Understanding Participation in a Hospital-Based HIV Support Group in Limpopo Province; South Africa

Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV/AIDS; especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups. Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study. Results: The participants attended because they were referred by a health-care worker; wanted information; wanted emotional support; accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support; accepting one's HIV status; reducing stigma and isolation; increasing hope; forging new friendships; helping others; obtaining HIV-related information; developing strategies to change behaviour; gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group; long queues at the HIV clinic; concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict; burn-out and impractical protocols. Access to disability grants was also a concern. Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV/ AIDS through offering structured emotional; informational; instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally; support group leaders should receive appropriate training and regular debriefing

Adherence To HIV Antiretroviral Therapy Part II: Which Interventions Are Effective In Improving Adherence?

Interventions to support adherence to antiretroviral therapy (ART) can be classified into four categories: cognitive; beha-vioural and affective interventions and (modified) directly observed therapy (DOT.) Cognitive interventions improve HIV- and ART-related knowledge; but this is not consistently associated with better adhe-rence. Cognitive interventions that are combined with behavioural or psychological strategies are more effective in improving adherence; especially in patients who previously were less adherent. These include interventions that improve self-efficacy; provide stress management/expressive support therapy or motivational interviewing. As yet there is no evidence for the role of affective interventions and modified DOT to improve adherence to ART. When designing interventions to address adherence; it should be borne in mind that multi-component interventions are more effective than single-focus interventions. A combination of educational; behavioural and affective components is suggested to ensure optimum adherence.In countries with a high prevalence of HIV; such as South Africa; careful patient preparation; rather than selecting patients based on non-clinical predictors of adherence; seems an appropriate method for scaling up ART. South African guidelines focus on comprehensive adherence support to all patients; with additional support to patients with less than 80adherence. More research on the effectiveness of interventions aimed at improving adherence is urgently needed; especially in develo-ping countries