Resilience in Relation to Adherence to Antiretroviral Therapy in People Living With HIV: A Qualitative Study.

Antiretroviral therapy (ART) adherence significantly impacts the survival and quality of life of people living with HIV (PLWH). Despite the challenges faced by PLWH, adherence remains crucial. Thus, cultivating resilience in ART is essential for optimal treatment outcomes. This qualitative study explored the experience of resilience in relation to ART adherence among PLWH. Semi-structured interviews with 10 participants were conducted and inductively analyzed. Participants' resilience in ART adherence was reflected in their achievements related to cultivating the habit of taking medication and in their convictions that the medication was a daily necessity. PLWH developed resilience through strategies encompassing finding purpose through faith and motivation, fostering wellness by obtaining adequate information, enjoying life, managing disease therapy, and adopting a healthy lifestyle, and building connections by finding adequate support and involving in the community. Nurses are crucial in HIV management, fostering resilience for successful ART adherence and ensuring effective treatment outcomes.

Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence.

This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.

Self-awareness as the key to successful adherence to antiretroviral therapy among people living with HIV in Indonesia: A grounded theory study.

Background: Adherence to antiretroviral therapy (ART) continues to pose a significant challenge for people living with HIV (PLWH). Non-adherence to ART can have far-reaching implications for patient well-being, particularly in increasing the risk of opportunistic infections when medication is not taken as prescribed. Objective: This study aimed to develop a theoretical model that explains how PLWH in Indonesia adhere to their ART regimen and the strategies they follow to maintain adherence. Methods: The study used a grounded theory approach. Data were collected through face-to-face in-depth interviews with 21 PLWH who had been taking ART for six months or more at a non-governmental organization (NGO) in Jakarta, Indonesia, between July 2019 and November 2019. Theoretical sampling was used, and the data analysis method of Corbin and Strauss was utilized, including open coding, axis coding, and selective coding. Results: Three stages were identified as a process of adherence to the ART regimen: 1) initiating ART, 2) missing the connection, and 3) taking control. Self-awareness was identified as the central core theme describing the ART adherence process. Conclusion: Having adequate self-awareness to take ART regularly is crucial to improving adherence to ART. Moreover, social support from one's spouse and family members can help patients maintain adherence. Therefore, self-awareness and support systems should be included as components in nursing interventions when starting ART therapy. In addition, nurses can help identify potential support persons and provide information related to ART therapy.

Classifying stigma experience of women living with HIV in Indonesia through the social ecological model.

Little is known how stigma theories apply to women living with HIV (WLWH). To apply stigma theories to WLWH, and locate within the dimensions of the Social-Ecological Model (SEM). Using a literature review and a theoretical subtraction to apply stigma forms to the SEM dimensions. WLWH begin to self-stigmatize, receive stigma based on fear from the family and community. Healthcare providers and society stigmatize WLWH by ascribing character flaws to them. The SEM allowed us to locate the dimensions of stigma and identify areas for future interventions for WLWH in Indonesia and other countries.

Spousal intimacy, type of antiretroviral drug and antiretroviral therapy adherence among HIV patients in Bandung, Indonesia.

BACKGROUND: Antiretroviral therapy (ART) has been proven effective in reducing the mortality rates among people living with HIV/AIDS (PLWH). However, poor adherence to ART may result in treatment failure. Few studies examine the relationship between spousal intimacy, type of ART and ART adherence. This study aimed to investigate the association between spousal intimacy, type of antiretroviral therapy (ART) and antiretroviral therapy adherence among PLWH in Bandung, Indonesia. DESIGN AND METHODS: A cross-sectional study was conducted involving 115 adult PLWH who were receiving ART at least for 6 months in RSUD Kota Bandung, they were selected with consecutive sampling.  The data were analyzed using chi-square test. RESULTS: The majority of PLWH (61.74%) reported had high level of spousal intimacy, about 93.91% PLWH used first line of ART, and 88.69% had high adherence in consuming ART. Spousal intimacy had a significant relationship to antiretroviral adherence (p<0.001) and type of ART (p=0.031, OR: 7.35) significantly associated with antiretroviral adherence. CONCLUSIONS: PLWH who have high levels of spousal intimacy also have high levels of antiretroviral adherence. PLWH on first-line ART were 7.3 times more adherent on ART.

Factors influencing transmission of tuberculosis in Ngeu Nata culture among Ngada community in Kupang, East Nusa Tenggara, Indonesia: Cross sectional study.

BACKGROUND: Eating "sirih/Betel" (Ngeu Nata) as a culture in Ngada society can become one of the primary sources of tuberculosis transmission due to sharing leaves and betel liquid reservoirs together with other people. If one of the people who share leaves is tuberculosis (TB) patient, it can transmit TB to other people. The purpose of this study was to identify the factors that influence tuberculosis transmission in "Ngeu Nata" culture using the health belief model approach. DESIGN AND METHODS: This study used cross-sectional, involving 110 respondents, selected by consecutive sampling.  The respondents were Bajawa ethnicity, age 36-67, at least consume Betel once a day together with other people in Ngada district, East Nusa Tenggara. RESULTS: The results showed that most respondents had high transmission behavior in betel-eating culture (51.8%). Factors related to TB transmission behavior: medical history of TB (p=0.028), knowledge about TB (p=0.038), the perception of TB severity  (p=0.037); the perception of benefits (p=0.039) and the perception of barrier (p=0.038). The dominant factor was knowledge, (OR 2.36 (95% CI) 1.01-5.51). CONCLUSION: Implication: nurses should include aspects of the "Ngeu Nata" culture in designing TB education for Bajawa ethnicity in order to prevent TB transmission in Ngada district, East Nusa Tenggara.

Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study.

BACKGROUND: Female sex workers play a crucial part in HIV transmission. Having unprotective condom during sexual activity can lead to HIV infection. Having lower power in condom negotiation with clients can lead  FSW not to using condoms during sexual activity. Alcohol consumption was also mediated HIV risk behavior among FSW. This study aimed to evaluate the relationship between condom use-negotiation, alcohol consumption and HIV-risk sexual behavior among female sex workers (FSW) in Kupang. DESIGN AND METHODS: A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The data were analyzed using univariate and the Chi-square test. RESULTS: The majority of FSWs (61.6%) reported had low negotiation condom use with their clients, about 77.6% reported high levels of alcohol consumption and 64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003) and alcohol consumption (p-value: 0.037) were found to be significantly associated with HIV-risk sexual behavior. CONCLUSIONS: Future interventions on HIV prevention should focus on empowering young FSWs with condom negotiation skills in order to increase condom use. It is also recommended to include information about alcohol consumption and its relationship with HIV-risk behavior in order to have better health outcomes for FSW.

The experiences of women from Atoin Meto tribe who performed Sifon ritual in the context of HIV/AIDS transmission.

BACKGROUND: Sifon is ritual sexual intercourse after male circumcision from the Atoin Meto tribe that contributes to HIV/AIDS transmission. Ritual Sifon may put at risk for HIV infection and also sexual transmission diseases (STDs). Doing ritual Sifon as a culture, without using protection during intercourse becomes one way to get HIV infection from infected men. Few studies explore this phenomenon among women who become Sifon. Therefore, the aim of this study is to explore the experience of Sifon women in the context of HIV/AIDS transmission. DESIGN AND METHODS: The data were collected from March to July 2020. This study used a phenomenological approach with a purposive sampling technique. INCLUSION CRITERIA: the women from Atoin Meto tribe aged above eighteen years old who have been Sifon women for at least six months. The participants were recruited through traditional healers in Nekbaun village of Kupang District and Timor Tengah Selatan District. The data were analyzed by the Colaizzi method. RESULTS: Thirteen women were interviewed and we found four themes: lack of knowledge about HIV/AIDS transmission, unaware Sifon women, women who experienced STDs, using traditional medicine to treat STDs (Timor medicine). CONCLUSIONS: The interpretation of Sifon women's experiences that performed Sifon rituals indicated that Sifon is a risk factor for transmitting HIV/AIDS. Preventive and promotional educational programs with a cultural approach are needed to reduce the risk of HIV/AIDS transmission.

The relationship between self-efficacy and spirituality in condom use behaviour among MSM-PLWHA in Bandung, indonesia.

BACKGROUND: The prevalence of HIV/AIDS, especially among men who have sex with men (MSM), is increasing. Disease transmission occurs because of the low use of condoms. This study aimed to identify the relationship between condom self-efficacy and spirituality in condom use behavior. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling techniques. It involved 251 people living with HIV/AIDS (PLWH) MSM. Chi-square test was used in bivariate analysis and then continued with the logistic regression analysis for multivariate analysis. RESULTS: The results show that there was a significant relationship between condom self-efficacy and condom use behavior with p-value <0.05 (OR=11.298; 95% CI: 4.35-20.1, p=0.000) and spirituality towards condom use behavior p-value <0.05 (OR=3.405; 95% CI: 0.85-3.21, p=0.00). In multivariate analysis of multiple logistic regression, condom self-efficacy is the factor that predominantly influences condom use behaviour. CONCLUSIONS: To improve the consistency of condom use, nurses need to prioritize interventions such as counselling activities that focus on increasing self-confidence (self-efficacy).

Gaining a "normal life": HIV-positive Indonesian female injection drug users in drug recovery.

The number of female injection drug users in Indonesia is rapidly increasing. This study explores the experiences of women living with HIV in recovery from heroin injection. Using a ground theory approach, 22 women former drug users in Jakarta participated in this study. Six themes emerged: the challenges of quitting, the role of self-motivation, the utility of methadone treatment, the importance of partner and family support, the transformation of "self" and situation, and the rewards of a normal life if successful. These women's accounts point to the personal and cultural challenges that they faced as women, wives, and mothers.

Correlations between drug use, HIV disclosure and interpersonal communication on sexual risk behaviour of HIV-positive men who have sex with men.

BACKGROUND: The Human Immunodeficiency Virus (HIV) epidemic is a global health problem whose number of cases are always higher among men who have sex with men (MSM). Most existing MSM have moderate and very high risk behaviour in HIV transmission. This study was designed to identify correlations between drug use, HIV disclosure and interpersonal communication patterns on sexual risk behaviour among HIV-positive MSM. METHODS: This study used a cross sectional design with a purposive sampling technique for participants who visited the voluntary counselling and testing (VCT) clinic in a referral hospital and snowball sampling technique for participants in the work area of a community health centre in Batam involving 126 HIV-positive MSM. Data were collected by 5 part questionnaire, namely demographic questionnaire, drug screening questionnaire, brief scale for HIV self disclosure, communication pattern questionnaire-short form, and safe sex behaviour questionnaire. Bivariate analysis was applied to determine whether there is a relationship between drug use, HIV disclosure, interpersonal communication and demographic characteristics (ethnicity, educational status) with sexual risk behaviour of MSM. Logistic regression analysis was used to explore the variables that most associated variable to sexual risk behaviour. THE RESULTS: The results showed that there was significant correlation between HIV disclosure and sexual risk behaviour (p = 0.019, α = 0.05, OR = 2.530) and significant correlation between interpersonal communication patterns and sexual risk behaviour (p = 0.016, α = 0.05, OR = 2.589). There is no significant correlation between demographic characteristics, namely: ethnicity and educational status with sexual behaviour at risk of MSM. In multiple logistic regression analysis, educational status was the factor that most associated with sexual risk behaviour among HIV-positive MSM (p = 0.027, α = 0.05, OR = 2.807, 95% CI = 1.125-7.006). CONCLUSIONS: HIV disclosure and interpersonal communication patterns have a significant negative correlation with sexual risk behaviour among HIV-positive MSM. MSM with low HIV disclosure have high risk sexual behaviour opportunities. MSM with the closed interpersonal communication pattern also has a high risk of sexual behaviour. Education status was the most associated variable to sexual risk behaviour of HIV-positive MSM. Nurses as professional health workers need to improve comprehensive assessment, personal counselling and plan specific learning model by involving HIV-positive MSM in reducing HIV transmission from risky behaviour.

The Correlation between Stigma and Family Acceptance with Religiosity of PLWH MSM in Medan, Indonesia.

There are several factors related to religiosity of PLWH MSM in Medan. This study aimed to identify the correlation between stigma and family acceptance with religiosity of PLWH MSM in Medan. This cross-sectional study applied purposive sampling technique and involved 175 samples from H. Adam Malik Public Central Hospital, Medan Pirngadi Hospital, Padang Bulan and Teladan Public Health Centers. The data was analyzed using the multiple logistic regression technique. Bivariate analysis showed a significant correlation between stigma along with family acceptance with religiosity of PLWH MSM in Medan (p = 0.005; α = 0.005).

Phenomenological study: the experiences of patients with nasopharyngeal cancer after undergoing chemoradiation.

BACKGROUND: Chemoradiation is a combination therapy of chemotherapy and radiotherapy. Because chemotherapy is given together with radiotherapy, the side effects are heavier and more severe for some patients. For nasopharyngeal cancer patients, the side effects involve nausea, vomiting, anorexia, diarrhea, mucositis, xerostomia, and tasting and hearing loss, which influence their quality of life. The purpose of this study was to explore the experiences of patients with head and neck cancer undergoing chemoradiation. METHODS: A Phenomenogical desctipve, involving in depth interviewes was conducted during a 6 month study period. Eleven patiets with nasopharyngeal cancer participated in indepth inteviews Colaizzi's method was used in analyzing data. The selection of participants in this study using purposive sampling method the inclusion criteria were1) the patient had been diagnosed with head and neck cancer, 2) minimum age of 18 years, and 3 had been received external chemoradiation, minimum 14 times of chmemoradiation. The study was conducted at one out-patientradiotherapy department. at Dharmais Cancer Centre Hospital, Jakarta. RESULT: The findings show three main themes: 1) xerostomia was the main physical complaint, 2) patients had decreased social interaction, and 3) having adequate support from the family was important for patients. CONCLUSION: The findings suggest involving family members when patients are undergoing chemoradiation. Adequate family support is needed to help the patients adapt to the side effects of chemoradiation with the best possible response.

A Content Analysis Study: Concerns of Indonesian Women Infected With HIV by Husbands Who Used Intravenous Drugs.

Few international studies document the concerns of women living with HIV (WLWH) who were infected by their intravenous drug-using husbands. Our content analysis described the concerns of this population by analyzing 12 interviews with WLWH. Three main concerns were discussed by the women: dealing with anger and being a dedicated wife, going home to one's parents as the only place to go, and being strong and staying alive for the children. Dealing with their own emotional responses to the HIV diagnosis, lacking financial resources after the husband's death, and remaining focused on staying healthy were major issues in their stories. Indonesia needs large-scale public HIV education campaigns about the risks women encounter as wives to husbands who use intravenous drugs as well as campaigns to educate husbands about their risks. Nurses need to encourage women to get tested during prenatal care to prevent infecting their children.