Psychosocial and economic aspects of HIV/AIDS and counseling of caretakers of HIV-infected children in Uganda

Department of Health Care and Culture, Faculty of Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
AIDS Care (Impact Factor: 1.6). 11/2000; 12(5):535-40. DOI: 10.1080/095401200750003725
Source: PubMed


The knowledge that her child is infected puts a heavy emotional burden on a mother. Despair or depression lead to difficulties in reacting to the options and advice given by health workers. The compliance of the mother also is largely dependent on her acceptance of the HIV status of the child. Additionally, the belief that the child might die any moment may cause her not to take proper care of the child anymore. Worries of the caretakers are frequently related to poverty. Counselling of caretakers at the health centre could and should be an important element in care for HIV-infected children. Psychological and material support and advice concerning HIV infection, proper childcare and material problems may empower the caretakers. This may lead to a better follow-up of the child by health care workers and to increased compliance of and better care by the caretaker, which will improve life and survival of an infected child.

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Available from: Ivan Wolffers, Sep 15, 2014
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    • "Health workers have their own peculiar challenges, which could influence their relationship and communication with clients and encourage them to adopt appropriate behaviours. They may be reluctant to be tested as a result of stigma [47], fear contamination, pessimistic and doubtful of their ability to provide care [48,49]. Conversely, a good rapport between providers and clients is an important determinant of patients’ acceptance of clinic-based interventions, including testing [50]. "
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    ABSTRACT: Background HIV testing and counseling (HTC) remains critical in the global efforts to reach a goal of universal access to prevention and timely human immunodeficiency virus (HIV) treatment and health care. Routine HIV testing has been shown to be cost-effective and life-saving by prolonging the life expectancy of HIV patients and reducing the annual HIV transmission rate. However, these benefits of routine HIV testing may not be seen among pregnant women attending antenatal clinic (ANC) due to health facility related factors. This paper presents the influence of health facility related factors on HTC to inform HTC implementation. Methods The study was cross-sectional in design and used structured questionnaire and interview guides to gather information from 300 pregnant women aged 18 to 49 years and had attended ANC for more than twice at the time of the study. Twelve health workers were interviewed as key informants. Respondents were selected from the five sub metro health facilities in the Kumasi Metropolis through systematic random sampling from August to November 2011. Pregnant women who had not tested after two or more ANC visits were classified as not utilizing HTC. Data was analyzed with STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level. Results Twenty-four percent of the pregnant women had not undergone HTC, with “never been told” emerging as the most cited reason as reported by 29.5% of respondents. Decisions by pregnant women to take up HTC were mostly influenced by factors such as lack of information, perceptions of privacy and confidentiality, waiting time, poor relationship with health staff and fear of being positive. Conclusions Access to HTC health facility alone does not translate into utilization of HTC service. Improving health facility related factors such as health education and information, confidentiality, health staff turnaround time and health staff-client relationship related to HTC will improve implementation.
    BMC Health Services Research 06/2014; 14(1):267. DOI:10.1186/1472-6963-14-267 · 1.71 Impact Factor
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    • "The improvement of training and support for informal and professional carers appears as a recurrent recommendation to lessen the burden of care. Identified areas of training include: basic hygiene, clinical aspects of care, symptom management (including fear of opioid addiction), prevention of patient to carer infection, care for children, counselling for patients and families, home-based care, information provision, and psychiatric and bereavement care [17,18,23,25,28,30,33,34,36,42,44-47]. Mtalane et al. recommended training for professional carers regarding the emotional, spiritual and cultural needs of the dying patient [48]. "
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    ABSTRACT: End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence. Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format. Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process. The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.
    BMC Palliative Care 03/2011; 10(1):6. DOI:10.1186/1472-684X-10-6 · 1.78 Impact Factor
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    • "The perceived usefulness of knowing a child's HIV status is important as it may promote acceptance and coping with the results and encourage caregivers' aspirations for the child's future, thereby improving the quality of care. The finding on high aspirations in this study differs from views expressed in a Ugandan study, indicating that some mothers would not care for an HIV positive child as the child would die anyway (Brouwer et al. 2000). Although the high aspirations could be real, they may also be unrealistic as studies have documented higher levels of wishful thinking among caregivers of HIV positive children than of HIV negative children (Klunklin and Harrigan 2002). "
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    ABSTRACT: Caregivers of young children identified as HIV positive, residing in Agincourt, rural South Africa were advised of their child’s status. How was this knowledge received, and how did it influence care-giving and support? Interviews were conducted in May to June 2008 with caregivers of HIV positive children aged 1–5 years, 1 year following the child’s HIV test and disclosure of status. Drawing on data from 31 semi-structured questionnaires and 21 in-depth interviews, we describe caregivers’ attitudes, reactions, fears and aspirations after learning a child’s HIV status, the perceived usefulness of the knowledge, barriers to care-giving and support received. Sociodemographic data collected through the questionnaire were analysed using Stata. Qualitative data were coded in NVIVO 8 and analysed inductively to identify themes and their repetitions and variations. Although almost half of the caregivers responded negatively initially, 1 year later, almost all had accepted and valued knowing their child’s HIV status as this had enhanced their competency in care-giving. Counselling from health providers and personal spirituality helped caregivers to accept the child’s status and cope with its implications. Most caregivers had high aspirations for the child’s future, despite some expressed difficulties associated with care-giving, including financial constraints, information gaps and barriers to healthcare. The results indicate an opportunity for paediatric HIV screening in communities with high HIV prevalence. This would facilitate early uptake of available interventions, so enhancing the survival of HIV positive children.
    Health & Social Care in the Community 04/2010; 18(3):264 - 271. DOI:10.1111/j.1365-2524.2009.00891.x · 1.15 Impact Factor
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