
children was found between uninfected Black women and HIV infected Black women. The combination
of age, member of previous abortions, and strength of religious belief was a better predictor of desire
for children than was self esteem and self efficacy.

Conclusions: Variables other than HIV status were significantly correlated with desire for children among
these low income Black women with and without HIV infection.