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Many studies have been undertaken in the last 10 years to determine the prevalence of both human immunodeficiency virus (HIV) infection and drug use in pregnant women. These studies could have a serious impact on the delivery of health care as well as the development of health policy. We provide an overview of the key findings from these studies and a critical review of their strengths and weaknesses. For example, although many prevalence studies were conducted with enough participants to reach statistical significance, flaws in study design limit the generalizability of the findings. In addition, the development of profiles, risk groups, or characteristics was an unsuccessful method of identifying pregnant women at risk for drug use or HIV infection. These findings have implications for the type of screening procedures that are undertaken in the clinical setting and the development of health policy at various levels of government. We also conclude that the issue of stigma and discrimination in relation to drug and HIV testing, as well as race, gender, and socioeconomic status, must be addressed. Finally, we outline how these studies could have a significant effect on the health of pregnant women.
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PMID:Prevalence of human immunodeficiency virus infection and drug use in pregnant women: a critical review of the literature. 914 Aug 52

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV.
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PMID:General paralysis of the insane and AIDS in old age psychiatry: epidemiology, clinical diagnosis, serology and ethics--the way forward. 988 13

Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.
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PMID:Burnout and AIDS care-related factors in HIV community clinical nurse specialists in the North of England. 1021 92

Our purpose in this paper is to demonstrate how stigma pervades the lives of human immunodeficiency virus (HIV)-positive mothers and their children. Data from a grounded theory study on HIV-positive mothers are used to illustrate Goffman's theory of stigma. This research is an example of "emergent fit," where extant theory is discovered by the interpretive researchers to fit much of the data. The sample included 18 HIV-positive mothers who participated in in-depth interviews. The HIV-positive mothers valued being perceived as normal but acknowledged that normalcy was lost for them because of the stigma of HIV. Consequently, they tried to pass as normal by managing information and manipulating their environment. They attempted to cover up their illness by lying and pretending. Health care professionals can provide quality, client-centered care when they understand the power that stigma holds over these women and the strategies that effectively mitigate the stigma.
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PMID:HIV-positive mothers and stigma. 1033 59

Women at risk for human immunodeficiency virus (HIV) infection are often poor and members of racial or ethnic minorities. In addition to legal concerns that might be common among persons with similar sociodemographic characteristics, HIV infection adds the potential of possible stigma and discrimination, as well as the prospect of illness and increased mortality. To determine women's perceptions of need for and access to legal services and whether such perceptions are affected by HIV infection, from November 1993 through September 1995 we interviewed 509 women with or at risk for HIV infection by virtue of injection drug use or high-risk sexual behaviors in New York and Baltimore, Maryland. A majority of women, regardless of HIV serostatus, reported current or future needs for legal assistance with government benefits. More than 25% reported needing current or future legal help with housing, debts, arrangements for care of children, a will, and advance directives. Substantial minorities of women reported other legal needs. HIV-positive women were significantly more likely to report anticipated future need for help with paternal custody or visitation, current need in making a will, and anticipated future assistance with advance directives. For most items, a majority of women thought they knew where to receive help. However, among women reporting a current need, only a minority actually were receiving legal assistance. This study suggests that the extent of legal needs among women with or at risk for HIV infection is substantial, and that few receive legal assistance. With few exceptions, at least for women early in the course of illness, HIV infection does not appear to alter the pattern or extent of legal needs. There are dramatic differences, regardless of HIV status, between expectation and reality in women's access to legal services.
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PMID:Self-reported legal needs of women with or at risk for HIV infection. The Her Study Group. 1060 93

The acquired immunodeficiency syndrome and human immunodeficiency virus have had a major impact on the practice of medicine in the past 2 decades. Medical professionals are once again faced with a lethal contagious disease that has been transmitted in the health care setting to both patients and providers. Because of the stigma and fear associated with the infection, civil rights legislation, such as the Americans With Disabilities Act, has been used to protect infected individuals from inappropriate discrimination based on unwarranted fears and public hysteria. Various courts, with the backing of organized medicine and the public health authorities, have made it clear that it is illegal for a physician to refuse to treat a patient based on the patient's seropositivity. Unfortunately, various courts, with the backing of the American Medical Association and the Centers for Disease Control and Prevention, have made it clear that infected physicians are not necessarily afforded equal protection under the civil rights statutes.
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PMID:AIDS, surgery, and the Americans With Disabilities Act. 1063 47

Dealing with the reality of the human immunodeficiency virus (HIV) is a life-changing challenge to perinatal women as they try to care for themselves and their children in environments that often include stigma, uncertainty, and limited access to information and health care. Our purpose for this interpretive hermeneutic study was to identify factors that women with HIV saw as helping or impeding their participation in their health care. We analyzed the qualitative data from open-ended interviews conducted with 18 women. We identified the facilitating themes of "Staying Healthy for Kids," "God Has His Reasons," and "My Family's There for Me." Barriers were "It Hurts to Know," "Health Care System Struggles," and "Kids and Buses and Taxies." We found that the women identified "Health Care Providers' Behaviors" as both an enhancing and an impeding factor to their health care participation. These findings can guide providers to offer more "user-friendly" support systems for women with HIV and their children.
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PMID:Health care participation of perinatal women with HIV: what helps and what gets in the way? 1088 35

An essential component of efforts to prevent new human immunodeficiency virus (HIV) infections in the United States is the use of voluntary HIV counseling and testing by persons at risk for HIV, especially members of underserved populations (1). To increase the number of persons at risk for HIV who receive voluntary HIV counseling and testing services, barriers to these services must be identified and removed. The stigmatization of persons infected with HIV and the groups most affected by HIV, including men who have sex with men and illicit drug users, is a barrier to testing (2,3). Measuring public attitudes and knowledge about HIV transmission to determine the prevalence and the correlates of stigmatizing attitudes is important for guiding efforts to remove barriers to HIV prevention. This report describes the results of a national public opinion survey conducted through the Internet to measure indicators of HIV-related stigma and knowledge of HIV transmission. The findings indicate that most persons do not have stigmatizing views.
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PMID:HIV-related knowledge and stigma--United States, 2000. 1118 10

Disclosure of human immunodeficiency virus (HIV) status is a difficult emotional task creating opportunities for both support and rejection. For Asian patients there may be additional self-imposed barriers to disclosure that are rooted in cultural values. The purpose of this article is to describe how Asian cultural values of harmony and avoidance of conflict affect the disclosure experiences of HIV-positive Asian American and immigrants. Effective practice guidelines have been developed based on this information. Based on in-depth interviews with 16 HIV-positive Asian men, three focal issues were identified that serve as barriers to disclosure to family members: protection of family from shame, protection of family from obligation to help, and avoidance of communication regarding highly personal information. Additionally, patients felt disclosure was inhibited by the lack of HIV education to which families living overseas may have access. This is compounded by their lack of access to translated materials that they could send to family members. Similar to past disclosure research with non-Asian samples, the findings suggest that gay Asian men seek emotional support from gay friends. They would consider disclosing to relatives only when health reasons necessitated it. It is essential that helping professionals be attentive to the dishonor that patients may experience through disclosure and the stigma associated with being gay. Patients who are considering making a disclosure may need assistance with thinking through ways to provide HIV/acquired immune deficiency syndrome (AIDS) education to those family members that have little knowledge in this area. This may include translating or locating informational brochures translated into the family's language.
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PMID:Disclosure of HIV status: cultural issues of Asian patients. 1122 33

Disclosure of the diagnosis of human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) to a child is a controversial and emotionally laden issue. To understand the factors that affect the process of disclosure and its consequences, we studied 99 parent-child dyads recruited from patients being treated at the National Cancer Institute (NCI). Parents and HIV-infected children were interviewed and administered several standardized measures. Parental depression, family environment, social support satisfaction, socioeconomic status, child and parent gender, child's age, parental HIV serostatus, and disease severity were used to predict disclosure status. Results indicate that the majority of caregivers do disclose the diagnosis to the child, usually with no ill effects, and that age is the most significant predictor of whether or not a child has been told. The Centers for Disease Control and Prevention currently estimate that there are over 6611 children with AIDS (under age 13), and 2184 adolescents with AIDS (ages 13-19) in America. As an increasing number of children who are born infected with HIV live to older ages, the question of when and how to talk with them about their illness becomes more crucial. In addition to the growing number of children infected with HIV, there are many thousands of children profoundly affected by the impact of this disease on a close family member--a mother, father, sibling, or other relative in the kinship network. Yet, the initial reaction most adults have upon learning of their own, or of a family member's, HIV diagnosis is that the diagnosis must be kept a closely guarded secret. One reason frequently cited by parents and family members is their fear that the stigma of AIDS will have a negative impact on their children and their families. Disclosure of an HIV diagnosis to a child is a controversial and emotionally laden issue in the pediatric health-care community as well. However, no systematic research has studied the issues that surround disclosure of an HIV diagnosis to the patient and the factors that predict disclosure.
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PMID:Factors associated with disclosure of diagnosis to children with HIV/AIDS. 1136 89


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