Voices of the women: feedback from women of child-bearing age who are living with HIV can help improve efficacy of psychosocial interventions / Voces de mujeres: la retroalimentación de mujeres en edad de parir viviendo con VIH puede aayudar a mejorar la eficacia de las intervenciones psicosociales

BACKGROUND: We hypothesized that voluntary counselling and testing during pregnancy are necessary but not sufficient to provide the holistic psychosocial support needed by Jamaican women living with HIV and/or AIDS. Based on this hypothesis, we investigated a range of coping methods and support systems used by HIV-infected women and a group of their HIV-negative counterparts before, during and immediately after their pregnancies. METHODS: Women attending obstetric clinics in urban Jamaica completed a quantitative survey aimed at discovering coping behaviours, social and spiritual support systems. Presurvey focus group studies and key informant interviews contributed to the design of the questionnaire while post-survey focus groups were used to probe the validity of the data gleaned from the questionnaire survey. Survey data were analyzed using non-parametric tests for trend with independent univariate tests. RESULTS: Fifty-five HIV-infected women and 51 HIV-negative women completed the survey. Compared with HIV-negative women, more HIV-infected women reported both feeling depressed (p = 0.07) and having difficulty concentrating (p = 0.05) during the month immediately prior to the study. Other statistically significant differences included: HIV-infected women were more likely to pray, to sleep and to change eating habits in response to worry and stress (p = 0.001 in each instance). Although several women declared religious faith, significantly fewer HIV-infected women were willing to talk to a religious leader about their problems compared to their HIV-negative counterparts (p < 0.001). CONCLUSIONS: Participation of HIV-infected women in post-survey focus groups augmented the survey findings. Many of the women reported negative emotions and some indicated serious challenges in accessing social support. The results point to the need for systematic documentation of psychosocial profiles as part of the approach to caring for these women. In addition, in the Jamaican sociocultural context, we recommend improved training of religious leaders and healthcare providers in psychosocial issues.

ANTECEDENTES: Planteamos la hipótesis de que someterse al asesoramiento y prueba voluntarios durante el embarazo es necesario, pero no suficiente para el apoyo psicosocial holístico que necesitan las mujeres jamaicanas que viven con VIH y/o SIDA. Sobre la base de esta hipótesis, investigamos una serie de métodos de afrontamiento y sistemas de apoyo usados por las mujeres infectadas por el VIH y un grupo de sus contrapartes VIH negativas antes, durante e inmediatamente después de sus embarazos. MÉTODOS: Mujeres que asistían a clínicas obstétricas en áreas urbanas de Jamaica, completaron una encuesta cuantitativa, encaminada a descubrir conductas de afrontamiento, y sistemas de apoyo social y espiritual. Estudios de grupos focales mediante encuestas y entrevistas a informantes claves, contribuyeron al diseño del cuestionario, mientras que grupos focales de post-encuesta fueron usados para investigar la validez de los datos recogidos de la encuesta-cuestionario. Los datos de la encuesta fueron analizados usando tests no paramétricos para tendencia con tests univariados independientes. RESULTADOS: Cincuenta y cinco de las mujeres infectadas con VIH y 51 de las mujeres VIH negativas, completaron la encuesta. En comparación con las mujeres VIH negativas, más mujeres infectadas con VIH reportaron sentirse deprimidas (p = 0.07) y tener dificultades con la concentración (p = 0.05) durante el mes inmediatamente anterior al estudio. Otras diferencias estadísticamente significativas fueron las siguientes: las mujeres infectadas con el VIH mostraron una mayor tendencia a orar, dormir y cambiar sus hábitos alimentarios en respuesta a la preocupación y el estrés (p = 0.001 en cada caso). Aunque varias mujeres declararon tener fe religiosa, significativamente pocas mujeres infectadas con VIH estuvieron dispuestas a hablar a un líder religioso acerca de sus problemas, en comparación con sus contrapartes VIH negativas (p < 0.001). CONCLUSIONES: La participación de mujeres infectadas con VIH en grupos focales de post-encuesta aumento marcadamente los hallazgos de la encuesta. Muchas de las mujeres reportaron emociones negativas y algunas indicaron serios desafíos en cuanto a tener acceso a algún apoyo social. Los resultados apuntan a la necesidad de poseer una documentación sistemática de los perfiles psicosociales como parte del abordaje del cuidado a estas mujeres. Además, en el contexto sociocultural de jamaica, recomendamos mejorar el entrenamiento de los líderes religiosos y los proveedores de salud en cuanto a las problemáticas psicosociales.

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2,580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46 percent vs 26 percent, p < 0.001) but not among women (19 percent vs 8 percent, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odd Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers