Challenging behaviour in HIV services

'Challenging behaviour' is a label, and one that is often misused in the context of mental health. Using a profile, this article identifies a number of behaviours that may challenge service. Peter has HIV and has developed a related opportunistic illness, affecting brain function. The author stresses the importance of person-centred care, urging providers to audit their services and evaluate the requirement for alterations to assessment documentation to meet the changing needs of individuals, families and children living with HIV/AIDS.     

A survey of psychologists' education, knowledge, and experience treating clients with HIV/AIDS.

Practicing psychologists are providing services to persons with HIV infection and those at-risk for AIDS. However, most practitioners have not received formal training about HIV/AIDS. In this study, the majority of psychologists surveyed had treated persons at-risk for the virus but had not received HIV/AIDS information in formal educational programs. Most respondents obtained knowledge through popular media. There is a growing body of specialized knowledge about HIV/AIDS for mental health professionals. In addition to better serving HIV-infected clients, psychologists with current multidisciplinary HIV/AIDS knowledge will be valuable members of health care teams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compliance with infection-control procedures and attitudes of oral health care providers toward patients with HIV/AIDS: a synthesis of the literature

Many publications on the knowledge, practice, and attitudes of oral health care providers can be found in the literature. This paper is a synthesis of literature on their compliance with infection-control procedures and their attitudes toward patients with HIV/AIDS. The literature indicates increased compliance with infection-control procedures. While some oral health care providers report negative attitudes toward treating patients with HIV/AIDS, their fear is decreasing, possibly due to their increased compliance with infection-control procedures and increased access to care for those with HIV/AIDS.     

Loss and bereavement: HIV/AIDS family caregiving experiences

The purpose of this grounded theory study was to describe the experience of HIV/AIDS family caregiving in the palliative phase. Seven in-depth interviews were conducted and analyzed using the constant comparative method. The analysis resulted in a conceptualization of HIV/AIDS family caregiving. This paper describes the "personal work" of caregivers, including reconciling that a loved one would die, making life-and-death decisions, and letting go. The nature of support received to attend to this work is highlighted, with attention to its influences on HIV/AIDS caregiver bereavement. The findings of this study provide some insights into the HIV/AIDS family caregiver experience and reveal a significant need for interventions designed to support caregivers in establishing the mechanisms required for bereavement resolution. The need for the creation of supportive networks for HIV/AIDS caregivers cannot be overstated. Further research is required to help clarify and expand on how social support might have an effect on HIV/AIDS family caregiver bereavement. With this knowledge, health-care providers will be better prepared to anticipate difficulties faced by caregivers, plan appropriate interventions to address these difficulties, prevent future problems, and plan care based on theory and research.     

Energy expenditure in workers who install plastic and metal pipes for water supplies and sewage

Since 1985, many drug abuse treatment centers and health care providers have implemented special education programs for individuals who inject drugs. They focus primarily on increasing awareness of the threat of the human immunodeficiency virus (HIV) being spread through drug injection equipment and by sexual activities. As part of the Drug Abuse Treatment for AIDS-Risk Reduction (DATAR) project, the AIDS/HIV Risk Reduction Module was designed to meet these special intervention needs. This study examined program impact on 110 methadone treatment clients. Results indicated that for those in treatment less than 4 months, the AIDS intervention program enhanced specialized knowledge about AIDS, aided in the reduction of AIDS-risky behaviors, and enhanced attitudes toward achieving and maintaining abstinence from drug use. Thus, AIDS education and intervention programs appear to be effective and should be emphasized in the early phase of drug abuse treatment.     

Lipolytic response during spontaneous hypoglycaemia in insulin-dependent diabetic subjects

OBJECTIVE: To gather qualitative data regarding HIV/AIDS patients' perspectives about HIV-1 protease inhibitors (PIs), and about their experiences taking and adhering to regimens containing PIs. DESIGN: Six focus groups of persons under care for HIV were conducted between September and November 1996 regarding participants' knowledge, awareness, experiences when taking, and adherence to antiretroviral regimens containing PIs. An identical discussion guide was used to facilitate all six groups. Focus group proceedings were audiotaped, transcribed, coded for themes, and analyzed qualitatively. SETTING: HIV/AIDS practices of three teaching hospitals and two community health centers. PATIENTS/PARTICIPANTS: Fifty-six patients with HIV disease: 28 men and 28 women. MEASUREMENTS AND MAIN RESULTS: Knowledge and positive impressions of PIs were prevalent among this diverse group of persons with HIV, and did not differ by race/ethnicity or gender. Most knew that these were new, potent medications for treating HIV/AIDS. Networks of persons with HIV and medical providers were the most important information sources. Those taking PIs were aware that adherence to the regimen is important, and most were using special strategies to maximize their own adherence, but expressed considerable frustration about the central role these medication regimens had assumed in their life. A subset who did not believe they would adhere to these regimens had declined treatment with them. Motivating factors for taking and adhering to these complex regimens were improving CD4 counts and viral loads and the patient-provider relationship. CONCLUSIONS: Among those with HIV/AIDS, awareness of PIs and their effectiveness is substantial, owing to the impact of informal networks and medical providers. This early positive "reputation" of PIs may enhance motivation for adherence. Those who are taking PIs invest substantial effort adhering to these complex regimens, but resent the need to make medications the focus of their lives.     

Rapidly expanded skin tube studied by histological and stereological observations

This study offers a new evaluation methodology for peer-education programs. Peer educators' knowledge, self-esteem, peer pressure, and the number of friends, neighbors, and relatives given HIV/AIDS information were compared before and after training using self-administered questionnaires. Significant changes were observed in knowledge, peer pressure, self-efficacy, numbers of people given condoms, number of formal and informal HIV/AIDS presentations, and numbers of HIV/AIDS discussions with friends and neighbors.     

Effect of replacing a high linoleate oil with a low linoleate, high alpha-linolenate oil, as compared with supplementing EPA or DHA, on reducing lipid mediator production in rat polymorphonuclear leukocytes

Training designed to improve AIDS knowledge, attitude, and practice was delivered to 96 traditional healers in the Central African Republic. The training (17 to 36 hours) was conducted by traditional healers with the assistance of staff from the Ministry of Health. Training included the following topics: prevention of HIV transmission during traditional practice; diagnosis, treatment, and prevention of sexually transmitted diseases; condom promotion; AIDS education at the community level; psychosocial support for people with AIDS; and promotion of a positive image for traditional healers. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. These assessments were conducted using structured interviews. Improvement in knowledge and/or attitudes was observed in all areas assessed except for prevention of HIV transmission during traditional practice. We concluded that AIDS training can be successfully delivered to traditional healers.     

"A grief observed": the experience of HIV-related illness and death among women in a clinic-based sample in New Haven, Connecticut

This study examined how women in a clinic-based sample in New Haven, Connecticut, (N = 168), have been affected by the AIDS epidemic. The aims of this study were to (a) document the proportion of women who knew individuals who were HIV positive, who were symptomatic with AIDS, or who had died from AIDS; (b) compare the demographics of women who knew someone infected with HIV with those of women who did not know anyone infected with HIV; and (c) examine prospectively the effects of the number of AIDS-related losses on women's mental health. Many women have been deeply affected by the AIDS epidemic: Nearly 3/4 of the women in this study knew at least 1 person who had died of AIDS. Women who experienced multiple AIDS-related losses over the course of the study were significantly more anxious than those who experienced no loss or 1 loss. Implications for clinical interventions are discussed.     

Attitudes of medical students to HIV and AIDS

OBJECTIVE--To assess the knowledge and attitudes of medical students to HIV/AIDS and whether attitudes correlate with knowledge and clinical experience. To determine if students felt adequately prepared to deal with medical and psychological aspects of HIV/AIDS. SUBJECTS AND METHODS--The subjects consisted of 190 London and 99 Cambridge medical students at the end of their genitourinary medicine attachment, plus 230 Cambridge medical students at the end of their second pre-clinical year. Between March 1991 and February 1992 all were asked to complete an anonymous questionnaire, covering factual knowledge and attitudes towards HIV/AIDS. MAIN RESULTS--Cambridge genitourinary medicine students, despite spending less time studying HIV infection than their London counterparts gave more correct answers to the factual questions, although this difference did not reach significance (52.4% vs. 47.5%, p = 0.14). One third of students believed that many health care workers were at high risk of acquiring HIV at work and one fifth thought doctors should have the right to refuse to treat people with HIV. Fourteen percent of Cambridge genitourinary medicine students indicated that most British people with HIV have only themselves to blame, by comparison with 4% of London students (p = 0.003). Thirty-nine per cent of Cambridge genitourinary medicine students expressed reluctance to care for someone with AIDS by comparison with 10% of London students (p = 0.0001). CONCLUSIONS--It is important that medical educators convey accurate information about HIV, including the actual risks posed by occupational exposure and try to ensure that medical students spend sufficient time seeing patients with HIV/AIDS during their training.     

Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: a comparative study

A survey was conducted to assess the knowledge of 30 oral hygiene (OH I & II) and 79 dental students (BCHD III & VI) on HIV infection and AIDS. A questionnaire consisting of twenty-nine questions based on the 'agree-disagree' format was prepared for this study. Clinical slides were projected to assess students' ability to identify oral manifestations of HIV infection. Most students agreed that HIV-sero-positive people were entitled to the same dignity and respect as those who were suffering from other illnesses. Students were concerned about treating sero-positive patients. They would preferably receive training in the management of these patients in a controlled environment. They had a poor perception of the risk of infection following needle-stick injury and whether HIV could be transmitted through contact with saliva. Most students felt that they had insufficient lectures on HIV/AIDS and had practically no clinical exposure to HIV-sero-positive patients.     

Rural school nurses' attitudes about AIDS and homosexuality

The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.     

An HIV/AIDS prevention project for Mexican homosexual men: an empowerment approach

In this intervention, participants design and implement an HIV/AIDS prevention project for Mexican homosexual men. The intervention is consistent with, and contributes to, empowerment theory because it enhances collective action, provides opportunities to develop knowledge and skills, creates needed resources, and includes shared control with professional and among participants. The intervention described provides an illustration of an empowering process and distinguishes itself from empowerment outcomes. An evaluation of the project is also described, but the outcomes were HIV/AIDS-related behaviors rather than psychological empowerment of the participants. The results suggest that the participants' HIV/AIDS knowledge and preventive behavior improved when compared to individuals who did not participate in the intervention. In addition, the intervention generated community change initiated by participants. Implications for designing interventions using an empowerment approach are discussed.     

HIV/AIDS related knowledge, attitudes, and preventive behavior of pregnant Korean women

OBJECTIVE: To assess HIV-AIDS-related knowledge, attitudes, and preventive behavior of pregnant Korean women before designing patient and public education programs. DESIGN: Pre-experimental cross-sectional survey. POPULATION, SAMPLE, SETTING, YEARS: Convenience sample of 409 women at six prenatal clinics in Seoul, Korea, in 1993. OUTCOME MEASURES: HIV-AIDS-related knowledge, attitudes, and preventive behavior. METHODS: Self-administered questionnaires. FINDINGS: The women described high levels of knowledge about HIV and AIDS risk factors but less knowledge about transmission of the virus, as well as attitudes of rejection toward unrelated people with HIV/AIDS; 16% provided condoms for their husband's use in extramarital sex, the primary risk behavior. CONCLUSIONS: Korean women are at risk for heterosexual transmission of HIV despite knowledge of risk factors. CLINICAL IMPLICATIONS: Korean education programs for women should focus on modes of heterosexual transmission, care of individuals with HIV or AIDS, self-assessment of HIV-AIDS risk, and self protection.     

Denaturation and reactivation of dimeric human glutathione reductase--an assay for folding inhibitors

In response to a Department of Health, England, circular encouraging policies of named voluntary antenatal HIV antibody testing, one West Midlands health authority in England introduced a policy of raising the issue proactively at the first antenatal attendance. In order to facilitate this policy a short staff education programme was provided for midwives. This paper reports on part of a study which aimed to evaluate the impact of the HIV awareness training programme. A sample of midwives (n = 65) was randomly selected for inclusion in the study. Thirty-three had attended training and 32 had not. Data were collected using a self-administered questionnaire exploring knowledge of aetiology of HIV/AIDS, knowledge of transmission, knowledge of obstetric and paediatric HIV, attitudes to HIV, issues related to antenatal HIV antibody testing and opinions about the HIV awareness training programme. Results indicated no significant difference in levels of knowledge or in attitude between those who had attended the training programme and those who had not. Similarly, no significant difference was found in terms of how midwives would react to women requesting HIV antibody testing. Many of the results contradict the current literature and as a conclusion it is suggested that there is a need to review HIV-related training for midwives.     

Awards for distinguished professional contributions: David William Purcell.

Presents the citation, biography, and selected bibliography for David William Purcell, the 1994 recipient of the American Psychological Association's Award for Distinguished Professional Contributions--Distinguished Contributions for Applied Psychology or Community Service by a Graduate Student or Intern (Individual or Group). From Purcell's citation: "David W. Purcell's contributions to community service during graduate training include being part of the founding and development of Positive Impact, Inc., a nonprofit, community-based organization in Atlanta that provides free mental health services, through volunteer mental health professionals, to low-income individuals affected by HIV. He was vice president of the founding Board of Directors and president of the Board during 1993-1994. He currently serves as secretary of the Board, and the organization has grown to 4 full-time members, over 80 volunteer providers, and a yearly budget of $200,000 supported by numerous grants." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current issues in the midwifery management of women living with HIV/AIDS

Changes in the clinical management of women living with human immunodeficiency virus (HIV) have occurred as a result of significant gains in the scientific knowledge of this retrovirus. As the incidence of HIV/AIDS continues to escalate among female adults and adolescents in the United States, all primary health care providers must anticipate the likelihood of encountering clients with HIV infection. Midwives must be adequately prepared to meet the challenges of managing women with HIV in the early stages of the disease. This article presents a comprehensive review of current demographic trends related to the HIV/AIDS epidemic among U.S. women and a brief overview of the essential immunopathogenesis of HIV. Contemporary issues related to universal counseling, updated testing procedures, and reproductive decision-making are covered. Initial primary care concerns and the management of newly infected seropositive women are included, with a focus on gynecologic issues. Guidance in the current management of HIV-positive pregnant women is offered. Updated antiretroviral prophylaxis recommendations are presented, to prevent perinatal transmission and to delay maternal immunosuppression with subsequent opportunistic infections. The article concludes with implications for health care professionals who provide care for this unique cohort of women.     

The HIV-epidemic in Norway 1996--mainly heterosexual transmission

Up to 1996, a total of 1,537 individuals had been reported as having HIV infection in Norway (population 4.3 million). 511 of these had developed AIDS and 410 had died from AIDS. 223 persons had acquired HIV heterosexually. Less than a fifth of these had acquired the infection from persons who themselves had been infected with HIV heterosexually in Norway. Named testing of pregnant women, recruits and blood donors confirms the limited spread of HIV. We estimate that the annual incidence of heterosexually acquired HIV infection has remained at 20-30 for the last ten years. Earlier prognoses for the epidemic in Norway were grossly erroneous, mainly owing to lack of knowledge about the factors determining the spread of HIV. Given the low rate of transmission of the virus and the sexual behaviour of Norwegians, there was never any real danger of a large heterosexual HIV epidemic in this country. The future efforts to combat the epidemic should focus on maintaining features that make Norwegian society less vulnerable to HIV.     

Do physicians discuss HIV and AIDS with patients? A survey of physician practices

HIV and AIDS continue to be major concerns to the health care community and the world around them. Preventive efforts and education have been the focus of the fight against AIDS thus far. By the year 2000, 75% of physicians are expected to conduct risk-reduction counseling for patients regularly. Previous studies show that a smaller percentage "routinely" follow this recommendation. The purpose of our study was to assess with what percentage of patients physicians discuss several HIV/ AIDS-related topics, what percentage of their patients are considered at risk for infection, and how comfortable the physicians are with their knowledge level and discussing the subject matter. We sent surveys to the last five graduating classes from St. Louis University School of Medicine and to 169 physician preceptors in the community. The survey asked about patients considered at risk, physician comfort level with HIV/ AIDS, the percentage of patients they discuss various HIV/AIDS topics with, and his or her preparedness for these discussions. Total responses were 464 (53.7%) representing all areas of medicine. Most of the physicians (72.9%) consider 0-25% of their patients at risk for HIV/AIDS. Eighty-one percent claim they are moderately or very comfortable discussing the material with patients and more than 90% feel they have at least adequate knowledge. Most of the respondents discuss the HIV/ AIDS topics with 0-25% of patients. Recent medical school graduates and primary care physicians are more comfortable with HIV/AIDS and discuss the surveyed topics with a higher percentage of patients.