Household Food Insecurity as Mediator of the Association Between Internalized Stigma and Opportunistic Infections.

Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections.

The relationship between HIV and AIDS and water scarcity in Nyamakate resettlements land, north-central Zimbabwe.

HIV and AIDS and water variability have been studied separately, yet, they impact on rural households simultaneously in an interactive manner. The study provide narratives on various realities from a study in the Nyamakate community that illustrates the dialectical relationship between HIV and AIDS and water scarcity. A qualitative research methodology was employed, and the following data collection tools were used: semi-structured interviews, focus group discussions (FGDs) and participant observations. The study showed that in the Nyamakate area, HIV- and AIDS-affected households utilise more water if there is a bedridden patient. Such households utilise an average of 145 litres per day and reported a water shortage of 103 litres per day. Although community rules and customs stipulate that water should be accessible to everyone, exclusion of HIV- and AIDS-affected households is underlined by cultural issues, scorn at poor levels of hygiene, infectious opportunistic infections and labour shortage, which limited access to water points by households directly affected by HIV and AIDS. In cases where women were overwhelmed with caregiving roles, men fetch water. We conclude that HIV and AIDS and water scarcity are dialectically related and hence should be considered in an interactive manner in order to understand the challenges faced by affected households.

[The perception of hospital by the siblings of children with cancer]. / La perception de i'hôpital par la fratrie d'un enfant traité pour un cancer.

The perception of hospital by the brothers and sisters of a child being treated for cancer is often ignored. Research based on interviews with children, with the participation of nurses and the psychologist of an onco-haematology department, attempts to analyse the importance of the involvement of siblings in the improvement of treatment.

Stress, diabetes, and infection: Syndemic suffering at an urban Kenyan hospital.

The complexity of sickness among Kenya's urban poor cannot be dissociated from how social and health problems become syndemic. Increasingly diabetes and other non-communicable diseases (NCDs) are emerging among low-income populations that also are most afflicted by social stress and infection. This article examines how social stress, psychological distress, and physical illness among patients in a public hospital in Nairobi, Kenya, produce syndemic suffering, defined by lived experiences of syndemic clustering such as diabetes with depression and infection. We recruited 100 urban public hospital patients, of which half were women, and half had type 2 diabetes from June to August 2014. We administered written informed consent and collected anthropometrics and blood samples before we conducted lengthy mixed qualitative and survey interviews. We analyzed social stress in narrative interviews using content analysis and evaluated social and physical contributors to mental distress with frequency tables and logistic regression. We found that people experienced diabetes through a complex social and medical framework, where social problems were cause and consequence to psychological and physical suffering. Women's narratives revealed more social suffering as well as more mental distress and somatic symptoms, including multi-morbidities, than men's. People with diabetes reported not only concurrent anxiety and depression but also common infections, including malaria, tuberculosis, and HIV/AIDS. Narratives reveal how NCDs concurrent with infections, and HIV in particular, produce financial challenges for patients, especially when HIV treatment is free and patients must pay out-of-pocket for diabetes care. Future studies should investigate syndemic clustering of infections and NCDs among low-income populations at the population-level.

Psychiatric consultation issues in pediatric HIV and AIDS.

Psychotherapy issues raised by children with HIV infections or AIDS can be very disturbing to even experienced child psychiatrists. This paper explores specific issues with case examples to demonstrate useful approaches to complex problems such as reentry into the school setting, issues of blame when one family member infects others, the choice of an HIV infected woman to have a child, and primary prevention among adolescents.

A prospective assessment of opiate addiction treatment protocols for inpatients with HIV-related syndromes.

A sample of 114 intravenous drug abusers hospitalized for HIV-spectrum diseases, was allowed to choose between methadone maintenance, partial or complete withdrawal as inpatient programs and was reassessed 4 days after discharge. One third of the patients had relapsed into heroin abuse. Rates of early relapse were significantly lower in the partial withdrawal group and higher in the methadone maintenance group. Patients with longer hospitalization and more severe HIV-related syndromes were particularly at risk of early relapse. Also, 45 former intravenous drug abusers were reassessed. Relapses were even more frequent than among active abusers, especially if the drug-free period before admission had been shorter than 1 year.

Nutritional assessment of drug addicts.

OBJECTIVE: To discern if factors such as organic pathology, sex, duration and/or intensity of drug addiction, alcohol abuse, hepatitis B infection, anorexia with poor food and drink consumption, or disturbance of social and familial networks, are related to an impaired nutritional status in hospitalized drug addicts. DESIGN: Cross-sectional prospective study. SETTING: Detoxication unit and internal medicine unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology and 18 with acute organic pathology related to drug addiction. The immunological study was compared with a control group composed of 50 healthy and well-nourished individuals (26 women and 24 men), age-matched with our patients. RESULTS: Drug addicts without organic pathology were under-nourished: 92.4% weighed under the mean weight for the population and 55.7% had had a weight loss above 5%. The distribution of mid-upper arm circumference (MUAC), triceps skinfold (TSF) measurement and mid-arm muscle area (MAMA) compared with the percentiles for the population showed a shift towards lower values. We found a high percentage of patients with a high lymphocyte count (55%). Despite the high lymphocyte count, delayed hypersensitivity was depressed in our patients. Of our patients, 66.4% exhibited anorexia at admission. The mean calorific intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. However, in most cases, malnutrition (usually marasmus-like malnutrition) was not very severe; only 30% of the drug addicts weighed less than 80% of the mean weight for the population, or admitted to a weight loss above 10%, and by subjective nutritional assessment, only 18% were deeply malnourished. Otherwise, the nutritional status was very poor in drug addicts with acute organic pathology. We also found a worse nutritional status in our patients related to female sex, intensity of drug addiction, anorexia with poor food and drink consumption, and disturbance of the social and familial networks. CONCLUSIONS: Many drug addicts suffer from calorie and protein malnutrition. This mainutrition is related to female sex, intensity of drug addiction, anorexia and poor food and drink consumption, and disturbance of the social and familial links. Acute organic pathology leads to a significant worsening of the nutritional status of drug addicts.

Survey of attitudes of nurses working with AIDS patients.

This article reports the results of a ten-question anonymous survey given to nurses at Westchester County Medical Center in July 1983 and January 1984 concerning attitudes about caring for AIDS patients. Two-thirds of the responding nurses reported that they had friends or family express concern about associating with hospital personnel who have contact with AIDS patients. Other questions showed that between one fourth and one half of nurses have a fear of caring for homosexual men and male prisoners because of their awareness about AIDS. One half of the nurses believe that AIDS can be transmitted to hospital personnel because of contact with patients despite precautions. The fear of caring for patients with AIDS as compared to caring for patients with hepatitis, a more contagious but less serious disease than AIDS, was highest in the intensive care unit staff. Eighty-five percent of the health care personnel responding believed that pregnant nurses should not care for AIDS patients and one half of the nurses responding indicated that they would ask for a transfer if they had to care for AIDS patients on a regular basis. The implication of these findings for future treatment programs, medical and nursing education and psychologic support for staff are discussed.

Illness concerns, attitudes towards homosexuality, and social support in gay men with AIDS.

High levels of illness-related psychologic distress, marked social stigmatization and loss of social support, and negative internalized feelings towards homosexuality have previously been reported in homosexual men with the diagnosis of acquired immune deficiency syndrome (AIDS). We assessed 50 homosexual or bisexual men who were within 3 months of their AIDS diagnosis with respect to medical status, illness concerns, attitudes towards homosexuality, and social support. Subjects reported levels of illness-related concerns comparable to previously studied cancer patients. Their attitudes towards homosexuality were similar to previously studied healthy homosexual males. Their social support needs were variable, as was their satisfaction with specific types of social support. Their social networks were moderately small. In this AIDS subject group, illness concerns, attitudes toward homosexuality, and social support satisfaction were significantly correlated with each other, and with previously reported levels of psychologic distress and subjective (but not objective) measures of health status.

The relationship between information-seeking and information-avoiding coping styles and the reporting of psychological and physical symptoms.

The present paper describes a prospective study of the relationship between information-seeking and information-avoiding coping styles ('monitoring' and 'blunting') and the reporting of both psychological and physical symptoms. The results suggested that blunting was directly associated with the reporting of both psychological symptoms and symptoms associated with opportunistic infections (such as colds, 'flu etc.). Furthermore, this association between blunting and symptom report was independent of initial symptom levels and of some other factors which have been shown to influence health status (i.e. the frequency of negative life experiences, the frequency of daily hassles and levels of trait anxiety). No significant relationships were found between monitoring and symptom report. It is argued that the most likely explanation of these results is that high blunters report more illness symptoms as a result of failing to respond to initial illness cues or seeking remedial treatment only at a later stage in the development of a disorder.

Autism and Clostridium tetani.

Autism is a severe developmental disability believed to have multiple etiologies. This paper outlines the possibility of a subacute, chronic tetanus infection of the intestinal tract as the underlying cause for symptoms of autism observed in some individuals. A significant percentage of individuals with autism have a history of extensive antibiotic use. Oral antibiotics significantly disrupt protective intestinal microbiota, creating a favorable environment for colonization by opportunistic pathogens. Clostridium tetani is an ubiquitous anaerobic bacillus that produces a potent neurotoxin. Intestinal colonization by C. tetani, and subsequent neurotoxin release, have been demonstrated in laboratory animals which were fed vegetative cells. The vagus nerve is capable of transporting tetanus neurotoxin (TeNT) and provides a route of ascent from the intestinal tract to the CNS. This route bypasses TeNT's normal preferential binding sites in the spinal cord, and therefore the symptoms of a typical tetanus infection are not evident. Once in the brain, TeNT disrupts the release of neurotransmitters by the proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein. This inhibition of neurotransmitter release would explain a wide variety of behavioral deficits apparent in autism. Lab animals injected in the brain with TeNT have exhibited many of these behaviors. Some children with autism have also shown a significant reduction in stereotyped behaviors when treated with antimicrobials effective against intestinal clostridia. When viewed as sequelae to a subacute, chronic tetanus infection, many of the puzzling abnormalities of autism have a logical basis. A review of atypical tetanus cases, and strategies to test the validity of this paper's hypothesis, are included.

Effect of cognitive behaviour therapy on depressive symptoms among HIV-infected outpatients in Kenya

Timely diagnosis and treatment of depression among persons living with HIV (PLWH) in sub-Saharan Africa which is home to about 70% of global HIV infection is disproportionately low. In Kenya, the effect of cognitive behaviour therapy (CBT) for depression has scarcely been established through a study. Hence, we conducted an experimental study to test the effectiveness of CBT for depression among PLWH attending outpatient clinics in western Kenya. The intervention was a 2-hour weekly group-CBT conducted for 6 successive weeks. Out of 53 participants recruited, 26 were randomly assigned to CBT and 27 to control arms of the study. Data were collected using Patient Health Questionnaire (PHQ-9). Depression symptom was diagnosed for a score of >5 and reported functional impairment in the past 2 weeks. At baseline, the difference in median PHQ scores for CBT and control groups was not statistically significant (p= .644, 95%CI). At month-2, a significantly higher proportion of participants in the CBT condition had a reduction in depressive symptoms (a drop of 5.8 points) compared to those in the control arm who had a drop of 1.9 points (p= .001, 95% CI). We assessed the effect of CBT on depression and found a statistically significant result, Z= -3.276, p <.001, with a relatively large effect size (r= .5). The treatment effect of CBT was evidently sustained at 2 months post-treatment. We therefore recommend a larger randomised controlled trial to evaluate the effectiveness of CBT for long term treatment gains in similar settings (AU)

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[Rehabilitation, social medical evaluation and counselling in HIV-infected patients]. / Rehabilitation, sozialmedizinische Beurteilung und Beratung bei HIV-infizierten Patienten.

An inpatient rehabilitation programme for HIV-infected patients is described. Since the early nineties some 1,200 patients with HIV infection have been treated in our internal and orthopaedic rehabilitation clinic. Beside internal and orthopaedic diagnostics, supporting compliance with antiretroviral therapy, motivating the patients for regular moderate exercises and specific nutritional counselling are major issues of the programme. From the psychological point of view, the patients are offered to aquire relaxation and stress coping techniques, to take part in non-smoking courses and to use individual psychological counselling in case of depression or panic. In addition, all HIV-infected patients are offered individual advice on their disease and necessary changes in lifestyle. Finally, the programme includes social medical evaluation and counselling. As the majority of the patients are still working or are of working age, evaluating the capacity for work and potential introduction of occupational rehabilitation measures are prominent. Almost 70 percent of the HIV-infected patients who had been treated in our clinic over the last few years were fully capable of returning to their previous occupation. Our experiences demonstrate that statements such as rehabilitation of AIDS patients being useless because of its missing prospects of success, are not up-to-date any longer. Since introduction of combination antiretroviral therapy many patients with HIV infection are able to return to their previous occupation if they receive the necessary medical und psychosocial support.