Background: Emerging adulthood (18 to 29 years old) is a critical age group in relation to the Human Immunodeficiency Virus (HIV) epidemic and to mental health. A major public health concern globally, in management of HIV, is that emerging adults have suboptimal antiretroviral therapy (ART) adherence, yet they are the largest group initiating ART. In addition, common mental disorders (CMDs), including depression and anxiety have their peak incidence during this period and they have been found to increase risk of non-adherence to ART. Those with CMDs may have different types of barriers than those without CMDs. Furthermore, those with CMDs might be more likely to have a greater number of barriers to adherence than those without because of the way symptoms of CMDs impact on memory, problem solving skills and concentration. Aims: The main aim of this study was to describe barriers to adherence to ART in emerging adults living with HIV with probable CMDs (i.e. depression and/or anxiety) and accessing HIV treatment at a government clinic in Harare, Zimbabwe, compared to emerging adults living with HIV without probable CMDs. The specific objectives were: a. to determine the prevalence of probable CMDs among emerging adults living with HIV, b. to describe the prevalence, severity and common barriers to ART adherence, measured using the 22-item Barriers to Adherence (BARTA scale) in emerging adults living with HIV with probable CMDs and to compare this with those without probable CMDs. Methods: A representative sample of 223 emerging adults aged 18 to 29 years were recruited in a crosssectional study using the random sampling technique. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Barriers to Adherence Scale (BARTA scale) were used to assess probable depression, probable anxiety and barriers to adherence respectively. Data Analysis: Univariate Descriptive statistics were used to describe the socio-demographic, prevalence of probable CMDs, prevalence of barriers to adherence, overall median of total BARTA score (severity of barriers to ART adherence) for the whole sample and overall median number of barriers to ART adherence for the whole sample. Chi-square analyses were used to compare the prevalence of barriers (no barrier vs. at least one) between participants with and without probable CMDs. Non-parametric Wilcoxon rank-sum tests and Kruskal Wallis tests (for variables with more than two categories) were used to I. Compare the number of barriers to ART adherence between participants with and without a probable CMDs; II. Compare the severity of barriers to ART adherence between participants with and without probable CMDs, using overall scores on the BARTA scale III. Assess the relationship between demographic variables, HIV related variables, Substance Use Disorders (SUD) and total BARTA scores. Variables which were significantly associated with BARTA scores were entered into a negative binomial regression model, to assess the relationship between CMDs and severity of barriers to ART adherence, this time controlling for possible demographic confounding factors. Results: The prevalence of probable CMDs (i.e. probable depression and/or probable anxiety) was 33.2%. Specifically, 31.8% had probable depression and 16.1% had probable anxiety. Results: showed that 76.2 % of the sample experienced at least one barrier to ART adherence and that 94.5% of those with CMDs experienced at least one barrier to adherence compared to 67.1% of those without CMDs (p>0.001). We found a significant difference (U=-7.209, p<0.001) between the number of barriers experienced by participants with and without CMDs: participants with a CMD reported a greater number of barriers (median (md) =5, IQR=3-7) compared to those without CMDs (md= 1, IQR=0-4). A statistically significant difference was also found in total BARTA scores between participants with and without CMDs: participants with a CMD reported a greater BARTA score (md=7, IQR=4-12) compared to those without a CMD (md= 2, IQR=0-4; U=-7.415, p<0.001). The most frequent barriers reported by emerging adults living with HIV with probable CMDs were 'forgetting' (68.0%), 'thinking too much' (49.0%), 'having to take ART in front of others' (41.0%) and 'not having a reminder' (39.0%). The most frequent barriers for emerging adults living with HIV without probable CMDs were 'forgetting' (30%), 'not having medications with them' (21%), 'not wanting others to know their status' (20%) and 'not having a reminder' (19%). Although 'forgetting' and 'not having a reminder' were among the top barriers in both groups, those with probable CMDs reported them more frequently. Conclusion: This study has shown that firstly, CMDs and barriers to ART adherence are prevalent among emerging adults living with HIV. Secondly, emerging adults living with HIV with probable CMDs experience a high number of barriers to ART adherence and more severely than those without probable CMDs. Finally, emerging adults with CMDs reported barriers such as forgetting and not having a reminder more frequently than those without CMDs. This calls for routine screening for probable CMDs and barriers to ART adherence in HIV clinics. Furthermore, there is need to come up with tailored psychological interventions that can simultaneously treat CMDs and reduce barriers to ART adherence among emerging adults living with HIV.

Syftet med denna studie är att utifrån sociokulturellt perspektiv, utforska hur tre musikpedagoger beskriver att de använder sig av mentala träningsmetoder i sin undervisning. Vilka mentala träningsmetoder beskriver tre musikpedagoger att de använder sig av i sin undervisning? På vilka sätt beskrivs dessa metoder komma till användning? Studiens data har samlats in genom kvalitativa intervjuer med tre yrkesverksamma musikpedagoger som använder sig av mental träning på varierade sätt i sin pedagogiska verksamhet. I resultatet framkommer att ju mer utbildning i mental träning musikpedagogerna har, desto tydligare och mer uttalad strategi beskriver de. De beskrivna strategierna betraktas som generaliserbara lärandehjälpmedel som utgår från en grundidé. Ingen av dem uppger att de angriper ett problem direkt, utan de arbetar med det som helhet under pågående inlärningsprocesser. En grupp betraktas som ett viktigt arbetsredskap då diskussioner och utforskande frågor ses som nyckelstrategier, det är eleverna själva som ska finna lösningar på sina problem, inte lärarna. Det är också här medvetenhet och analys kommer med i bilden. Gemensamt är synen på kropp och sinne, där det ena anses påverka det andra. Lugn och avslappning anses därför också vara bra komplement till mental träning. De tre informanterna är överens om att det råder obalans mellan tekniskt övande och mentalt övande eller övande på känsla, inlevelse och uttryck, vilka de aktivt söker balansera och skapa jämvikt emellan. / The purpose of this study is to explore how three music educators describe the use of mental training methods in their teaching. What kind of mental training methods are described? In what ways are they used? Sociocultural perspective is theoretical framework and data consist of qualitative interviews with three professional music educators who use mental training in varied ways. The analyses show that training provides more explicit strategies. The informants’ strategies are considered as generalizable, learning aids based on basic concepts. The informants state that they always work with a mental problem as a whole during an on-going learning process. A group is regarded as an important tool since discussions are seen as key strategies. It is also regarded as important that students are given the space to find problems and solutions themselves; this is also the place where awareness and analysis comes into the picture. The informants give an image of mind and body, which is considered to affect one another. Tranquillity and relaxation are considered as a good complement to mental training. The three informants state that there is an imbalance between technical practicing and mental exercising, why they always searches for balance between these.