The Population Council/Horizons (New Delhi and Washington, DC) and the Society for Service to Urban Poverty (New Delhi) are conducting an operations research study in three New Delhi hospitals. The study, entitled "Improving the hospital environment for HIV-positive clients in India," is endorsed by the National AIDS Control Organization (NACO) of India. The main objective is to assess factors that affect the quality and type of care received by the general patient population, with special emphasis on patients with HIV. Another objective is to assess and address factors that affect staff safety with respect to infectious diseases. As part of the study, a practical checklist was developed that can be used by managers and others to identify institutional strengths, pinpoint problems, and set goals for improvement of services for people living with HIV/AIDS (PLHA) and staff safety. The PLHA-friendly Achievement Checklist is intended as a self-assessment tool for managers to use in gauging how well their facility reaches, serves, and treats HIV-positive patients. NACO plans to distribute the checklist to all government medical facilities throughout India.
SummaryAccess to voluntary counselling and HIV testing (VCT) remains limited in most parts of Ghana with rural populations being the least served. Services remain facility-based and employ the use of an ever-dwindling number of health workers as counsellors. This study assessed approval for the use of lay counsellors to promote community-based voluntary counselling and testing for HIV and the extent of HIV/AIDS-related stigma in the Kassena-Nankana district of rural northern Ghana. A cross-sectional questionnaire survey was conducted. Logistic regression was used to identify predictors of the tendency to stigmatize people living with HIV/AIDS (PLWHAs). Focus group discussions were held and analytical coding of the data performed. The majority (91·1%) of the 403 respondents indicated a desire to know their HIV status. Most (88·1%) respondents considered locations outside of the health facility as preferred places for VCT. The majority (98·7%) of respondents approved the use of lay counsellors. About a quarter (24%) of respondents believed that it was possible to acquire HIV through sharing a drinking cup with a PLWHA. About half (52·1%) of the respondents considered that a teacher with HIV/AIDS should not be allowed to teach, while 77·2% would not buy vegetables from a PLWHA. Respondents who believed that sharing a drinking cup with a PLWHA could transmit HIV infection (OR 2·50, 95%CI 1·52–4·11) and respondents without formal education (OR 2·94, 95%CI 1·38–6·27) were more likely to stigmatize PLWHAs. In contrast, respondents with knowledge of the availability of antiretroviral (ARV) drugs were less likely to do so (OR 0·40, 95%CI 0·22–0·73). Findings from the thirteen focus group discussions reinforced approval for community-based VCT and lay counsellors but revealed concerns about stigma and confidentiality. In conclusion, community-based VCT and the use of lay counsellors may be acceptable options for promoting access. Interventional studies are required to assess feasibility and cost-effectiveness.
AbstractIntroductionPersons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services. The coexistence of psychiatric and dental problems in PLWHA leads to more complex diagnostic assessments and treatments compared to the general population. The aim of the present study was to identify relevant themes from the perspectives of important stakeholders regarding the barriers to and facilitators of patient referral to these services.MethodSemi‐structured Key Informant Interviews (KIIs) were conducted with nine program directors and other key staff from New York State HIV clinics to examine barriers to and facilitators of successful dental and mental health referrals and factors that affect patient motivation.ResultsPrimary themes crystalized around dental and mental health referral, subject knowledge and perspective, patient barriers, and strategies to overcome barriers. Identified barriers included mental health and HIV status stigma, social determinants of health, fear, disconnectedness, and inconsistent access for dental care. Facilitators identified included case management, integrated one‐stop‐shop care, and interprofessional awareness and collaboration. Potential patient motivators included process improvement strategies such as transportation support, case management, incentives, and building trust.ConclusionSpecific strategies to facilitate patient motivation such as care coordination and interprofessional collaboration is useful for improving dental and mental health referrals.
In the wake of the AIDS crisis, 'traditional' Thai medicine has received new attention as a means by which people living with HIV and AIDS (PLWHA) can receive some level of care. The revitalization of Thai medicine, however, is complicated by the competing organizational politics and social dynamics that regulate discourses and practices of health and health care in Thailand. This paper examines how Thai medicine is being (re)placed in the context of competing health-care systems and practices. Specifically, this analysis focuses on the complex interrelationships between 'traditional,' holistic medicine and 'modern,' allopathic medicine in a Thai context; and investigates the role of 'Thai medicine' (phaet phaen thai) and 'village medicine' (phaet pheun baan) as part of governmental and non-governmental efforts to provide health care to PLWHA in Chiang Mai, Thailand. The provisioning of such health care, however, takes place within the context of a struggle over 'local knowledge' and 'global change' and the ways in which places are organized in relation to the available treatment regimens for HIV/AIDS care. What this paper suggests is that the meanings of health and health care are inextricably linked to the complex, contested nature of social relations as they flow in, and are reworked through, particular places.
In the wake of the AIDS crisis, 'traditional' Thai medicine has received new attention as a means by which people living with HIV and AIDS (PLWHA) can receive some level of care. The revitalization of Thai medicine, however, is complicated by the competing organizational politics and social dynamics that regulate discourses and practices of health and health care in Thailand. This paper examines how Thai medicine is being (re)placed in the context of competing health-care systems and practices. Specifically, this analysis focuses on the complex interrelationships between 'traditional,' holistic medicine and 'modern,' allopathic medicine in a Thai context; and investigates the role of 'Thai medicine' (phaet phaen thai) and 'village medicine' (phaet pheun baan) as part of governmental and non-governmental efforts to provide health care to PLWHA in Chiang Mai, Thailand. The provisioning of such health care, however, takes place within the context of a struggle over 'local knowledge' and 'global change' and the ways in which places are organized in relation to the available treatment regimens for HIV/AIDS care. What this paper suggests is that the meanings of health and health care are inextricably linked to the complex, contested nature of social relations as they flow in, and are reworked through, particular places.
Background: Karo District is one of the districts in North Sumatera province where from 2016 to 2018 the number of HIV sufferers increased dramatically to 384 people and then it increased to 775 people up to September 2020. The aim of this study was to explore the experiences of people with HIV/AIDS and the experiences of the church members regarding people living with HIV/AIDS (PLWHA).Design and Methods: Qualitative research design with descriptive phenomenology approach. Data collection was carried out by interviewing 34 participants in Karo District. The data analysis in this study used the Collaizi technique.Results: Five themes were obtained from the results of the study, namely the responses of the participants diagnosed with HIV/AIDS, health problems faced by PLWHA, stigma and discrimination, the support of family and church members given to PWLHA, and family/church members' expectations toward PLWHA.Conclusions: Based on the findings of the themes, the role of the National AIDS Commission of Moderamen Karo Batak Protestant Church (GBKP) in responding to HIV and AIDS cannot be optimally implemented because of some obstacles namely, localization which is a determinant of the spread of cases, the unavailability of service and ARV in all health centers, lack of sectoral cross-cooperation, very insufficient financial support from the government, the role of nurses played only in the hospitals and the stigmatism to those people with HIV/AIDS due to lack of knowledge of HIV and AIDS.
The number of HIV/AIDS and Sexually Transmited Infectious Diseases (PIMS) incidence in Indonesia, especially in Central Java are growing every year. Provincial government set a regulation in controlling disease that refers to the HIV/ AIDS Control Program and PIMS in the First Level of Health Facilities by the Ministry of Health in 2016. It is hoped that this program can break the chain of HIV/AIDS and PIMS cases while at the same time making a generation that healthy and productive quality. The aim of this study was to determine the implementation of programs to control HIV/AIDS and PIMS in Banyumas regency. The design of this study was descriptive qualitative through in-depth interviews. The main informants were ten HIV Counseling and Testing (KTHIV) of Public Health Center, triangulation informants were People Living With HIV/AIDS (PLWHA) patients, Clinical Doctors, Head of Department of Health Services P2P. The data were collected by in-depth interview technique. In addition to the interview, a survey was also conducted with PLWHA. Processing and analysis of data were using taxonomic analysis. The implementation of HIV/AIDS control program policies has not been optimal in its implementation. The lack of optimal implementation of HIV/AIDS and PIMS prevention policies is due to several aspects, i.e. policy accuracy, implementation accuracy, target accuracy, environmental accuracy, and process accuracy. Increasing monitoring and evaluation related to a program's policies is needed. Morover, it is important to improve the quality of human resources and careful planning related to the control program.
Optimal and strict adherence to Antiretroviral Viral Therapy a need for over the long period to achieve the goals of ART and obtain maximum benefits of ART. However, PLWHA find it very difficult to take ARVs drug as precisely as they should for a number of reasons. Therefore, this study aimed at examining the level of antiretroviral therapy adherence and identifying possible associated factors for ART adherence behavior in Jimma zone government ART facilities. A facility based cross-sectional study was conducted in the ART clinics of Jimma zone governmental health facilities in which ARV treatment supplied from November 25/2015 – February 30/2016 for a period of 4 months. 352 adult PLWHA (190 female and 162 male) ranged in age from 15-62 years (Mean=37.1, SD= 8.95), with 100% response rate, were our study participants. Binary logistic regression was used to perform bivariate and multivariate analyses to determine the association between study variables and ART adherence status. 259(73.6%) participants were adherent (>=95%) and 93(26.4%) were non-adherent (<95%) to the prescribed dose of ARV drugs over the past seven days prior to the interview. The main reasons for skipping the prescribed ARV drugs were, busyness (78.5%), having too many pills (71%), felt depressed (68.8%), taking the drugs reminded HIV infected (66.7%), did not want other see (62.4%), and felt asleep(60.2%). The last stepwise regression analysis revealed that, educational status, knowledge of HIV/AIDS, use of additional drugs and access to reliable pharmacy were significantly associated with ART adherence status. So, efforts to maximize ART adherence should focus on addressing these associated significant factors.
Optimal and strict adherence to Antiretroviral Viral Therapy a need for over the long period to achieve the goals of ART and obtain maximum benefits of ART. However, PLWHA find it very difficult to take ARVs drug as precisely as they should for a number of reasons. Therefore, this study aimed at examining the level of antiretroviral therapy adherence and identifying possible associated factors for ART adherence behavior in Jimma zone government ART facilities. A facility based cross-sectional study was conducted in the ART clinics of Jimma zone governmental health facilities in which ARV treatment supplied from November 25/2015 – February 30/2016 for a period of 4 months. 352 adult PLWHA (190 female and 162 male) ranged in age from 15-62 years (Mean=37.1, SD= 8.95), with 100% response rate, were our study participants. Binary logistic regression was used to perform bivariate and multivariate analyses to determine the association between study variables and ART adherence status. 259(73.6%) participants were adherent (>=95%) and 93(26.4%) were non-adherent (<95%) to the prescribed dose of ARV drugs over the past seven days prior to the interview. The main reasons for skipping the prescribed ARV drugs were, busyness (78.5%), having too many pills (71%), felt depressed (68.8%), taking the drugs reminded HIV infected (66.7%), did not want other see (62.4%), and felt asleep(60.2%). The last stepwise regression analysis revealed that, educational status, knowledge of HIV/AIDS, use of additional drugs and access to reliable pharmacy were significantly associated with ART adherence status. So, efforts to maximize ART adherence should focus on addressing these associated significant factors.
Background The adoption of the UNAIDS 90-90-90 targets acceleration plan and the implementation of 'test and treat' strategy has resulted in a significant increase in the number of people living with HIV/AIDS (PLWHA) receiving lifelong antiretroviral therapy (ART). To improve and sustain ART retention in care and virologic suppression, innovative service delivery models are needed. In 2010, Médecins Sans Frontières (MSF) set-up decentralized community ART refill centres ("poste de distribution communautaire", PODI) for follow-up of stable ART patients from Kabinda Hospital (CHK), in Kinshasa, Democratic Republic of Congo. Objective To assess retention in care and virologic suppression on ART after transfer to the three main PODIs in Kinshasa. Methods A retrospective cohort study was conducted using routine program data for PLWH aged >15 years and stable on ART transferred from CHK to a PODI between January 2015 and June 2017. Kaplan-Meier analysis was used to estimate retention in care. Viral load (VL) suppression was defined as a VL ≤ 1000 copies/ml. Results A total of 337 patients were transferred to a PODI. Of these, 306 (91%) patients were on ART 12 months after transfer to PODI and were eligible for the 12-month routine VL testing. A total of 118 (39%) had VL done at 12 months; VL suppression was 93% (n=110). Median time from enrolment into PODI to 12-month routine VL was 14.6 months [IQR: 12.2-20.8]. Overall, 189 (62%) patients had at least one VL load test done during follow-up. Retention in PODI at 6, 12 and 18 months was 96%, 92% and 88% respectively. Retention at 18 months was statistically different between PODIs; 91%, 88% and 78% in PODI East, PODI West and PODI Central respectively, (p=0.0349). Conclusion Retention and VL suppression in community-based ART refill centers were high, although VL coverage was low. HIV programs need to scale–up VL testing services PLWHA receiving ART in PODIs.
Objective: To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. Design: A crossover randomized controlled trial in four sites. Setting: Government ART centres (ARTCs) offering core services in the greater Mumbai area. Participants: Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. Intervention: Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. Main outcome measure: HIV stigma, measured using the 16-item Berger Stigma scale. Methods: The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. Results: At baseline, 57% of participants had moderate-high levels of stigma (scores > 40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: βcoeff = −9.71; p < 0.001; group intervention: βcoeff = −5.22; p < 0.001; individual counselling: βcoeff = −4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (βcoeff = −10.29; p < 0.001), followed by GI+CA+IC (βcoeff = −8.23, p < 0.001). Conclusion: Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program.
People living with HIV/AIDS (PLWHA) hope to live healthily, so that Peer Support Group (PSG) responds to the PLWHA's psychosocial and medical needs. The objective of research was to study the Solo Plus PSG's intervention to the change of PLWHA's health behavior in Surakarta. This qualitative research with case study approach was conducted on the chairperson and members of Solo Plus, People Affected by HIV/AIDS (PABHA), Surakarta AIDS Commission, health workers, and NGOs caring about AIDS in Surakarta. Data was collected through observation, in-depth interview, and documentation, while data validation was carried out using source triangulation. The explanatory analysis technique used in this case study was Simmel's social shape and Schramer's U theories. The result of research showed that Solo Plus held monthly routine meeting for information on the session attended by many parties like psychiatrist, herbalist, Voluntary Counseling and Testing (VCT); psychosocial support members; improved the capacity of organization and PSG members with training, policy advocacy and public awareness through harings with government; initiated the establishment of satellite PSG in surrounding areas to support PLWHA; participated actively in socializing the prevention of HIV to community; gave testimony in many events; supported Care Support and Treatment (CST) care, case management, such as VCT referral, CST, Local Health Insurance, CD 4 test, liver and kidney function test, Prevention of Mother to Child Transmission (PMTCT); provided Supplementary Food; and facilitated PLWHA in Penitentiary, visited hospitals and houses; supported the sustainable livelihood of PSG members; and developed network. Keywords: Community intervention, behavior change, peer support group AbstrakOrang dengan HIV/AIDS (ODHA) berharap dapat sehat, sehingga Kelompok Dukungan Sebaya (KDS) merespons atas kebutuhan psikososial medis ODHA. Tujuan penelitian ini mengkaji intervensi KDS Solo Plus terhadap perubahan perilaku kesehatan ODHA di Surakarta. Penelitian kualitatif dengan pendekatan studi kasus ini dilakukan terhadap ketua dan anggota Solo Plus, Orang Hidup dengan HIV/AIDS (OHIDA), Komisi Penanggulangan AIDS Kota Surakarta, petugas pelayanan kesehatan, dan LSM peduli AIDS di Surakarta. Data dikumpulkan dengan observasi, wawancara mendalam dan dokumentasi, serta untuk menguji validitas data digunakan triangulasi sumber. Teknik analisis eksplanasi studi kasus ini menggunakan teori bentuk sosial dari Simmel dan teori U dari Schramer. Hasil penelitian menunjukkan bahwa Solo Plus melakukan pertemuan rutin bulanan untuk info sesi dari berbagai pihak, seperti psikiatri, herbalis, Voluntary Counseling and Testing (VCT); memberi dukungan psikososial; peningkatan kapasitas organisasi dan anggota KDS dengan pelatihan; advokasi kebijakan dan penyadaran publik melalui audiensi dengan pemerintah; menginisiasi pembentukan KDS satelit di sekitarnya untuk mendukung ODHA; terlibat aktif dalam sosialisasi pencegahan HIV ke masyarakat; testimoni di berbagai even; mendukung layanan Care Support and Treatment (CST); manajemen kasus, seperti rujukan VCT, CST, Jaminan Kesehatan Daerah; test CD 4, test fungsi hati dan ginjal, Prevention of Mother to Child Transmision (PMTCT); Pemberian Makanan Tambahan, dan pendampingan ODHA di Lembaga Pemasyarakatan, kunjungan di rumah sakit maupun di rumah; mendukung keberlanjutan mata pencaharian anggota KDS serta mengembangkan jaringan kerja. Kata kunci : Intervensi komunitas, perubahan perilaku, kelompok dukungan sebaya
At the conclusion of the Paris AIDS Summit in 1994, 42 governments issued a declaration supporting the greater involvement of people living with HIV/AIDS (PLHA) in policy formulation and service delivery. Despite growing recognition of its importance, there has been little research that examines PLHA involvement in the delivery of prevention, care, and support services in developing countries and its effects on PLHA, others affected by HIV/AIDS, and nongovernmental organizations (NGOs). To address this gap, the Horizons Program and the International HIV/AIDS Alliance conducted a study of PLHA involvement in NGOs in Burkina Faso, Ecuador, Maharashtra State, India, and Zambia between October 1998 and August 2001. As noted in this brief, the goal of the study was to identify the conditions that foster PLHA involvement and the strategies that organizations can use to achieve meaningful involvement of PLHA. Seventeen NGOs participated in the study, which focuses on HIV/AIDS prevention, care, and support. The NGOs chosen represent different types of organizations and a range of PLHA involvement.
ABSTRACTLittle is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3–4 and; 23% had 5–29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard‐to‐engage populations should consider these findings when planning interventions.
The purpose of this research is to know the strategy to survive a transvestite in HIWASO comunity who infected with HIV/AIDS, and to know the role of HIWASO to take care their member how infected HIV/AIDS.This research used social action theory by Max Weber that contain 4 kind of social action that is zwerk rational, werk rational, act of affection, and traditional action. The kind of this research is qualitative with case studies approachment. The data is taken with in depth interviews technique, observation, and documentation. The technique of selecting informant uses purposive sampling technique. Source triangulation is used to ensure the validity of data used triangulation source, while the analysis of the data used is an interactive model.From the results of the research, it can be concluded that survive strategy of transvestite with HIV/AIDS in HIWASO comunity is open status, motivation, and ARV therapy. Open status be the basic thing for transvestite with HIV/AIDS. In this case, more motivation that they get, more desire PLWHA can survive too. After got support, transvestite with HIV/AIDS in HIWASO get ARV therapy. That therapy must giving to them continously till the end. As for some role that doing by HIWASO to PLWH is between: help to pay therapy, as the third person in taking some donation by some one who care, reserve some place for member of PLWH. Meanwhile moral support is; support/motivation, as a companion for member who can't open teir status, reserve some place if his/her family reject him/her, as the public space for the one who infected, as ARV controler, and to be an alarm for them.That survive strategy if review with social action theory it can conclude if; (1) zwerk rational: ARV therapy survive (2) werk rational; active in KDS and government support (3) act of affection; support by HIWASO and keep his/her couple after infected by HIV (4) tradisonal act; there is structure language of transvestite. About the strategy of open status, it's not compatible if must review with sosial action theory by Weber. So in this case, the researcher expand werk rational theory by Weber to be rational awareness to review open status.Keywords : Survive Stategy, Transvestite, PLWHA
