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The field of post-traumatic stress syndrome, as it relates to disease survival and HIV/AIDS, is the subject of books, papers, and research. This reference section lists material related to patient outlook and despair, living with uncertainty, loss and grief, and survival mechanisms. Research contacts in Fremont, CA and New York City are listed.
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PMID:Clearinghouse: hope and uncertainty. 1136 43

The purpose of this study was to describe the dynamics of hope in a) people fearing a diagnosis of HIV or living with HIV/AIDS and b) their significant others, from the perspective of caregivers working in voluntary organizations in Finland. Individual interviews with eight caregivers were analysed using the grounded theory method. Living with the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a person fearing a diagnosis of HIV, becoming aware of HIV contagion, and living with HIV/AIDS. Mirroring the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a significant other of a person fearing a diagnosis of HIV, or living with HIV/AIDS. It is important to take into consideration the dynamics of hope in taking care of people fearing a diagnosis of HIV or living with HIV/AIDS and their significant others.
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PMID:Dynamically fluctuating hope, despair and hopelessness along the HIV/AIDS continuum as described by caregivers in voluntary organizations in Finland. 1188 54

Rwanda may represent the first example of an entire society breaking down because of the prevalence of AIDS. It was known that infection rates in Rwanda were among the highest in the world, yet few Rwandans, even those tested, were given a diagnosis. Analysts believe that this situation led to feelings of fear and despair which fueled the recent violence. It has been estimated that as many as 70% of sex workers, 30-40% of pregnant women, and 4-65% of soldiers were infected. The disease decimated the officer corps, leaving an unstable leadership and a lack of discipline. In addition, although 98% of the people in Rwanda were aware of the epidemic, only 5% changed their behavior as a result of this knowledge. Because the government failed to acknowledge AIDS as a problem, public discussion was prohibited. It is instructive that when the atrocities began, HIV/AIDS workers were among the first to be murdered. Although it will be impossible to pinpoint the amount of influence that this epidemic had on the breakdown of civilization in Rwanda, it is important to ask this question. Attention is also being paid to the appropriate strategies for dealing with AIDS in postwar conditions. Is it reasonable to hand out condoms, for example, to a population struggling with cholera? Also, how can AIDS awareness be maintained in a country which must deal with repairing the far-reaching damages of war?
AIDS Anal Afr
PMID:Did HIV contribute to the breakdown of society in Rwanda? A question worth asking. 1228 3

Kika, a 35-year-old Ugandan mother of five was widowed by AIDS in 1990. After her husband's death, she lost her job and was forced to return to her late father's land and to give some of her children to her mother's care. Soon after she returned, her three-year-old daughter began showing symptoms of HIV infection. In total despair, Kika contacted TASO (The AIDS Support Organization) for help. TASO counselors have helped Kika identify possible income-generating projects which she is trying desperately to realize. This is very difficult because she has no capital to invest in her scheme. Her neighbors and sisters know her status and treat her kindly. Her mother probably suspects that Kira has AIDS but will never discuss it with her. Kika has been celibate since her husband died because she does not want to transmit the disease to another man or to another potential child. Her concern is entirely vested in producing enough income to take care of her children until she dies.
AIDS Anal Afr 1995 Aug
PMID:"I want to work" -- Kika's story. Special report: women and HIV. 1228 48

Nigeria may be taken to represent countries with an evolving HIV/AIDS epidemic. With particular reference to paediatric HIV, the voluntary testing of young children and their parents may provide an important entry point for the institution of control measures. However, there is a paucity of knowledge about how individuals perceive voluntary testing. This knowledge is important to the development of guidelines for counselling. To reduce this gap, 258 parents of hospitalized children (> 1 month to 15 years of age) were interviewed using a structured questionnaire. In addition, to complement the data, four examples of seropositive mother's responses during post-test counselling are presented and analyzed. In the survey, 223 (86%) parents were HIV/AIDS aware but only 88 (39%) of these parents could describe one or more route(s) of transmission and none described vertical transmission. Among the respondents, 153 (62%) of 248 would consent to the screening of self, and 195 (85%) of 230 to the screening of a hospitalized child if based on his/her clinical condition. Perceptions of good health and lack of exposure, and despair owing to lack of a specific treatment, were the common reasons for refusing consent. These represent some of the issues which would need to be addressed to increase the acceptance of voluntary testing. The fear of a break up of families with seropositive mothers but seronegative fathers was a major concern expressed during post-test counselling. HIV-discordance among couples may be frequent and should be considered in the formulation of policies on counselling and voluntary testing.
AIDS Care 2002 Oct
PMID:Perception of voluntary screening for paediatric HIV and response to post-test counselling by Nigerian parents. 1241 18

This small descriptive study investigated the experiences of Ugandan women living with a diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), exploring what assisted them to cope and identifying their future concerns. A purposeful sample of seven HIV-positive women was accessed through two indigenous non-governmental organizations in Eastern Uganda. Single semi-structured interviews were conducted on location. Following analysis of the narrative data, three principal aspects of their experiences emerged: loss and adversity, constructive living, and future uncertainties. Loss and adversity encompassed bereavements, multiple psychosocial losses and physical suffering. Constructive living related to the ability to adopt positive living activities, rebuilding shattered lives, sometimes from the brink of despair. Since the participants were all mothers, future concerns focused on child care anxieties. Stress and uncertainty surrounding HIV testing of children was also evident. Despite the cultural contrast, many of the findings were remarkably similar to those documented in Western literature. The women related their experiences with an absence of self-pity or resentment. Resilience, resourcefulness and hope were typically, perhaps instinctively, demonstrated.
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PMID:A study of the experiences of women living with HIV/AIDS in Uganda. 1241 95

Hope is an important protective phenomenon in human life, particularly given that long-lasting despair or hopelessness may threaten human existence. However, previous knowledge on the topic related to people affected by HIV/AIDS is scant. The purpose of this study was to explore the dynamics of hope in significant others of people living with HIV/AIDS and persons living with HIV (PLWH) or AIDS (PLWA) from the perspective of significant others in Finland. Eleven interviews were conducted with six significant others. The data were analyzed using the grounded theory method. The dynamics of hope, as it emerged from the data, is constructed of three main elements: hope, despair, hopelessness, and their reciprocal relationships. An alternating balance between hope, despair, and hopelessness based on the factors contributing to them emerged as central in the dynamics of hope. The dynamics of hope are closely connected to the basic process of searching for one's own way with HIV/AIDS, in becoming HIV-positive, and living with HIV/AIDS. In significant others, the dynamics of hope are closely connected to the basic process of HIV, changing from abstract to concrete in a relationship with a PLWH/PLWA.
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PMID:Dynamics of hope in HIV/AIDS affected people: an exploration of significant others' experiences. 1465 73

HIV vaccine availability does not guarantee uptake. Given suboptimal uptake of highly efficacious and already accessible vaccines in the United States, low vaccine coverage in the developing world, and the expectation that initial HIV vaccines will be only partially efficacious, the public health community will face formidable challenges in disseminating U.S. Food and Drug Administration (FDA)-approved HIV vaccines. HIV/AIDS stigma, fear of vaccine- induced HIV infection, social side effects of testing HIV-positive, and mistrust of government and research present additional obstacles to HIV vaccine dissemination. Increased risk behaviors because of HIV vaccine availability can undermine the effectiveness of partially efficacious vaccines in reducing HIV incidence. HIV vaccine efficacy trials also face significant challenges in recruitment of sufficient volunteers and possible increases in risk behaviors due to trial participation. Planning and designing interventions to facilitate successful recruitment for large-scale phase 3 efficacy trials is a vital step towards U.S. FDA-approved HIV vaccines. Rather than despair in the face of momentous HIV vaccine dissemination challenges, or presume unrealistically that vaccine uptake will ensue automatically and that risk behavior increases will not occur, let us deem the estimated 10-year window to an approved HIV vaccine as an opportunity to investigate and confront these challenges. A consumer research agenda founded on social marketing principles is needed to facilitate the design of empirically-based interventions tailored to the unique needs and preferences of specific segments of consumers. Social marketing interventions may increase future HIV vaccine uptake and clinical trial participation, and mitigate increases in HIV risk behaviors.
AIDS Patient Care STDS 2004 Dec
PMID:Challenges for HIV vaccine dissemination and clinical trial recruitment: if we build it, will they come? 1565 80

The challenges of working with medically and mentally ill persons with a paucity of resources, inadequate networks of social support, and multiple stresses and losses maybe daunting to even the most seasoned of caregivers. A psychiatric trainee may be overwhelmed by the despair, sorrow, and desperation en-countered in the day-to-day care of the complex severely ill patient with lethalmedical and lethal psychiatric diagnoses. Individuals who are infected with HIV and hepatitis C, who are polysubstance users, and who are benzodiazepine dependent present with inordinate demands for prescribed substances to use or to sell in the street. The trainee needs to become comfortable with both limit-setting and harm reduction in order to keep the patient engaged in both lifesaving medical and psychiatric care. Nurturing and supportive supervision enables the trainee to integrate skills and work toward an understanding of countertransferences. An ego-supportive psychodynamic approach to supervision in an AIDS psychiatry fellowship facilitates conflict resolution and improves the care of patients with complex and severe medical illness.
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PMID:Preserving a sense of wonder: the integration of an ego-supportive psychodynamic approach to supervision in an AIDS psychiatry fellowship. 1623 73

I have mentioned it before and I want to repeat it now, that we in Africa share a common history, heritage and basic problems of development. We, therefore, have an inescapable responsibility of pooling our talents and resources in shaping our common destiny. In fulfillment of its mission, AFHES, through its organized con notgresses and this Journal, is an invaluable vessel for enabling us to promote better health for the peoples of this continent. Africa is a continent endowed with great potential that, for one reason or an notother, has been ignored or misused, resulting in the current crisis now enveloping the continent. There is the escalating debt burden, falling agricultural productivity and the ever-increasing population. Efforts to improve the situation are hampered by adverse factors such as malnutrition, HTV/AIDS, malaria and other causes of ill health; wars, poor environmental management and the ever-worrisome problem of refugees. At the sunrise of the 21st Century, we must wake up and reverse the current trend by focusing our resources on priority areas of development. The fight for freedom from the yoke of colonialism and the traumatic experience of apartheid has been won. In some African countries, however, the winning of the fight for freedom has opened up a new fight, a fight that is more fierce and bloody than that which set us free. These include civil strife and internecine wars giving rise to a new black Diaspora, which is far greater than the one experienced during the period of slavery and slave trade. People supposed to build these nations have either been killed or forced into exile. Those intellectually endowed have sought refuge in safer and economically developed countries and, by the same process, also weaken the al notready weak economies of their mother countries. They have, therefore, helped to strengthen the already strong economies of the developed nations. This is indeed, a sad situation that poses a formidable challenge to the future well being of the conti notnent. Civil strife has resulted in the increased numbers of displaced persons and has caused a big setback in the fight against diseases and causes of ill health. In addition, there are new challenges created by emergence of new infections, re-emergence of diseases that had been put under control; and the changing epidemiological patterns and manifestations of existing diseases. Since disease and ill health know no bound notary, we must all be prepared to find solutions to diseases and causes of ill health that continuously haunt this continent. As health experts, we are concerned. We should not be responding to health emergencies occasioned by civil strife. We need peace as it will guarantee not only freedom and personal security, but it will also guarantee our future and the future of those to come after us. We are well aware that as is the case with developed nations, the development of our continent rests on the utilization of research findings, which must be useful, contextual and must stand the test of time. This is our mission and our hope. Africa is at the crossroads. We must not despair or quit, lest we become irrel notevant both to ourselves and to the rest of mankind. Let African governments give science a chance. As I have said several times before and I am still saying it now, quitters never win and winners never quit. We have no alternative but to be winners!
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PMID:The place of science in a continent at the crossroads. 1765 41


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