Background Being diagnosed with HIV/AIDS and commencement of lifelong antiretroviral therapy (ART) with the requirement of high adherence can exacerbate or trigger depressive disorders. Prevalence of major depression is substantially higher in people living with HIV/AIDS (PLWHA) than those in the general population. More than 50% of PLWHA are likely to meet one or more criteria for depression in their lifetime. However, access to interventions for depressive disorders remains limited in Low- and Middle-Income Countries (LMICs) where more than 90% of people with depressive disorders are not receiving formal treatment. The role of evidence-based psychological treatments has been fundamental in reducing the huge treatment gap in LMICs. Although brief, flexible and effective psychological treatments are emerging, issues in relation to their acceptability, feasibility and effectiveness in HIV populations remain unexplored. Therefore, this thesis aimed to adapt and pilot group interpersonal therapy (IPT) for treatment of depressive symptoms including its acceptability and feasibility for PLWHA. This thesis has been the first that attempted to adapt and pilot group IPT for treatment of depression in the HIV population in Ethiopia. The findings of this thesis can serve as a baseline for researchers interested in adapting or developing psychological treatments in the HIV population in Ethiopia. The findings contribute information on the process used in examining acceptability and feasibility of psychological interventions which provides indications for conducting future trials to test the effectiveness of group IPT. Methods First, a systematic review and meta-analysis of randomised controlled trials was conducted to identify the most effective psychological treatments for depressive symptoms for PLWHA in LMICs. Second, a survey of major depressive disorder (MDD) was conducted among PLWHA who were attending ART follow-up appointments at the Felege-Hiwot Referral Hospital (FHRH) in Northwest Ethiopia. The survey served as a baseline to identify cases for piloting of group IPT and helped to identify areas for intervention. Third, the intervention areas were further explored among stakeholders from the ART clinic including PLWHA and this was followed by a stepwise adaptation of the group IPT manual. Furthermore, a formative qualitative study was conducted to examine explanatory models of depression and to explore acceptable contexts for implementation of group IPT. A total of three focus groups were conducted with purposively selected case managers, adherence supporters and service users 2 at the ART clinic. The qualitative data were analysed based on a framework approach using predefined thematic concepts. Fourth, a pilot study of the group IPT intervention was conducted among PLWHA to evaluate the acceptability and feasibility of peer-administered group IPT for treatment of depressive symptoms for PLWHA in Ethiopia. A single-arm, prepost, peer-administered, group IPT interventional study was conducted with 31 consecutively recruited participants. The participants were assigned to four IPT groups for the intervention. A post-intervention evaluation of depressive symptoms, perceived social support (PSS), functional disability and quality of life (QoL) was conducted using the same instruments used at the baseline. No control group was included in this pilot study. Results The findings of the systematic review and meta-analysis revealed that trials that used IPT have shown good effectiveness in treating depressive symptoms of PLWHA in LMICs. The baseline study found 32.5% prevalence of MDD among randomly selected PLWHA (N=393). MDD was positively associated with reduced adherence to ART, functional disability and negatively associated with overall QoL. Overall findings of the baseline and the qualitative study indicated that psychosocial problems are the most important factors that need intervention for depression for PLWHA. The main findings in relation to the adaptation of the WHO group IPT were: i) an IPT group that contains five to ten people was perceived to be acceptable and mixed gender groups were recommended; ii) sessions were recommended to be conducted in private rooms for 1.5 to 2 hours, and on a weekly basis. Findings of the pilot study indicated that depression scores reduced significantly between baseline and postintervention (mean difference (MD)=9.92; t=-7.82; p<0.001). The mean PSS scores (MD=0.79; t=2.84; p=0.009) and the mean QoL scores (MD=0.39, t=4.58, p<0.001) improved significantly between baseline and post-intervention. All the IPT intervention areas (life change, disagreement, grief and loneliness) were found to be applicable to and important areas associated with depression in PLWHA in Ethiopia. Most importantly, disagreement within a family and life change due to HIV/AIDS, such as sickness and separation were faced by almost all PLWHA included in the study, followed by loneliness or social isolation as result of HIV stigma, and grief due to loss of loved ones including a spouse, a child, a mother or a father. Overall evaluation of the pilot indicated that the procedures and outcomes of group based IPT were perceived as acceptable. Participants of the intervention gained benefits in resolving psychosocial problems and reported high satisfaction with counsellors and intervention setting. The eight weekly sessions that lasted around two hours were acceptable; however, 3 additional sessions were recommended by some counsellors until everyone recovers from depression. Conclusion The overall findings of this thesis suggested that group IPT was found to be acceptable and feasible for PLWHA in Ethiopia. Future studies should focus on examining its effectiveness for treating depressive disorders among PLWHA in Ethiopia.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>

<p>The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites / beneficial effects of ART / disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination / hunger, poverty, transportation and opportunity costs / hospital factors / non-disclosure / inaccurate knowledge and perceptions about HIV and ART / certain religious beliefs and advice / coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities / financial assistance / perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.</p>

No description available.

HIV has remained a public health problem in Nigeria. The purpose of this cross-sectional study was to examine the effect of social support and HIV-related stigma on depression in people living with HIV/AIDS (PLWHA) and to examine the moderating effect of sociodemographic factors, Quality of Life (QOL), and time since HIV diagnosis on this relationship. This study was based on the social cognitive theory. Data were collected from 98 PLWHA attending the antiretroviral clinic of Federal Medical Center, Umuahia, Nigeria. Regression analyses were used to examine the relationships between the variables. Some 24.5% of the study participants were depressed. Significant relationships identified included negative relationships between depression and social support, positive relationships between depression and negative self-image, and a combination of poor social support and HIV-related stigma having synergic effects in predicting depression. Sociodemographic variables, quality of life, and time since HIV diagnosis did not have a moderating effect on the relationship between social support, HIV-related stigma, and depression in PLWHA. There is a need to improve social support and reduce HIV-related stigma in PLWHA in order to improve their mental health. These findings can help in bringing about positive social change by informing the development of public health initiatives aimed at improving the mental health of PLWHA.

We wanted to know how the subject HIV/AIDS was handled in the Indian newspaper The Hindu, which is written in English, during a period of 16 days (30 October-14 November) in 2005 compared to the corresponding period during 2007. Because we liked to study what kind of differences there were in the reporting between these two years. In addition we also wanted to learn how people living with HIV and AIDS are represented in pictures and text. To find out this was the purpose with this investigation. The study is made from the theory of stigma, semiotics and from a professional model of the normative theory. The articles about HIV/AIDS were quantitatively analyzed with help of a schedule of codes and we performed a qualitative analysis on several articles, four from 2005 and four from 2007. We also did four research interviews based on how people infected with HIV thought about journalists’ reporting in general and also one specific article that was written about HIV/AIDS. A journalist at The Hindu was interviewed so that we could learn more about how the editorial staff on a newspaper work and what they should have in mind when they write about the subject. He told us that the newspaper didn’t have any written guidelines to follow when they made an article about HIV/AIDS. The result of our study was that The Hindu wrote more about HIV/AIDS 2007 compared to 2005 and the articles were larger and had more pictures. In the qualitative text analysis we found out that the articles from 2005 often were about the disease, while the articles from 2007 were more about the HIV-positives and the problems they sometimes face with discrimination and stigmatisation. 2005 journalists used doctors and experts as sources, two years later the journalists talked more with ordinary people. These results are similar to earlier research in the same subject. We could also see that children living with HIV/AIDS now could be found in the articles, they were the ones who got least space in the media before. Even though the media are starting to talk more with people living with HIV/AIDS, we found out during our research interviews with PLWHA in India that it may be hard to get someone to openly talk about the subject, because it’s taboo. And one man we interviewed said he would commit suicide if a journalist revealed his status. The PLWHA are less stereotyped in the paper nowadays, but the fear and the discrimination in the society still seem to be there.

<p>In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia.</p>

<p>The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites / beneficial effects of ART / disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination / hunger, poverty, transportation and opportunity costs / hospital factors / non-disclosure / inaccurate knowledge and perceptions about HIV and ART / certain religious beliefs and advice / coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities / financial assistance / perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.</p>

<p>We wanted to know how the subject HIV/AIDS was handled in the Indian newspaper The Hindu, which is written in English, during a period of 16 days (30 October-14 November) in 2005 compared to the corresponding period during 2007. Because we liked to study what kind of differences there were in the reporting between these two years. In addition we also wanted to learn how people living with HIV and AIDS are represented in pictures and text. To find out this was the purpose with this investigation.</p><p>The study is made from the theory of stigma, semiotics and from a professional model of the normative theory. The articles about HIV/AIDS were quantitatively analyzed with help of a schedule of codes and we performed a qualitative analysis on several articles, four from 2005 and four from 2007. We also did four research interviews based on how people infected with HIV thought about journalists’ reporting in general and also one specific article that was written about HIV/AIDS.</p><p>A journalist at The Hindu was interviewed so that we could learn more about how the editorial staff on a newspaper work and what they should have in mind when they write about the subject. He told us that the newspaper didn’t have any written guidelines to follow when they made an article about HIV/AIDS.</p><p>The result of our study was that The Hindu wrote more about HIV/AIDS 2007 compared to 2005 and the articles were larger and had more pictures. In the qualitative text analysis we found out that the articles from 2005 often were about the disease, while the articles from 2007 were more about the HIV-positives and the problems they sometimes face with discrimination and stigmatisation. 2005 journalists used doctors and experts as sources, two years later the journalists talked more with ordinary people. These results are similar to earlier research in the same subject. We could also see that children living with HIV/AIDS now could be found in the articles, they were the ones who got least space in the media before.</p><p>Even though the media are starting to talk more with people living with HIV/AIDS, we found out during our research interviews with PLWHA in India that it may be hard to get someone to openly talk about the subject, because it’s taboo. And one man we interviewed said he would commit suicide if a journalist revealed his status. The PLWHA are less stereotyped in the paper nowadays, but the fear and the discrimination in the society still seem to be there.</p>

Magister Public Health - MPH / In the era of AIDS, food and nutrition are becoming more of a priority for many households and communities. This is more so now that treatment is available for people infected with HIV and AIDS. Food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Evidence of the ways in which food insecurity and malnutrition may interfere with the effectiveness of antiretroviral therapy is well documented. Aim: The purpose of the study was to inform improvements in food security interventions for PLWHA through an investigation of existing food security interventions in the Khomas Region, Namibia. / South Africa