Male Promiscuity

Understanding contemporary sociocultural constructions of masculinity and sexuality is crucial in the struggle against HIV/AIDS. This article discusses lay conceptualizations and enactments of manhood, in interaction with emic interpretations and practices of promiscuity. Data were collected from motorbike taxi-riders in southwest Uganda using ethnographic participant observation, a semi-structured questionnaire (n = 221), focus group discussions, in-depth interviews, case studies, and interactive workshops. Meanings and interpretations of masculinity are deeply imbued with sociocultural symbols drawn from the traditional, ritualistic, political, economic, and contemporary contexts. Social scripts and expectations are for males to engage in sexual activity as evidence of maturation. Higher social status, economic well-being, power, and “more manhood” are associated with multiple sexual partners. This male ideology perpetuates patriarchy and the commoditization of women, disparages messages of anti-HIV/AIDS campaigns, and supports risky sexual behavior. Sexual and reproductive health interventions should widen contemporary local perceptions and understandings of manhood to include safe sexual behavior. </jats:p

Impact of cancer anorexia-cachexia syndrome on health-related quality of life and resource utilisation: a systematic review

Introduction: Cancer anorexia-cachexia syndrome (CACS) negatively impacts patients’ quality of life (QoL) and increases the burden on healthcare resources. Objectives: To review published CACS data regarding health-related QOL (HRQoL) and its economic impact on the healthcare system. Methods: Searches were conducted in MEDLINE, EMBASE, DARE, and NHS EED databases. Results: A total of 458 HRQoL and 189 healthcare resources utilisation abstracts were screened, and 42 and 2 full-text articles were included, respectively. The EORTC QLQ-C30 and FAACT instruments were most favoured for assessing HRQOL but none of the current tools cover all domains affected by CACS. Economic estimates for managing CACS are scarce, with studies lacking a breakdown of healthcare resource utilisation items. Conclusions: HRQoL instruments that can better assess and incorporate all the domains affected by CACS are required. Rigorous assessment of costs and benefits of treatment are needed to understand the magnitude of the impact of CACS

A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life

Introduction: Chemotherapy-induced diarrhea (CID) diminishes physical performance, raises anxiety and depression levels, and increases healthcare resource utilization. Objective: To understand the impact that CID has on health-related quality of life (HRQoL) and on healthcare resource utilization. Methods: Systematic searches were conducted in MEDLINE, EMBASE, DARE, and the NHS EED databases. Results: A total of 22 articles were retrieved for full review (n=17, HRQoL; n=5 healthcare resource utilization). Only 2 studies had assessed HRQoL in patients experiencing CID, while cost studies demonstrated that CID episodes are unnecessarily expensive and can be avoided if diagnosed and treated early. Conclusions: Better management of CID has the potential to reduce overall economic burden and improve patients’ HRQoL. Available evidence also relays the need to conduct larger studies that assess HRQoL and consider cost beyond direct medical costs in order to understand the full impact of CID on HRQoL and healthcare resource utilization

The charms and challenges of antiretroviral therapy in Uganda: the DART experience

Antiretroviral therapy (ART) improves the quality of life of people living with HIV/AIDS. However, adherence remains a challenge. A total of eight focus group discussions (FGD) were conducted with participants from a randomised controlled trial that monitored strategies for managing ART in African adults: Development of Antiretroviral Therapy. All FGD participants had received ART for at least one year. Perceived benefits of ART were key motivators for adherence. These benefits included improved physical health, restored self-esteem, acceptance in the community and hope for a longer and healthier life and reduced fear of HIV/AIDS-related death. Barriers to adherence included a high pill burden, ART side effects and socio-economic constraints, including lack of food and safe water for taking the pills. Visible ART side effects and involvement in an exclusively HIV/AIDS clinic could expose their HIV status, thus exacerbating stigma. Gender and socio-economic differences were found in the variety of strategies employed to ensure adherence. ART was perceived as improving the overall quality of life of recipients; however, it is crucial for ART programmes to be gender and socio-economic cognizant in order to enhance adherence to a lifelong therapy

The role of HIV testing, counselling, and treatment in coping with HIV/AIDS in Uganda: a qualitative analysis.

HIV/AIDS has had a devastating impact at individual, household and community levels. This qualitative research investigates the role of HIV voluntary counselling and testing (VCT) and treatment in enabling HIV-positive Ugandans to cope with this disease. Twelve predetermined focus group discussions (FGDs) were conducted; six with men and six with women. Half of the men and women's groups were receiving antiretroviral therapy (ART) and half were not. An FGD was held with the health care providers administering ART. Testing for HIV was perceived as soliciting a death warrant. Participants affirmed that the incentive for testing was the possibility of accessing free ART. They described experiencing gender-variant stigma and depression on confirming their HIV status and commended the role of counselling in supporting them to adopt positive living. For those receiving ART, counselling reinforced treatment adherence. The findings also revealed gender differences in treatment adherence strategies. ART was described to reduce disease symptoms and restore physical health allowing them to resume their daily activities. Additionally, ART was preferred over traditional herbal treatment because it had clear dosages, expiry dates and was scientifically manufactured. Those that were not receiving ART bore myths and misconceptions about the effectiveness and side effects of ART, delaying the decision to seek treatment. Stigma and the attached concern of HIV/AIDS-related swift death, is a major barrier for VCT. Based on this study's findings, ensuring the provision of quality assured and gender conscious VCT and ART delivery services will enhance positive living and enforce compliance to ART programmes

Utility assessment of HIV/AIDS-related health states in HIV-infected Ugandans.

OBJECTIVE: To assess the psychometric performance of using standard gamble (SG), time trade-off (TTO) and visual analogue scale (VAS) in the evaluation of three predetermined HIV/AIDS health states in HIV-infected Ugandans, for use in cost-effectiveness analyses. METHODS: We recruited participants with CD4 cells <200/microl from the Development of AntiRetroviral Therapy in Africa (DART) trial cohort [randomized trial evaluating antiretroviral therapy (ART) management strategies] in Uganda, before they initiated ART (n = 276). A comparison group of ART-naive HIV-infected individuals was recruited from the Entebbe Cohort study (n = 159). Participants were interviewed and asked to rate his/her own health state using VAS; rank and evaluate HIV/AIDS predetermined health states using TTO and SG relative to an improved health state. Tools were tested for psychometrical properties. RESULTS: Women constituted 64% and 76% of the DART and Entebbe Cohorts. Mean age was 36.5 and 36.7 years, respectively. Participants could discriminate between predetermined HIV/AIDS health states. Deterioration in health status was associated with a reduction in rating scores (VAS), increased willingness to give up time (TTO) and acceptance of increased risk (SG) to achieve a better health state, independent of the participant's actual health state, as measured by CD4 cell counts. CONCLUSION: VAS, TTO and SG have good psychometric properties, making them good candidates for use in resource-constrained settings. Further research in a wider population is necessary to generate an evidence base with which to inform resource allocation decisions