Family Caregiving to AIDS Patients: The Role of Gender in Caregiver Burden in Uganda

The objectives of the study were: 1) What is the burden of care for male and female family caregivers of AIDS patients? and 2) Which factors influence the family care burden for AIDS patients at home? A questionnaire was completed by 29 male and 91 female family caregivers of AIDS patients living in four rural areas in western Uganda. Participating caregivers were selected from a patient list of the home-based care program for AIDS patients and then interviewed. The responses from the questionnaire were used to calculate care burden scores for caregivers of both genders and the scores in each group were compared. In addition, other factors relevant to the burden of family care were extracted and tested in bivariate and multivariate analysis to test whether they were predictors of the care burden. Results show that the care burden scores were high in all domains, except those regarding relationship within the families and substance abuse. Both male and female caregivers reported a similar care burden. Caregivers for spouses had higher care burden scores compared to those who cared for other relatives. The intensity of care was also a significant predictor of the care burden, while other factors such as age, duration of care, and cognitive function of the care recipient were not associated with the care burden score. The high burden of care-giving puts family caregivers at risk for a lower health status, social isolation and depression. As both male and female caregivers report similar care burden scores for the same responsibilities, men are not unduly overburdened with the family care of AIDS patients compared to women and should be more actively involved in the care-giving process at home

Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral therapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIV-infected persons on HAART have different fertility desires compared to persons not on HAART, and if the knowledge about HIV transmission from mother-to-child is different in the two groups.</p> <p>Methods</p> <p>The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who were on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living in a rural area of western Uganda. The desire for future children was measured by the question in the questionnaire "Do you want more children in future." The respondents' HAART status was derived from the interviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze the relationship between HAART treatment status and the desire for future children.</p> <p>Results</p> <p>Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95% CI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant predictors for desiring more children were younger age, having a higher number of living children and male sex. Knowledge of the risks for mother-to-child-transmission of HIV was similar in both groups.</p> <p>Conclusions</p> <p>The conclusions from this study are that the HAART treatment status of HIV patients did not influence the desire for children. The non-significant association between the desire for more children and the HAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the positive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care system ensures proper training of staff and appropriate communication to those living with HIV as well as to the general community.</p

Who's talking? Communication between health providers and HIV-infected adults related to herbal medicine for AIDS treatment in western Uganda

Communication between patients and physicians about herbal medicine is valuable, enabling physicians to address issues of potential herb-drug interactions and ensuring appropriate medical care. As seemingly harmless herbal remedies may have detrimental interactions with various HIV antiretroviral drugs, the importance of communication is intensified, but often stifled around the use of herbal medicine in the treatment of HIV/AIDS. In western Uganda, 137 HIV-infected adults attending conventional HIV/AIDS treatment programmes (67 of whom were receiving antiretroviral therapy) shared their experiences and perceptions about traditional herbal medicine and related patient-physician communication issues through interviews and focus group discussions. Although close to 64% of respondents reported using herbal medicine after being diagnosed with HIV, only 16% of these respondents had informed their conventional medical practitioners about using these herbs. Furthermore, only 13% of antiretroviral therapy recipients had inquired about concurrent herb-antiretroviral drug use with their HIV/AIDS treatment providers, largely because they perceived a low acceptance and support for herbal medicine by conventional medical practitioners. Importantly however, almost 68% of HIV-infected adults indicated they would be willing to discuss herbal medicine use if directly asked by a conventional medical practitioner, and the overwhelming majority (91%) said they were amenable to following physician advice about herbal medicine. As such, improved patient-physician communication about herbal medicine is needed, and we recommend that herbal medicine histories be completed when patient histories are taken. Also, HIV/AIDS treatment programmes should be encouraged to develop specific patient-physician communication standards and best practice guidelines to ensure that patients can make informed decisions about herb and pharmaceutical drug co-therapy based on known risks, particularly in the case of AIDS patients receiving antiretroviral therapy. Communication about herbal medicine usage should be viewed as a timely and cost-effective component of antiretroviral therapy programmes, one which may contribute to the overall success of AIDS treatment in Africa.Herbal medicine Communication HIV/AIDS Antiretroviral Africa Uganda Traditional medicine

Enough Children: Reproduction, Risk and “Unmet Need” among People Receiving Antiretroviral Treatment in Western Uganda

In this paper, we use survey (n=87) and interview (n=30) data to investigate orientations towards future childbearing among people receiving antiretroviral treatment and their family members in western Uganda. We investigate how reproductive options are perceived, by those receiving treatment and those closest to them, and consider what these perceptions suggest about the existence of an &ldquo;unmet need&rdquo; for birth control for women with HIV. While most people say they do not wish to have more children while on treatment, this intention coexists with contradictory desires for the benefits and happiness that more children might bring. We argue that the factors influencing birth desires and outcomes are so complex and contradictory that it is virtually impossible to predict demand or uptake of birth control as more and more people with AIDS in Africa gain the ability to access antiretroviral treatments.Keywords: HAART, AIDS, fertility, contraception, Uganda, unmet needAfr J Reprod Health 2012; 16[1]:133-14

Assez d’enfants: Reproduction, risque et besoin « non satisfait » chez les gens qui suivent un traitement antirétroviral en Ouganda de l’Ouest

In this paper, we use survey (n=87) and interview (n=30) data to investigate orientations towards future childbearing among people receiving antiretroviral treatment and their family members in western Uganda. We investigate how reproductive options are perceived, by those receiving treatment and those closest to them, and consider what these perceptions suggest about the existence of an “unmet need” for birth control for women with HIV. While most people say they do not wish to have more children while on treatment, this intention coexists with contradictory desires for the benefits and happiness that more children might bring. We argue that the factors influencing birth desires and outcomes are so complex and contradictory that it is virtually impossible to predict demand or uptake of birth control as more and more people with AIDS in Africa gain the ability to access antiretroviral treatments (Afr J Reprod Health 2012; 16[1]:133-144).Dans cet article, nous nous servons des données d’enquête (n=87) et d’interview pour étudier des orientations futures envers la maternité chez les gens qui suivent un traitement antirétroviral et chez les membres de leurs membres de leurs familles en Ouganda de l’ouest. Nous étudions comment les gens qui suivent le traitement et leurs plus proches aperçoivent les options reproductives et nous considérons ce que suggèrent ces perceptions par rapport à l’existence d’un « besoin non satisfait » pour la limitation des naissances chez les femmes séropositives. Alors que la plupart des femmes disent qu’elles ne veulent pas avoir d’autres enfants pendant le traitement, cette intention coexiste avec les désirs contradictoires pour les bénéfices et la joie que peut apporter d’autres enfants. Nous soutenons que les facteurs qui influent sur les désirs pour la maternité et les conséquences sont si complexes et contradictoires qu’il est pratiquement impossible de prédire ou d’accepter la limitation des naissances au fur et à mesure que les gens séropositifs en Afrique deviennent capables d’avoir accès aux traitements antirétroviraux (Afr J Reprod Health 2012; 16[1]:133-144)

Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda

Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13–0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20–17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients