Impairments and perceived competence in persons living with HIV/AIDS

Medical advances have transformed HIV/AIDS from a short-term terminal illness to a long-term chronic condition. Consequently, the disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities and wider community participation. These changes have necessitated rehabilitation interventions for persons with HIV/AIDS to focus on issues related to enabling participation in all spheres of everyday activities. However, limited information is available on the impairments prevalent in the emergent population of people living with HIV/AIDS and on the impact of these impairments on the person's functional performance and participation in various occupations of daily living. The present study attempted to explore these issues as they are experienced by the emergent population of people living with HIV/AIDS. The purpose of the study was: (1) to explore occupational functioning across various activities, (2) to describe the various impairments prevalent in this population, and (3) to examine the impact of these impairments on the person's perceived occupational competence. Two instruments, the Sign and symptom checklist for persons with HIV disease and the Occupational Self-Assessment were administered to a sample of 35 individuals (Mean age=42.8 yrs.) living in supportive living facilities. Impairments most commonly identified by the participants included: fatigue; fear/worries; difficulty concentrating; muscle aches; and depression. The two primary areas of occupational functioning where participants reported experiencing moderate to severe difficulty included: managing finances and physically engaging in activities which were reported by 67.7% and 35.5% of the participants respectively. No statistically significant correlation was observed between various measures of impairments and the overall measure of perceived occupational competence for the sample of individuals living with HIV/AIDS included in this study.     

Back to work: vocational issues and strategies for Canadians living with HIV/AIDS

Much has been written since the first appearance of HIV/AIDS in 1981 about its effects on the Canadian health care and social services systems. However, researchers have given limited attention to issues of entry or re-entry to the competitive job market for HIV positive individuals. The emergence of highly active antiretroviral therapies (HAART) has allowed a significant number of persons who are HIV positive to experience a major recovery in health and energy. This increase in physical health has in turn led to a re-examination of the possibility of returning to former types and levels of activity, including the prospect of going back to work or entering the competitive workforce for the first time. The purpose of this paper is to outline some of the issues and concerns that impact HIV positive individuals' attempts to return to or enter the competitive workforce, particularly those relating to disability policies and public insurance. Data from in-depth interviews with a sample of people living with HIV/AIDS (PHAs) are used to help illustrate the disconnect between these policies and the lived experiences of PHAs. Also discussed are the opportunities for Canadian policies and practices to employ a functional definition of disability and a philosophy of early intervention in vocational rehabilitation.     

Living long-term with HIV/AIDS: exploring impact in psychosocial and vocational domains

In the last decade, new treatments for the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) have led to improved health and longer life expectancies for many HIV-positive individuals. Coping with HIV/AIDS as a chronic, rather than terminal illness presents new challenges for those living with the disease and for service providers. This review of HIV/AIDS-related literature attempts to address the major medical, psychological and psychosocial challenges related to living long-term with HIV/AIDS and consider how they may present obstacles to attainment of educational and vocational goals for HIV-positive individuals. Implications for service providers and suggestions for future research are discussed. An exploratory study of needs assessment is proposed.     

Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.     

Chapter 4: Lesbians and HIV Disease

Lesbian women, both as individuals and as a community, are affected by the AIDS crisis. They are found among the carriers of HIV and among personal caretakers. They are among the activists, the professionals, and the volunteers whose energy and commitment drives AIDS political and service organizations. This article explores some of the problems and issues that have emerged in the relationship of lesbian women to HIV disease and to the AIDS movement. The author examines: (1) problems related to the identification and treatment of lesbians infected with HIV; (2) problems related to the absence of research and education about woman-to-woman sexual transmissions of HIV; (3) the involvement and motivation of lesbians in the development of AIDS activist and service organizations; and (4) the transformational quality of the AIDS crisis and the questions and reevaluations it has stimulated among lesbians, especially with regard to homophobia, classism, and sexism.     

Challenges and Opportunities in HIV/AIDS Counseling: A Case of Jharkhand

The study highlights the challenges and opportunities in HIV/AIDS counseling. The major challenges are recruiting the right individuals and their capacity building and retention. The finding shows that most of the counselors are not befitting in terms of qualification and experience besides motivation, remuneration, and other issues. The study suggests that to ensure the effective counseling to reverse the epidemic, it is important to focus on such issues through appropriate policy interventions.     

Gay Bars and Serendipity

Abstract

HIV/AIDS continues to be a serious public health issue. As HIV changes from an acute disease to a more chronic illness, it places increased responsibility on family caregivers to provide on-going assistance. Based on a conceptual model of caregiving resilience, this study found high variation in caregiving outcomes with many caregivers demonstrating high levels of well-being despite adverse life circumstances. Factors that contributed significantly to caregiver well-being included income, caregiver health, discrimination, multiple loss, dispositional optimism and self-empowerment. These findings suggest that HIV/AIDS and caregiving entail more than stress and distress and that future research needs to consider caregiving within the context of a historically disadvantaged community, resilience of informal caregivers, and risk and protective factors at the personal, cultural and community levels. Such information is necessary to design community-based interventions to support informal caregivers and persons living with HIV/AIDS.     

Migration,Poverty, and Risk of HIV Infection: An Application of Social Capital Theory

A majority of current HIV/AIDS interventions are designed primarily after individual-based public health models and pay little attention to the socioeconomic environment in which HIV transmission occurs. This article focuses on outlining how migration acts as a conduit for disease transmission in South Africa and then proposes a macro-level prevention model based on social capital theory, thus then supplementing current prevention literature. It is based on the argument that social disruption and stresses from migration lead to sexual interactions during the migration periods that amplify the risk of HIV transmission among migrants.     

Violence,rape, and sexual coercion: everyday love in a South African township

This paper presents findings of an anthropological study among pregnant adolescents in Cape Town, South Africa. The inquiry focuses on the sexual dynamics within adolescent relationships. The study reveals widespread male coercion and violence within sexual relationships. Informants describe assault as a regular feature of their relationships. In South Africa, power relations between men and women are commonly manifested as and imposed through sexual violence and assault. Men use physical assault to force sexual contact, beating their female partners if they refuse to have sex, are suspected of sexual infidelity, or are found to be using contraceptives. Moreover, women experience abuse such as gang rape. Yet, health promotion interventions fail to acknowledge sexual encounters as instances in which unequal power relations between men and women are expressed. It is these power relations which determine women's ability or inability to protect themselves against sexually transmitted disease, pregnancy, and unwelcome sexual acts. This study underlines the need to consider gender power issues in the design and impact assessment of HIV/AIDS and reproductive health interventions and in challenging male violence.     

“Empowered Criminals and Global Subjects”: Transnational Norms and Sexual Minorities in India

In this paper, I comparatively examine the influence of transnational advocacy on legal struggles around sex work and homosexuality in contemporary India. While transnational scholars of sexuality understand globalization as a contradictory and uneven process, there has been little attention to how this unevenness is manifest in the realm of sexual rights and law. Based on qualitative research, I show how transnational discourses on health—in particular, HIV/AIDS interventions—and on human rights interact unevenly with national discourses on sexuality. Whereas discourses regarding HIV/AIDS enable sex workers to mobilize at the national level, global anti-trafficking discourses effectively reduce sex workers to “victims.” For Indian LGBTQ groups, discourses regarding the HIV/AIDS epidemic and global human rights enable these groups to problematize the anti-sodomy law in national politics. However, national legal discourses effectively reduce LGBQ individuals to “criminals,” and legal advancements in this arena are uneven. Focusing on this unevenness produced by transnational advocacy this paper highlights how sexual rights are articulated in context of asymmetric and uneven globalizations.     

A Model Program for Increasing Treatment Access for African American Women Who Use Crack Cocaine and Are at Risk of Contracting HIV

ABSTRACT

In the United States, the threat of HIV/AIDS to African-American women's health has become the focus of much concern. This article describes a federally funded community-based program that provides services to African-American women at risk for HIV/AIDS in Nashville, TN. This program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important to the continued development of culturally relevant interventions that are vital to stemming the disproportionate rates of HIV/AIDS within the African-American community by ensuring treatment access to all populations.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

Training Mental Health Professionals on Ethical Issues and HIV/AIDS

This report describes the importance of ethics training for mental health professionals working with persons infected or affected by HIV/AIDS. We first describe three major ethical dilemmas (confidentiality, duty to warn, and suicide) faced by mental health providers serving persons with HIV/AIDS, and the legal and clinical aspects of these dilemmas. We present data from the South Texas AIDS Training Project describing the types of mental health professionals who have attended workshops on ethical issues and HIV/AIDS. Finally, we report observations about the impact of the ethics training sessions on the participants' knowledge and attitudes.     

Work status, benefits, and financial resources among people with HIV/AIDS

With the advent of more advanced treatments and therapies, people with HIV/AIDS are experiencing significant improvements in their health, making many of their ongoing employment and career goals more realistic. However, people with HIV/AIDS continue to have major concerns regarding the impact of working on their benefits and entitlements, including apprehensions about potential economic hardships related to loss of financial supports and health insurance coverage. This article focuses on factors related to employment status, sources of health benefits, and entitlements among people with HIV/AIDS. In addition, results of the study demonstrate differences in employment status, benefit types, and the amount of financial support individuals receive based on gender.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

HIV/AIDS and return to work: a literature review one-decade post-introduction of combination therapy (HAART)

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000-950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the US, issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns. The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.     

“I AM STILL SUFFERING:” THE DILEMMA OF MULTIPLE RECOVERIES IN THE LIVES OF METHADONE MAINTENANCE PATIENTS

This study examines narratives on the meaning of addiction recovery through interviews with 45 methadone maintenance treatment (MMT) patients. Results show that heroin addicts are dealing with multiple recoveries and many are simultaneous to each other: recoveries concerning (1) addiction, (2) associational disruptions, (3) self-identity and actualization, (4) drug induced diseases (HIV/AIDS, HCV, etc.), and (5) catalyzing event(s). The research findings, anathema of clinical MMT views on recovery, suggest that drug addicted individuals might benefit from interventions that address their multiple recovery issues as opposed to ones that emphasize recovery strictly in sobriety terms.     

Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.