Development of structured support groups for HIV-positive women in South Africa

Women living with HIV in a stigmatising community need support to cope with their HIV status. In a process of action research, a structured support group programme was designed to meet the needs of women to cope with their diagnosis and interpersonal relationships.The emphasis was on identifying their needs and developing programme material to address those needs through group participation and interaction.The programme was pilot-tested at two sites located in two townships in Tshwane, South Africa. Feedback after each session made it possible to adjust the programme to the needs of the participants. In a formative evaluation, audio-taped sessions, process notes of facilitators, and experiences of the participants were used to identify therapeutic elements, the value of the groups and the problems in the implementation process.Women reported benefit from participation in the support groups. A 10-session structured programme to be used in support groups addressing the most important needs of HIV-positive women was developed.Les femmes vivant avec le VIH dans une communauté stigmatisante ont besoin de soutien afin de faire face à leur statut de VIH.Au cours du processus de la recherche active, un programme de groupe de soutien structuré a été conçu avec le but de répondre aux besoins de ces femmes pour qu’elles puissent faire face au diagnostic et aux relations personnelles. L’important était d’identifier les besoins et de développer le matériel nécessaire au programme afin d’aborder ces besoins à travers la participation et l’interaction du groupe. Des essais pilotes du programme ont été fait dans deux sites situés dans deux banlieues à Tshwane, Afrique du Sud. La réaction au bout de chacune des sessions a permis une adaptation du programme aux besoins des participants. Durant l’évaluation formative les enregistrements de sessions, les notes du processus des animateurs et les expériences personnelles des participants ont été employé dans le but de relever les éléments thérapeutiques, l’importance de groupes et les problèmes émergeant de l’exécution du processus. Les femmes ont signalé que la participation aux groupes de soutien a été rentable. Un programme structuré, ayant dix sessions, a été aménagé pour être utilisé dans les groupes de soutien avec le but d’aborder les besoins les plus importants des femmes séropositives.This research was supported by grants 5R24-HD 043558-03 (awarded to Bridget Jeffery, University of Pretoria under the auspices of the Medical Research Council, Unit for Maternal and Infant Health Care Strategies) from the National Institute for Child and Health Development, and P30-MH62294 (Center for Interdisciplinary Research on AIDS, CIRA, awarded to Michael Merson,Yale University) from the National Institute of Mental Health, USA.http://www.sahara.org.zagv201

The coping strategies used over a two-year period by HIV-positive women who had been diagnosed during pregnancy

Structured interviews were conducted with 224 HIV-positive women diagnosed during pregnancy, at antenatal clinics in Tshwane, South Africa, in order to investigate the use of coping strategies during the first two years after diagnosis. Interviews were conducted between one and four weeks after diagnosis during pregnancy, with three follow-up interviews conducted post-partum. Coping strategies were assessed with an adapted version of the Brief COPE. It was found that active coping was used more often than avoidant coping throughout the study period. Active coping increased over time, while avoidant coping decreased at first but increased again between 6 and 21 months after diagnosis. The most frequently used coping strategies included acceptance, direct action, positive reframing, religion and distraction. At first, women coped through internalised strategies. Over time, outwardfocused strategies developed. Avoidant coping patterns differed from previous research indicating that women diagnosed during pregnancy deal with the consequences of HIV after the baby is born. Recommendations for mental health services are made.National Institute of Child Health and Human Development (NICHD) grant R24HD43558http://www.tandfonline.com/loi/caic20hb201

Psychosocial variables associated with coping of HIV-positive women diagnosed during pregnancy

To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of two years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women’s ability to cope and enhance their health and that of their infants.National Institute of Child Health and Human Development (NICHD) grant R24HD43558http://www.springer.com/public+health/journal/10461gv201

Support group processes : perspectives from HIV-infected women in South Africa

This study examined the experiences and perceived benefits of support group participation among HIV-infected women in South Africa. From a qualitative analysis of responses, key psychological processes through which support groups are potentially beneficial were identified. These processes included identification, modelling, acceptance, and empowerment. The participants’ consequent life changes were explored in order to associate these processes with the positive outcomes of support group participation. Through understanding the relationship between the psychological processes within a support group setting and the potential benefits, and by targeting these processes in the development and implementation of future support group interventions, a framework is provided for achieving positive outcomes associated with support group participation.NICHD grant R24HD43558http://www.tandfonline.com/loi/uqrp20gv201

Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their youngchildren (6–10 years) with a view to strengthening the relationship between them. Strong mother–child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother–child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their youngchildren. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother–child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.The National Institute of Mental Health (NIMH) grant R01 MH076442-01.http://www.elsevier.com/locate/evalprogplangv201

Impact of structured support groups for pregnant South African women recently diagnosed HIV positive

The authors of this study evaluated a structured 10-session psy- chosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p < 0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t = 2.68, p < 0.05) and lower levels of avoidant coping (t = -2.02, p < 0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t = 2.11, p < 0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one’s HIV status, but may not have sustainable benefits over time.http://www.tandfonline.com/loi/wwah2

A randomized clinical trial of an intervention to promote resilience in young children of HIV-positive mothers in South Africa

OBJECTIVE : To assess the efficacy of an intervention designed to promote resilience in young children living with their HIV-positive mothers. DESIGN / METHODS : HIV-positive women attending clinics in Tshwane, South Africa and their children, aged 6 - 10 years, were randomised to the intervention (I) or standard care (S). The intervention consisted of 24 weekly group sessions led by community care workers. Mothers and children were in separate groups for 14 sessions, followed by 10 interactive sessions. The primary focus was on parent-child communication and parenting. Assessments were completed by mothers and children at baseline and 6, 12 and 18 months. Repeated mixed linear analyses were used to assess change over time.RESULTS : Of 390 mother-child pairs, 84.6% (I:161 & S:169) completed at least two interviews and were included in the analyses. Children’s mean age was 8.4 years and 42% of mothers had been ill in the prior three months. Attendance in groups was variable: only 45.7% attended >16 sessions. Intervention mothers reported significant improvements in children’s externalizing behaviors (ß=-2.8, P=0.002), communication (ß=4.3, P=0.025) and daily living skills (ß=5.9, P=0.024), while improvement in internalizing behaviors and socialization was not significant (P=0.061 and 0.052 respectively). Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence. CONCLUSIONS : This is the first study demonstrating benefits of an intervention designed to promote resilience among young children of HIV-positive mothers. The intervention was specifically designed for an African context, and has the potential to benefit large numbers of children, if it can be widely implemented.http://journals.lww.com/aidsonline2015-06-30hb201

Behavior and psychological functioning of young children of HIV-positive mothers in South Africa

Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications. Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they are HIV positive, although they may be asymptomatic. Presently, it is unclear whether the psychological functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill, that children suffer adverse effects. We, thus, aimed to compare the behavior and psychological functioning of young children (aged 6 10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n 509) and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for sociodemographic characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had been told their mothers were sick compared with children who had been told nothing had less internalizing and externalizing behaviors and improved daily living skills. This study, therefore, provides evidence that maternal HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV status was associated with improved behavior and psychological functioning among young children.National Institute of Mental Health (Grant 5R01HD057834)http://www.tandfonline.com/loi/caic20hb201

An intervention for boys aimed at the prevention of violence against women – Qualitative outcome

Programmes designed to empower women in an attempt to eradicate violence against them address only one side of the coin. To promote respectful gender relationships, it is also necessary to change the destructive perceptions of masculinity commonly found among men and boys. The 12-session Hero Empathy Programme was implemented for Grade 5 boys at 10 primary schools in low-resourced communities in South Africa (age range: 10–13 years; black = 100%). The aim was to expose all the Grade 5 boys in those schools to alternative perspectives on masculinity and respectful gender relationships. Before the intervention, focus group discussions were held with the boys to gain an understanding of their conceptualisations and experiences in their communities. Focus group discussions held after the intervention explored changes in the boys’ gender perspectives and behaviour. After the intervention, boys questioned gender stereotypes, respected girls more, showed less violence towards girls and accepted a positive perspective of masculinity, which is to be strong and to provide for and protect the family. The intervention showed promise with regard to its ability to promote respectful gender relationships from a young age. To enhance sustainability and have an effect on the social norms of communities, the intervention should be widely implemented.

Cognitive stimulation in pre-school facilities in a disadvantaged community

The aim of the research was to develop and evaluate a cognitive stimulation programme to promote school readiness in South African pre-school children from a disadvantaged background. Two groups consisting of 23 children each made up the experimental and control groups. A repeated measurement quasi-experimental research design was applied to evaluate the programme using the Herbst Measuring Instrument for Toddlers (Herbst 1994) to assess the cognitive abilities of children before and after the intervention. The results of the evaluation showed that the cognitive stimulation programme had positive effects on the experimental group, although the control group showed mixed results. It can be concluded that cognitive development of educationally and culturally disadvantaged pre-school children can be overcome with a suitable basic programme and limited equipment to facilitate their entering into formal schooling. The appropriateness of the research design for research in community settings is discussed. Le but de la recherche était de developper et d évoluer le programme de stimulation pour promouvoir l' aptitude des enfants Sud Africain a l école venant d' un milieu désavantagé. Deux groupes de 23 enfants chacun consistant en un groupe experimental et un groupe de contrôle. Un plan de recherche quasi-experimental de mesure repetée était appliqué pour évoluer le programme en utilisant les instruments de mesure HERBST pour de petits enfants apprenant à mancher (1994) pour évoluer les abilités des enfants avant et après l'intervention. Les résultats de l'évaluation motraient que le programme de stimulation avait des effects positives sur le groupe experimental, bien sur le groupe de control des resultants mixtes.(ou varié) Il peut être conclu qu'un developpement et culturellement avant l'age de l'école peut être vaincu avec un programme de base, convenable et un êquipement limitê pour faciliter leurs entrée dans l'éducation formelle.la convenance du plan de recherchedans les communoutés cadres est examinee.Journal of Psychology in Africa 2004, 14(1): 17–2