RESUMEN
OBJECTIVE: To explore the accounts and perspectives of junior doctors who were offered an HIV test by their employing National Health Service (NHS) trust and discuss ethical issues posed by this new policy. DESIGN: Qualitative in-depth interview study. SETTING: 4 NHS hospital trusts. PARTICIPANTS: 24 junior doctors who had been offered an HIV test as part of their pre-employment occupational health checks. RESULTS: The manner in which HIV tests were offered to junior doctors varied both between and within the NHS trusts. Overall, the doctors were highly critical of the way the HIV test was offered. Recurrent themes surrounding a lack of discussion and information regarding the indications for the test and implications of a positive result influenced the the doctors' perception of their experiences. As a consequence of the shortcomings of how the test was offered, most of the doctors held the misperception that HIV testing was mandatory and many felt unable to decline the test. The majority of doctors referred to patient protection as adequate justification for being offered an HIV test. CONCLUSIONS: Junior doctors offered an HIV test under new Department of Health occupational health guidance were disparaging about how the test was offered. The findings of this study affect thousands of junior doctors in the UK, and the impact of these results is extensive. Participants' suggestions regarding how the process of offering an HIV test can be improved are discussed and ethical issues regarding the new Department of Health policy are highlighted.
Asunto(s)
Serodiagnóstico del SIDA/ética , Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Serodiagnóstico del SIDA/métodos , Serodiagnóstico del SIDA/psicología , Adulto , Coerción , Femenino , Infecciones por VIH/diagnóstico , Política de Salud , Humanos , Internado y Residencia , Masculino , Exámenes Obligatorios/ética , Exámenes Obligatorios/legislación & jurisprudencia , Programas Nacionales de Salud , Investigación Cualitativa , Reino Unido , Adulto JovenRESUMEN
Although policies and programs exist to promote safe motherhood in sub-Saharan Africa, maternal health has not improved and may be deteriorating in some countries. Part of the explanation may be the adverse effects of HIV/AIDS on maternity care. We conducted a study in Kisumu, Kenya to explore how fears related to HIV/AIDS affect women's uptake and health workers' provision of labor and delivery services. In-depth qualitative interviews with 17 maternity workers, 14 pregnant or postpartum women, four male partners and two traditional birth attendants; as well as structured observations of 22 births; were conducted at four health facilities. Participants reported that fears of HIV testing; fears of involuntary disclosure of HIV status to others, including spouses; and HIV/AIDS stigma are among the reasons that women avoid delivering in health facilities. Maternity workers now have to take into account the HIV status of the women they serve (as well as their own fears of becoming infected and stigmatized) but do not seem to be adequately prepared to handle issues related to consent, confidentiality and disclosure. Importantly, it appeared that women of unknown HIV status during labor and delivery were likely to be targets of stigma and discriminatory practices and that these women were not receiving needed counseling services. The findings suggest that increasing infection control precautions will not be enough to address the challenges faced by maternity care providers in caring for women in high-HIV-prevalence settings. Maternity workers need enhanced culturally sensitive training regarding consent, confidentiality and disclosure. Furthermore, this study points to the necessity of paying more attention to the care of women of unknown HIV-serostatus during labor and delivery. Such interventions may improve the quality of maternity care, increase utilization and contribute to overall improvements in maternal health, while also enhancing prevention of mother-to-child-transmission and HIV care.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Parto Obstétrico/psicología , Infecciones por VIH/psicología , Complicaciones Infecciosas del Embarazo/psicología , Serodiagnóstico del SIDA/métodos , Adolescente , Adulto , Actitud del Personal de Salud , Atención a la Salud/normas , Parto Obstétrico/normas , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Kenia , Trabajo de Parto/psicología , Masculino , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Atención Prenatal/estadística & datos numéricos , EstereotipoRESUMEN
OBJECTIVE: To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point-of-care HIV test (RPOCT) among pregnant women and their midwives. DESIGN: A retrospective review of 717 notes to determine current HIV screening practices and a cross-sectional survey using a self-completed questionnaire for pregnant women and midwives. SETTING: The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands. PARTICIPANTS: 486 women attending the ANC or admitted to the PNW during a fortnight in May-June 2006. 72 midwives on the delivery ward completed a second questionnaire. RESULTS: The questionnaire showed that 90.4% of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6% of the decliners. 92.8% of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2% would be happy to offer the test with appropriate training and guidance. CONCLUSIONS: Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is also acceptable to a clinically significant proportion of those who decline the standard test (21 of 59) and therefore has the potential to increase screening and detection rates. Hence, by allowing early diagnosis and the initiation of antenatal interventions, it could reduce the rate of mother-to-child transmission (MTCT) in the UK.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Infecciones por VIH/diagnóstico , Aceptación de la Atención de Salud , Sistemas de Atención de Punto , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Actitud del Personal de Salud , Competencia Clínica , Inglaterra/epidemiología , Métodos Epidemiológicos , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Persona de Mediana Edad , Partería , Embarazo , Atención Prenatal/métodosRESUMEN
OBJECTIVE: To describe perceptions, experiences, knowledge, beliefs and the willingness of injecting drug users to be HIV tested by using rapid tests. METHODS: A qualitative exploratory study was carried out among injecting drug users from December 2003 to February 2004 in five Brazilian cities, located in four regions of Brazil. A semi-structured interview guide containing both closed and open-ended questions was used to address perceptions about non-conventional testing procedures, and non-traditional ways to provide testing access to injecting drug users. A total of 106 interviews, about 26 per region, were conducted. RESULTS: Characteristics of the population studied, common thoughts about HIV rapid testing, preference for using blood or saliva specimens, and other testing preferences, were presented together with reported advantages and disadvantages of each option. The study findings showed that the use of rapid tests among these users is feasible and that they are willing to be tested using rapid HIV tests, especially if some issues related to privacy and reliability of the test could be addressed. CONCLUSIONS: The study findings showed that rapid tests may be well accepted for this population. These tests can be considered a valuable tool, allowing a more injecting drug users to learn their HIV status and possibly be referred to treatment and should support more effective testing strategies for them.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud , Abuso de Sustancias por Vía Intravenosa/psicología , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/psicología , Adolescente , Adulto , Distribución por Edad , Brasil , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/terapia , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Investigación Cualitativa , Asunción de Riesgos , Distribución por SexoRESUMEN
African traditional health practitioners are an important source of health care for many South Africans. Thus, they are a health resource in this society. However, the integration of traditional health practitioners into the mainstream of health care is a complex process. Various factors contribute to this complexity, including the skepticism and reservation with which some western health practitioners view traditional health practitioners. This paper highlights the perceived strengths and weaknesses of the traditional healing system for people living with HIV/AIDS, as perceived by western health practitioners. The use of traditional practitioners as a choice of health care is attributed to both the strengths and weaknesses of this system of health care. The strength of the traditional healing system is in its sharing of the worldview and belief system of its users, it being an alternative to an inefficient western health care system (official system), privacy and absence of time limitations per consultation, treating patients psychologically, and scientifically unexplained physiological relief of the symptoms of specific illnesses. The perceived weaknesses of the traditional healing system include harmful treatment regimens, especially for people living with HIV/AIDS; prolonging the seeking of appropriate health care when traditional remedies fail to produce the desired effect; destroying interpersonal relationships of people living with HIV/AIDS through witchcraft accusations; psychological torment caused by the belief that HIV/AIDS can be cured by traditional remedies/intervention; and increasing the workload of western practitioners who are requested by patients to conduct multiple HIV tests after undergoing various traditional treatment regimens to cure HIV/AIDS. It is recommended that traditional practitioners be encouraged to adapt harmful traditional healing practices to the benefit of their patients in a non-judgemental and non-critical manner. In addition, joint workshops should be conducted with traditional and western practitioners to demystify traditional healing practices.
Asunto(s)
Actitud del Personal de Salud/etnología , Agentes Comunitarios de Salud/psicología , Infecciones por VIH/etnología , Medicinas Tradicionales Africanas , Personal de Enfermería/psicología , Médicos de Familia/psicología , Serodiagnóstico del SIDA/psicología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interpersonales , Masculino , Investigación Metodológica en Enfermería , Aceptación de la Atención de Salud/etnología , Investigación Cualitativa , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Carga de TrabajoRESUMEN
People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Grupo Paritario , Prejuicio , Adolescente , Adulto , Anciano , Emigración e Inmigración , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Namibia/epidemiología , Medición de Riesgo , Hechicería/psicologíaRESUMEN
BACKGROUND: The Botswana government recently implemented a policy of routine or "opt-out" HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1-1.9), higher education (AOR = 2.0, 95% CI = 1.5-2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3-2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1-2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2-2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5-0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45-0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). CONCLUSIONS: Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.
Asunto(s)
Serodiagnóstico del SIDA/estadística & datos numéricos , Pruebas Diagnósticas de Rutina , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Derechos Humanos , Tamizaje Masivo , Serodiagnóstico del SIDA/métodos , Serodiagnóstico del SIDA/psicología , Adulto , Actitud Frente a la Salud , Botswana/epidemiología , Confidencialidad , Estudios Transversales , Pruebas Diagnósticas de Rutina/psicología , Miedo , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Seroprevalencia de VIH , Política de Salud , Humanos , Masculino , Tamizaje Masivo/psicología , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Programas Nacionales de Salud , Prejuicio , Negativa a Participar , Riesgo , Sexo Seguro , Conducta Sexual , Violencia , Programas VoluntariosRESUMEN
A central challenge of the AIDS epidemic among African American women is promoting acceptance of repeat HIV testing among those at risk of infection. We conducted an exploratory study designed to identify behavioral and psychosocial correlates of intent for repeat HIV testing among women disenfranchised from traditional health care delivery systems. Face-to-face interviews were conducted with 143 women attending an urgent care center in the urban South. In multivariate analyses, three psychosocial correlates were significantly associated with women's intent for repeat testing. Women who expressed less worry about HIV were substantially more likely, than those expressing greater worry, to report low intent for repeat testing [adjusted odds ratio (AOR) = 10.6, p = 0.001]. Concern about having blood drawn was also robustly associated with intent (AOR = 7.3, p = 0.002). Finally, a one unit increase on the 5-point scale assessing less agreement that having HIV would make life complicated corresponded to 3.3 greater odds of indicating low intent (AOR = 3.3, p = 0.002). Study findings provide a potential focal point for efforts designed to promote repeat HIV testing among women from the study population.
Asunto(s)
Serodiagnóstico del SIDA/psicología , Instituciones de Atención Ambulatoria , Negro o Afroamericano/etnología , Motivación , Pobreza/etnología , Servicios Urbanos de Salud , Mujeres/psicología , Serodiagnóstico del SIDA/estadística & datos numéricos , Adolescente , Adulto , Negro o Afroamericano/educación , Negro o Afroamericano/estadística & datos numéricos , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Estudios Transversales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Georgia/epidemiología , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/normas , Humanos , Modelos Logísticos , Persona de Mediana Edad , Modelos Psicológicos , Análisis Multivariante , Evaluación de Necesidades , Encuestas y Cuestionarios , Servicios Urbanos de Salud/estadística & datos numéricos , Mujeres/educación , Salud de la MujerRESUMEN
BACKGROUND: The Department of Health (DH) set a target for HIV testing--uptake should be at least 90% by 31 December 2002 (Department of midwife Health, 2000), i the number of 80% decrease in n order to see a babies born with HIV (Tookey et al, 2002). As an exercise to measure Newham Healthcare Trust against this standard and review the antenatal care HIV-positive women received, the maternity unit undertook an audit. One in 160 pregnant women receiving antenatal care in the London Borough of Newham are HIV positive (Communicable Disease Screening Centre, 2003), according to the HIV anonymous screening programme, however the rate of transmission to the baby is virtually zero, when babies were followed up at birth, six months and one year Healthcare NH S Trust, 2003). Newham's HIV testing uptake ranges from 80% to 90% (with an average of 88%). A strategy for improving the uptake has been to explore why the 10% to 20% of women decline testing; hence the Trust underwent an audit to explore the reasons women gave when they declined testing. Audit findings Some 2138 forms were returned over a seven-month period, of which 328 (15%) were from women who declined HIV testing. Uptake within that period ranged from 74% to 90%. Ten new positive women were identified. The HIV-specialist midwife carries a caseload and is aware of all positive women, therefore was able to identify the new cases. The reasons given for decline ranged from cultural and religious beliefs to those who said they were not at risk. Practice implications Where women are aware of their HIV status, services can be put in place to support them through their pregnancy and life as a positive parent, equally important is the ability to minimise the risk of transmission to babies, therefore it is vital that women understand the purpose of early diagnosis through testing and its consequences. Midwives have a vital role to play in ensuring pregnant women receive adequate information to form their decision. If a woman chooses not to have the test, midwives should explore her reasons without prejudice. It is also recommended that women who decline testing are reoffered the HIV test at their subsequent antenatal visit, allowing them the opportunity to digest the information and discuss it with a partner. The purpose of the audit was to assess how the Trust would meet the DH target (90% uptake), as part of a review of the maternity HIV service.
Asunto(s)
Serodiagnóstico del SIDA/enfermería , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Partería/normas , Complicaciones Infecciosas del Embarazo/diagnóstico , Mujeres Embarazadas/psicología , Negativa a Participar/estadística & datos numéricos , Serodiagnóstico del SIDA/psicología , Serodiagnóstico del SIDA/estadística & datos numéricos , Adulto , Inglaterra/epidemiología , Femenino , Infecciones por VIH/epidemiología , Humanos , Recién Nacido , Tamizaje Masivo/estadística & datos numéricos , Evaluación de Necesidades , Rol de la Enfermera , Relaciones Enfermero-Paciente , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Diagnóstico Prenatal/psicología , Diagnóstico Prenatal/estadística & datos numéricos , Estudios Prospectivos , Negativa a Participar/psicología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
AIDS: The field of psychoneuroimmunology has been evolving over the past thirty years and is based on connecting the mind and body using a concept known as hardiness. Hardiness generally consists of three main parameters: commitment, control, and challenge, but in working with HIV-infected patients, a fourth parameter, community, is added. Various mental health scales are used to assess how patients cope with stress; effects of stress on the immune system can also be assessed by determining proliferation of various types of lymphocytes. Various studies conducted on asymptomatic HIV-positive subjects prior to and following notification of HIV-1 antibody status measured immune system function in patients that were or were not involved in aerobic exercise or group, cognitive, or behavioral modification. Those who participated in interventions had lower or minimal decreases in immunologic parameters compared to controls. A University of Miami research team theorizes that in the absence of aerobic conditioning or behavioral restructuring, a cascade of events occurs which decreases the individual's immunologic endocrine and neuropathic functioning. The patients' hardiness is what keeps them from falling under a medical hex, that is, keeps them from allowing the person in power (the doctor) to take away their hope, which would cause the cascade to occur. Support groups are good ways to help patients develop hardiness within a trusting atmosphere.^ieng
Asunto(s)
Infecciones por VIH/psicología , Psiconeuroinmunología , Serodiagnóstico del SIDA/psicología , Adaptación Psicológica , Citocinas/metabolismo , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Humanos , Células Asesinas Naturales/inmunología , Linfocitos/inmunología , Poder Psicológico , Estrés PsicológicoRESUMEN
In 1988 a programme for care and follow-up of HIV-positive persons and AIDS patients was implemented by the existing health facilities (district health team and hospital team) of Kgatleng District, Botswana. A survey study in 1991 tried to indicate the effectiveness and bottlenecks of the programme. All advisory nurses (AN) were interviewed via two questionnaires: one pertaining to case management of clients and one on their perceptions of their work. Seventy-two of 109 HIV-infected persons accepted and received counselling. Response of the 72 varied: 26 with a good, 34 with a moderate and 12 with a bad response. Prevention, contact tracing and home visiting were studied, as well as ANs' experiences and opinions of the programme. Some behavioural change by clients was indicated by the results though its extent remains questionable. Programme problems included client migration and refusal of counselling, and discontinuation of HIV-testing facilities. Once a relationship was established, confidentiality, questions and fear of stigmatization posed major problems. One-to-one support of ANs could help them cope better with these problems as well as discuss their own worries.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Consejo , Países en Desarrollo , Seropositividad para VIH/psicología , Servicios de Atención de Salud a Domicilio , Grupo de Atención al Paciente , Serodiagnóstico del SIDA/psicología , Síndrome de Inmunodeficiencia Adquirida/terapia , Adolescente , Adulto , Botswana , Enfermería en Salud Comunitaria , Trazado de Contacto , Femenino , Seropositividad para VIH/terapia , Seropositividad para VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Medicina Tradicional , Persona de Mediana Edad , AutorrevelaciónRESUMEN
The present study concurrently measured psychological distress (state anxiety, depression, confusion, and intrusive thoughts), neuroendocrine (plasma cortisol concentrations), and immunologic [lymphocyte proliferative responses to phytohemagglutinin (PHA) and pokeweed mitogen (PWM)] changes in the 5-week periods preceding and following serostatus notification among asymptomatic Human Immunodeficiency Virus-type 1 (HIV-1) seropositive and seronegative gay men. Seropositives, as opposed to seronegatives, showed a disparity in predicted relationships among distress, cortisol, and immunologic measures across the prenotification to postnotification period. Individual difference analyses suggested that among seropositives, in contrast to seronegatives, plasma cortisol concentrations were negatively correlated with psychological distress and positively correlated with responses to PHA (assessed at study entry and after serostatus notification). This pattern in seropositives could not be explained by differences in prenotification perceived risk of infectivity, extraneous environmental stressors, or CD4 cell counts within the seropositive group.