Nurse Faculty Scholars - HIV

Fatigue in HIV and AIDS: An Analysis of Evidence

kdeming — Fri, 18 Jan 2013 17:38:32 +0000

Published Date:

Fri, 2013-01-18 (All day)

HIV-related fatigue continues to be the most common complaint of infected people. No physiological factors have been consistent predictors for fatigue; psychosocial factors, particularly depression, have emerged more consistently in studies. While clinicians would want to rule out common causes of fatigue such as hypothyroidism, hypogonadism, or anemia, there is scant research for most interventions, which makes it difficult to make definitive recommendations for their use. Modafinil has the strongest research evidence to date, with multiple studies finding it effective in relieving fatigue. However, researchers must continue to pursue ways to ameliorate fatigue in HIV infection, given the high financial, personal, and social costs suffered by people experiencing it.

Prevalence, self-care behaviors, and self-care activities for peripheral neuropathy symptoms of HIV/AIDS.

lsharp — Tue, 19 Oct 2010 12:44:08 +0000

Published Date:

Mon, 2010-03-01 (All day)

As part of a larger randomized controlled trial examining the efficacy of an HIV/AIDS symptom management manual (n = 775), this study examined the prevalence of peripheral neuropathy in HIV-infected individuals at 12 sites in the USA, Puerto Rico, and Africa. Neuropathy was reported by 44% of the sample; however, only 29.4% reported initiating self-care behaviors to address the neuropathy symptoms. Antiretroviral therapy was found to increase the frequency of neuropathy symptoms, with an increased mean intensity of 28%. A principal axis factor analysis with Promax rotation was used to assess the relationships in the frequency of use of the 18 self-care activities for neuropathy, revealing three distinct factors: (i) an interactive self-care factor; (ii) a complementary medicine factor; and (iii) a third factor consisting of the negative health items of smoking, alcohol, and street drugs. The study's results suggest that peripheral neuropathy is a common symptom and the presence of neuropathy is associated with self-care behaviors to ameliorate HIV symptoms. The implications for nursing practice include the assessment and evaluation of nursing interventions related to management strategies for neuropathy.

Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.

nfs — Wed, 29 Sep 2010 12:41:17 +0000

Published Date:

Mon, 2005-08-01 (All day)

Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions.

Social, behavioral, and health care factors associated with recent HIV testing among sexually active non-Hispanic Black Women in the United States.

nfs — Fri, 24 Sep 2010 15:38:13 +0000

Published Date:

Thu, 2009-01-01 (All day)

METHODS: Data from the 2002 National Survey of Family Growth were obtained. Our analyses focused on 1,122 sexually active non-Hispanic Black women aged 18-44 years. Descriptive and multivariate logistic regression analyses were conducted on the total sample of women and on 3 subsamples of women, stratified by age group.

MAIN FINDINGS: Only 29% of the total sample of women reported recent HIV testing. Younger age and recent Pap testing were positively associated with recent HIV testing, whereas uninsurance and no recent pregnancy were negatively associated with recent HIV testing. Unique factors of recent HIV testing also were revealed for each age group.

CONCLUSIONS: A low prevalence of Black women received HIV testing in 2001 and 2002. Efforts to facilitate access to and utilization of health care are needed because these factors were associated with HIV testing. Public health messages to increase HIV testing among this vulnerable population of women also need to consider the factors unique to each age group.

PURPOSE: We examined the prevalence of recent HIV testing among sexually active adult Black women in the United States and the social, behavioral, and health care factors associated with their receipt of these services.
METHODS: Data from the 2002 National Survey of Family Growth were obtained. Our analyses focused on 1,122 sexually active non-Hispanic Black women aged 18-44 years. Descriptive and multivariate logistic regression analyses were conducted on the total sample of women and on 3 subsamples of women, stratified by age group.

An examination of the relationships among gender, health status, social support, and HIV-related stigma.

nfs — Fri, 24 Sep 2010 15:15:20 +0000

Published Date:

Thu, 2010-07-01 (All day)

This secondary analysis used E. Goffman's (1963) model of stigma to examine how social support and health status are related to HIV stigma, after controlling for specific sociodemographic factors, and how these relationships differed between men and women living with HIV. Baseline data from 183 subjects in a behavioral randomized clinical trial were analyzed using multigroup structural equation modeling. Women reported significantly higher levels of stigma than men after controlling for race, history of injection drug use, and exposure category. HIV-related stigma was negatively predicted by social support regardless of gender. The theorized model explained a significant amount of the variance in stigma for men and women (24.4% and 44%, respectively) and may provide novel and individualized intervention points for health care providers to effect positive change in perceived stigma for the person living with HIV. The study offers insight into understanding the relationships among gender, health status, social support, and HIV-related stigma.

Does "Asymptomatic" Mean Without Symptoms for Those Living with HIV Infection?

nfs — Wed, 26 Aug 2009 13:57:36 +0000

Published Date:

Sat, 2009-02-28 (All day)

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as "asymptomatic" by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003-2005 and 2005-2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and symptom management with their clients at all stages of the disease.

Theories of Fatigue: Application in HIV/AIDS

nfs — Fri, 21 Aug 2009 18:50:54 +0000

Published Date:

Mon, 2006-01-30 (All day)

A number of theoretical fatigue frameworks have been developed by nurse scientists with the intention of guiding research, practice, and education in fatigue. However, there is a significant gap between theory development and research utilization of fatigue frameworks in clinical and intervention trials. The purpose of this report is to assess an example of an inductive fatigue framework and a deductive symptom management model: The Integrated Fatigue Model (IFM) and the revised University of California, San Francisco, Symptom Management Model (UCSF-SMM), to investigate their potential to guide future nursing research projects on fatigue. The IFM is a fatigue-specific comprehensive framework of 14 biological and psychosocial patterns that influence signs and symptoms of fatigue and trigger six fatigue dimensions. The developers emphasized that patterns could be interrelated and influence the dimensionality of fatigue. The UCSF-SMM is a multidimensional symptom management model embedded within the three nursing domains: person, environment, and health and illness. The model places symptom perceptions, symptom management strategies, and outcomes within these nursing domains to be the key components of a highly complex symptom management process. The IFM is an important development in the understanding and conceptualization of fatigue in cancer and in HIV/AIDS. However, it does not reach the level of integration of the UCSF-SMM in taking fatigue research a significant step forward by integrating symptom impact, symptom management, and symptom outcomes. Both models have significant weaknesses because of their complexity.