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Although the AIDS pandemic has catastrophic implications for all levels of South African society, it can be viewed as an opportunity to face the inevitability of human mortality with dignity rather than fear and denial and to rebuild shattered communities. This article discusses issues pertaining to counseling HIV-infected persons, the counselors themselves, and families and social groups affected by AIDS-related deaths. Counseling of HIV/AIDS patients is supportive in nature, with a focus on here-and-now issues such as unfinished business, reconciliation with family members, finding meaning in daily activities, and preserving a sense of personal control. This process can be obstructed, however, by distrust of authority figures, anger at experts who fail to cure the disease, and an internalized sense of shame and inferiority. The effectiveness of AIDS counselors depends on their ability to recognize and resolve personal conflicts triggered by HIV-positive clients, including feelings about death, helplessness, overidentification, and discomfort with sexual issues. Most South Africans will face bereavement and have to go through a mourning process for friends and relatives. Complicated and delayed grief reactions triggered by new and continuous losses can be expected. Involvement of community members in the grieving process, whether as helpers, volunteers, professionals, or recipients of service, offers South African society an opportunity for development of a new culture of compassion.
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PMID:Crisis as challenge: counselling counsellors, persons living with HIV / AIDS and survivors. 1229 92

At a time when the burden placed by HIV/AIDS on health systems, communities, and individual families is steadily increasing, policies such as structural adjustment and health reform are reducing health budgets. HIV-related chronic illness and deaths among health workers have further exacerbated pressures in the health sector and remaining staff suffer from stress and burnout. Factors contributing to stress among health workers in Africa and other developing countries include inadequate knowledge and support for treating HIV-related illnesses, lack of a safe blood supply, the terminal nature of HIV infection, lack of training in dealing with death and dying, discomfort discussing sexuality with patients, the social stigma associated with HIV/AIDS, and fears of occupational exposure to HIV. Since AIDS affects all areas of life, it requires a coordinated response from the health sector, education, social services, legal institutions, and religious and community groups.
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PMID:Coping with the burden. 1229 11

This paper discusses the gender dynamics of sexually transmitted diseases (STDs) and HIV/AIDS based on the relationship between gender violence, reproductive health, sexuality, STD and HIV/AIDS. This approach highlights AIDS as an increasingly female concern, a consequence of the social makeup of female and male sexuality, and the result of inequalities that characterizes many heterosexual relationships. Gender violence is considered as the most intimate enemy among most women with an extremely high indirect cost to development. Not only that, it also causes more death and disability among women aged 14-44 years, having greater risk from their husbands, fathers, and neighbors or colleagues. Moreover, the link between gender violence and HIV/AIDS and STD can be observed through the rising incidence of these infections among women particularly during unprotected vaginal intercourse. Also, these women often bear the pain and discomfort associated with STD because of social constraints. The study calls for further research into behavior change interventions that address gender dynamics to prevent the fatal intimacy of women's vulnerability to STD and HIV, the intimate enemy of gender violence and the fatal encounter with AIDS. Lastly, the paper includes information about the work of the Pacific Women's Resource Bureau and its pioneering initiative on the Pacific multi-site study on violence against women.
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PMID:New Caledonia: fatal intimacy: gender dynamics of STD and HIV / AIDS. 1229 69

Despite increasing need for HIV prevention research and intervention programs, the voices and stories of Asian and Pacific Islander men who have sex with men (API MSM) have remained absent from HIV prevention literature. Five focus groups with API MSM (N = 38) were conducted to identify psychological, social, and cultural factors related to HIV risk and protection. Six themes were identified based on focus group discussion: (a) dual-identity status, (b) coming out and disclosure issues, (c) relationships and dating, (d) substance use, (e) sexual risk reduction strategies, and (f) health and social services. Narrative data indicate that multilevel HIV prevention intervention strategies are necessary for addressing the unique psychosocial and behavioral HIV risk factors among API MSM, such as dual stigma stemming from homophobia and racism, discomfort with sexuality, power dynamics and stereotypes in relationships with White men, substance use, and low utilization of health and social services.
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PMID:HIV risk and prevention among Asian/Pacific Islander men who have sex with men: listen to our stories. 1263 May 96

The demographic, risk-taking, psychological, and social network characteristics of HIV+ patients receiving and not receiving antiretroviral therapy were compared to those characteristics in HIV+ and HIV- persons who are not in care. In this cohort study, we enrolled patients from the Grady Infectious Disease Program (IDP) Clinic in Atlanta, GA, defining group membership by their use of antiretroviral therapy at the time of ascertainment. We also enrolled HIV+ and HIV- persons from inner city neighbourhoods of Atlanta. We collected extensive survey information from both groups, as well as clinic and follow-up information from the Clinic groups. We attempted to interview each participant four times over a period of two years. We used scores for Risk, for Social Stress and for Psychological Distress to compare the groups. Persons receiving antiretroviral therapy continued to display risky behaviour and to experience a substantial degree of social stress and psychological distress. HIV+ persons in the community, however, had the most prominent profile for HIV-transmission risk, social stress, and psychological distress and display considerable cross-over in their patterns of risk-taking. Men who have sex with men appear to play a dominant role, through their risk behaviour and network affiliations, in the maintenance of HIV endemicity. Current approaches fail to give sufficient attention to the admixture of risk that occurs in inner city communities. Reaching HIV+ persons with antiretroviral therapy in such communities faces considerable social, structural, and psychological barriers that may be more important than simple adherence to medication.
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PMID:Once and future HIV treatment: a comparison of clinic and community groups. 1286 22

The aim of this study was to evaluate terminal care among hospitalized children who died of HIV/AIDS. The design was a retrospective chart review of the terminal hospitalization. The setting was a public, secondary and tertiary children's hospital in Cape Town, South Africa (SA). The patients included a consecutive series of in-patient deaths from HIV-related causes. The main outcome measures included: documentation of do not resuscitate (DNR) orders and comfort care plans, intensity of diagnostic and therapeutic interventions in the last 24 hours of life, and presence of pain and distress in last 48 hours of life. The results are based on the review of 165 out of 167 in-patient deaths. Of those, 79% of patients died in general wards. Median age and length of stay were 4 months and 6 days respectively. A total of 84% of patients had a DNR order. DNR orders appeared simultaneously in only 41% of medical and nursing notes. Only 44% of patients had a comfort care plan. Pain and distress in the last 48 hours was documented in 55% of patients who died in the general wards. Respiratory symptomatology and painful skin conditions accounted for most discomfort. Half (36/72) the patients with pain and distress, including 16 with a comfort care plan, received no analgesia. Conclusions drawn found that, despite clinical uncertainty, doctors made tough end of life decisions that included DNR orders and comfort care plans. The lower rate of comfort care plans suggests doctors had difficulty making the transition from curative to palliative care. Many comfort care plans were incoherent and included interventions unlikely to promote patients' comfort. In light of the HIV/AIDS pandemic in SA, reforms are needed to integrate palliative care within mainstream hospital medicine. However, without adequate human resources including trained interpreters, doctors and nurses will struggle to deliver optimal terminal care in acute hospitals.
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PMID:End of life care in HIV-infected children who died in hospital. 1287 69

The assessment of quality of life (QoL) is central to understanding how people's lives are affected by HIV infection. A reliable and valid measurement tool developed for cross-cultural use will be important in evaluating the global impact of the disease. This paper reports on the development and preliminary assessment of the WHOQOL-HIV pilot instrument that is designed for use with the WHOQOL-100 for persons living with HIV and AIDS (PLWHA). In this study, 900 people with a mean age of 32 from six culturally diverse sites completed the WHOQOL-100 along with 115 HIV specific items. Respondents were HIV asymptomatic (23%), HIV symptomatic (23%), had AIDS (20%) or were well (34%). Analyses to select the best items from the piloted instrument resulted in the inclusion of 33 items covering 12 new facets for a field trial version of the WHOQOL-HIV instrument; e.g. symptoms of HIV, body image, social inclusion, death and dying, and forgiveness. The results indicate excellent internal consistency for the scale (alpha=0.98) and its domains (alpha=0.87-0.94). For PLWHA, pain and discomfort, positive feelings, dependence on medication, sexual activity, financial resources and spiritual connection were particularly poor, indicating that the severest impact of HIV extends beyond physical well-being to the psycho-social-spiritual and environmental areas of QoL. Comparisons using ANOVA showed that persons who are at later stages of HIV infection, or are currently ill report poorer QoL than those that were well (p<0.01). Women report poorer QoL than men for almost every facet (p<0.01) and older persons (>30) reported lower negative feelings, and better social inclusion, spiritual connection, forgiveness and spiritual experience than younger persons. Finally, those with no education, or only primary education showed some of the poorest means. It is concluded that these new items and facets add value for measurement of QoL in PLWHA.
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PMID:Preliminary development of the World Health Organsiation's Quality of Life HIV instrument (WHOQOL-HIV): analysis of the pilot version. 1289 9

While the standard 200-item version of the Paced Auditory Serial Addition Task (PASAT) is a sensitive neuropsychological instrument, it can be quite aversive to some patients due to its length and progressively increasing difficulty. We present demographically-corrected norms for 50 and 100-item short-form versions in a sample of 560 neurologically normal adults. Age, education, and ethnicity (but not gender) were found to be significant predictors of performance. In a clinical sample of 786 HIV-infected adults, diagnostic accuracy of the 50, 100, and 200-item versions was essentially equivalent (using clinical ratings of a comprehensive neuropsychological battery as the gold standard, overall classification rates of the three PASAT versions were 71%, 74%, and 73%, respectively), with better specificity (89-92%) than sensitivity (46-53%). The 50-item version showed moderate ceiling effects, but the 100-item test did not. In a mixed clinical sample of 40 subjects, the 50-item version was administered more than twice as fast as the 200-item version, and was tolerated better (discomfort rating of 4.0 vs. 5.9 on a 10-point scale, p < .05). We conclude that in many cases the PASAT-50 and PASAT-100 provide equivalent diagnostic accuracy with a significant reduction in administration time and patient discomfort.
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PMID:The 50 and 100-item short forms of the Paced Auditory Serial Addition Task (PASAT): demographically corrected norms and comparisons with the full PASAT in normal and clinical samples. 1291 Nov 8

The AIDS crisis has challenged black churches to examine how to provide spiritual support to individuals who are living with HIV. The dilemmas facing some black churches have been specifically related to providing support without embracing homosexuality. The doctrine guiding some black churches has caused psychological discomfort for both homosexual and heterosexual HIV infected individuals because of the stigma associated with HIV. Previous research showed that heterosexuals reported more distress than homosexuals. The purpose of this study was to examine a subset of African Americans (n = 49) who were heterosexual. Data were drawn from a larger data set (N = 117) collected in California. All participants were HIV seropositive or had AIDS. A questionnaire examining existential and religious well-being, demographic variables, and depression was administered. Religious well-being and existential well-being together explained 32% of the variance in depression. Implications for mental health nurses are discussed.
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PMID:The contribution of religious and existential well-being to depression among African American heterosexuals with HIV infection. 1466 Mar 19

An application for access to an experimental hepatitis C drug under Canada's Special Access Programme has been turned down. In the process, Canada's drug regulators have created discomfort and uncertainty about how the Special Access Programme is managed.
Can HIV AIDS Policy Law Rev 2002 Dec
PMID:Regulators deny access to experimental hepatitis C drug. 1471 94


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