Factors influencing intent to get pregnant in HIV-infected women living in the southern USA.

This descriptive study sought to identify factors that influence HIV-infected women's intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent (n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.

Preventing perinatal human immunodeficiency virus transmission: factors influencing women's intentions toward zidovudine therapy.

BACKGROUND: Despite the benefits of zidovudine (ZDV) therapy in preventing perinatal transmission of the human immunodeficiency virus, HIV-infected women may not accept or adhere to therapy. METHODS: This descriptive study identified factors in 322 HIV-infected women that influence intention to take ZDV if becoming pregnant and to give it to their newborns. RESULTS: Logistic regression analysis showed the likelihood of taking ZDV in pregnancy and giving it to newborns was greater in women who believed ZDV slowed disease progression, ZDV was effective in preventing perinatal transmission, and their primary health care provider (PHCP) was positive about ZDV therapy. Additionally, women who were sexually active and had been pregnant since HIV diagnosis were more likely to intend to give ZDV to newborns. CONCLUSIONS: Positive beliefs concerning ZDV effectiveness and the perception that their PHCP has a positive view of ZDV therapy during pregnancy are significant factors in women's ZDV-related decisions.

Depressive symptoms among African American women with HIV disease.

Depressive symptoms are a common response to HIV disease and evidence suggests that women may be at particular risk. Very little of the research on depressive symptoms within the context of HIV disease has included women, however, and even fewer studies have targeted African American women. In a beginning effort to address this gap, the authors performed a secondary analysis of data collected from 1992-1995 in a sample of 264 HIV+ women. The purpose of the secondary analysis was to describe the levels of depressive symptoms for a subsample of 152 African American subjects and to identify significant covariates. The original analysis was based on a stress and coping framework and was designed to provide a description of stressors, resistance factors, and adaptational outcomes of HIV+ women. It included various measures of psychological distress and quality of life. Depressive symptoms were not examined in the original analysis as an outcome of HIV disease, however. In the secondary analysis, depressive symptoms were operationalized using a depression subscale of the Brief Symptom Inventory (BSI) (Deragotis, 1993). Major categories of correlates examined included person resources, environmental resources, coping responses, and disease-related stressors. The data used in the analysis were collected during the fourth and fifth interviews of the longitudinal study, with 152 of the African American women having completed both interviews. Variance in depressive symptoms was analyzed using ANOVA, zero-order correlations, and multiple regression analysis. The mean depressive symptoms score for the subsample of African American women was considerably higher than published means for female and male normative samples, respectively. The regression model accounted for over half of the variance in depressive symptoms (R2 = .515). Significant correlates included self-esteem, family cohesion, HIV symptoms and quality of life. The findings support personal and social resources and disease-related factors as important correlates of HIV+ African American women's depressive symptoms and suggest the need for interventions to address such factors.

Spiritual activities as a resistance resource for women with human immunodeficiency virus.

BACKGROUND: Few studies have investigated the role that spiritual activities play in the adaptational outcomes of women with human immunodeficiency virus (HIV) disease. OBJECTIVE: To examine the role of spiritual activities as a resource that may reduce the negative effects of disease-related stressors on the adaptational outcomes in HIV-infected women. METHODS: A theoretically based causal model was tested to examine the role of spiritual activities as a moderator of the impact of HIV-related stressors (functional impairment, work impairment, and HIV-related symptoms) on two stress-related adaptational outcomes (emotional distress and quality of life), using a clinic-based sample of 184 HIV-positive women. RESULTS: Findings indicated that as spiritual activities increased, emotional distress decreased even when adjustments were made for HIV-related stressors. A positive relationship between spiritual activities and quality of life was found, which approached significance. Findings showed that HIV-related stressors have a significant negative effect on both emotional distress and quality of life. CONCLUSIONS: The findings support the hypothesis that spiritual activities are an important psychological resource accounting for individual variability in adjustment to the stressors associated with HIV disease.

Long-term disease management needs of southern African Americans with diabetes.

PURPOSE: This qualitative study explored the issues, concerns, and needs of low-income, southern African Americans in managing type 2 diabetes over time. METHODS: Two focus groups (N = 22) were conducted with the target population to collect data. Group sessions were audiotaped and transcribed verbatim. Content analysis was used to analyze the data. RESULTS: The data revealed an overall theme of learning to live with diabetes, which consisted of 3 processes: (1) symptom management, (2) making healthy choice, and (3) emotional adjustment. This article focuses on the processes of symptom management and making healthy choices. Findings suggest that the sequential processes of symptom management and making healthy choices occurred over time primarily through experiential learning in this population and were influenced by social support, caring and collaborative provider-client relationships, and access to resources and culturally sensitive supportive services. CONCLUSIONS: Experiential educational methods that incorporate social support and access to resources may be more appropriate than the traditional didactic method of teaching diabetes self-care.

Telephone triage and consultation: an emerging role for nurses.

Telephone triage and consultation is increasingly being used to counsel patients about the appropriate level and timing of care. Nurses are becoming the most frequently used health care professionals providing this care. Although roles vary, consensus is emerging about role definition, scope of practice, and use of protocols. Professional associations and state boards of nursing are examining critical issues related to licensure and standards of practice. Nurses who practice telephone triage and consultation indicate that it is an exciting and demanding specialty with unique issues related to quality, documentation, amount of experience necessary, information resources, and supportive technology. The issues reported by practicing nurses are not necessarily those reported in the literature (e.g., liability, licensure, and practice standards). Developing or modifying current standards of practice needs immediate attention from professional nursing groups, as does the issue of licensure. Nursing educators need to be aware of this emerging role and prepare their students to function competently in this area. Finally, researchers have a rich and varied field of study around this new practice field and its impact on patient care and outcomes.

Experiences of violence in HIV-seropositive women in the south-eastern United States of America.

Women represent one of the fastest growing groups being diagnosed with HIV infection. Because of the circumstances under which they live, women at the highest risk for HIV infection may also be at risk for verbal, physical and sexual violence. The purpose of this study was to examine the frequency and type of violence experienced by women infected with HIV, and describe associations between reported violence, self-esteem and sense of competence. The study used a descriptive design and was conducted in the south-eastern United States. The sample consisted of 194 women infected with HIV. Women were primarily single, African-Americans residing in urban areas with an annual household income of less than $10,000 per year. Participants completed face-to-face interviews using a structured questionnaire which included a frequency of violence scale, Rosenberg's self-esteem scale, and Pearlin and Schooler's mastery scale. Approximately 15% of women reported at least one event of physical abuse and 55% at least one event of verbal abuse in the past 6 months. Verbal abuse experienced by women was the strongest net negative predictor of self-esteem and competence. These findings indicate that HIV-infected women are at risk for experiencing physical abuse and verbal abuse, and the experience of violence is associated with lower self-esteem and competence.

The care of women with AIDS: special needs and considerations.

The growing number of women being diagnosed with HIV/AIDS mandates the need to focus attention on the special needs of this population. Although women have many of the same devastating physical manifestations of HIV infection as men do, they face unique psychological and social issues that influence their ability to respond to their disease in the same ways. Women with HIV/AIDS are disproportionally poor or minority women who lack resources to maintain their health. It is impossible to address HIV infection in women without considering such factors as poverty, discrimination, and gender role expectations. This article uses a biopsychosocial framework to discuss a range of specific issues affecting the health and well-being of women with HIV/AIDS.

Student projects enhance competency in community-based nursing practice.

Trends in healthcare delivery toward community-based care challenge nurse educators to design nursing curricula and learning experiences that prepare students for practice in community settings. The authors describe how faculty used student projects to enhance community learning experiences. The projects were designed to help students gain skill in the process of program design and evaluation and an appreciation and enthusiasm for community-based nursing practice.

The effectiveness of coping strategies used by HIV-seropositive women.

The effectiveness of active and passive coping strategies was examined in a sample of 264 women infected with HIV. Coping was measured concurrent with, and 3 months prior to, measurement of physical symptoms and emotional distress. Two causal models were tested: one for active coping and one for passive coping. Active coping strategies examined included seeking social support, managing the illness, and spiritual activities. Avoidance was used as an indicator of passive coping. In both models, physical symptoms and emotional distress were positively and significantly related. The findings indicated that, whereas current avoidance coping was not related to emotional distress, current active coping was positively related to physical symptoms and negatively related to emotional distress. The immediate effects of active coping appeared to serve a protective function in that emotional distress decreased with greater use of active coping, even as physical symptoms increased. Avoidance coping had no such protective effect for emotional distress. In addition, the use of avoidance coping decreased and active coping increased as physical symptoms increased, suggesting that active coping is more likely to be used with increasing levels of physical symptoms. The findings suggest that interventions that support attempts to use active coping strategies as physical symptoms increase may be effective in promoting positive adaptation to HIV disease.

Quality of life in HIV-infected women in the south-eastern United States.

The purpose of this study was to evaluate the relative importance of social (social support, material resources, disclosure, and family functioning) and psychological factors (stigma, emotional distress, intrusion, avoidance, and fatalism) as predictors of the quality of life of women infected with HIV. The cross-sectional data were drawn from interviews of a sample of 264 women recruited from 8 HIV/AIDS treatment sites in a south-eastern state. Variance in quality of life variables, included limited daily functioning, general anxiety, and HIV symptoms was analyzed using ANOVA, correlations, and hierarchical multiple regression analysis. Limited daily functioning was predicted by stigma, fatalism, employment status, and stage of disease (R2 = 0.179). General anxiety was predicted by emotional distress, intrusion, and marital status (R2 = 0.503). Reported HIV symptoms were predicted by material resources, disclosure, intrusion, age, employment status, and race (R2 = 0.294). The results of this study support that social and, particularly, psychological factors are important in their influence on quality of life in women with HIV infection and suggest the need for interventions which address such factors.

Resources, stigma, and patterns of disclosure in rural women with HIV infection.

A growing number of cases of HIV infection are being diagnosed in rural communities especially among women. Although HIV-specific education and care delivery programs have been focused on rural areas in recent years, limited data are available on the impact of such initiatives on the lives of women with HIV infection. The purpose of this study was to examine characteristics of women with HIV disease living in rural communities. The study used a cross-sectional sample of rural women in Georgia. Data analysis indicated that although a majority of the women reported adequate resources, there was a group of women for whom resources for basic needs were not always adequate. Additionally, women with HIV who had not progressed to AIDS had greater difficulty in obtaining a number of resources. Almost half of the women felt stigmatized due to having HIV. Yet, a high percentage of these women had disclosed their HIV status to health care workers, sexual partners, and family. Study results provide insight into the needs of HIV-infected rural women from their perspective. This information can be important to nurses working in public health and community settings as they face the challenge of developing effective health care services for this population.

An exploration of the meaning and use of spirituality among women with HIV/AIDS.

Disease progression and the onset of AIDS slowly strip away the human form and dignity. As the physical body succumbs to the disease, those with HIV/AIDS search for meaning in life as they seek ways to prolong survival. The purpose of this study was to explore the meaning and use of spirituality in women infected with HIV/AIDS. Data were generated through the use of focus group methodology in eight sessions. The sample was composed of 45 women, aged 20 to 63, of whom 12 were white and 33 were black. Focus group sessions generated 76 descriptions of spirituality and six major themes: relationship with a supreme being, prayer and meditation, healing, peace, love, and religiosity. The acceptance of spirituality as a component of health and quality of life requires a shift in perspective that may allow for the development of new treatment and care strategies that are meaningful to those whose conditions are presently incurable.

The impact of HIV on emotional distress of infected women: cognitive appraisal and coping as mediators.

This study examined the role of psychological factors as mediators of the impact of HIV-related stressors on emotional distress of a clinic-based sample of 264 HIV+ women. Based upon Lazarus and colleagues' cognitively oriented theory of stress and coping, causal modeling was used to test for mediating effects of cognitive appraisal (intrusive thoughts and perceived stigma) and coping variables (avoidance and fatalism) on emotional distress within the context of HIV-related stressors (functional impairment and work performance impairment). The findings supported the mediating effects of cognitive appraisal but not of the coping variables. Consistent with theory, the effect of HIV-related stressors on emotional distress was indirect through cognitive appraisal; however, there were no significant direct effects of HIV-related stressors, fatalism or avoidance on emotional distress. The causal model accounted for significant portions of variance in emotional distress (R2 = .49) and the model fit, as a whole, was more than adequate. The findings indicate that how HIV+ women think about HIV-related stressors is an important factor that may account for individual variability in the ability to maintain a sense of subjective well-being in the face of a devastating fatal disease.

A model emerges for the community-based nurse care management of older adults.

Changes in the demographics of older adults and the structure and financing of the health care delivery system have created a need to develop alternative models of care delivery for the elderly. The nurse care management model is a potentially cost-effective solution for provision of comprehensive care to this population. By providing timely health promotion and illness prevention education, as well as coordinating community resources, nurses can reduce the health care costs of this growing segment of the population. Funding this model, however, remains a challenge as such services are not directly reimbursed by third-party payers.

Self-care activities of women infected with human immunodeficiency virus.

The article describes a qualitative focus group study exploring the self-care activities undertaken by women testing positive for human immunodeficiency virus (HIV) to promote and maintain their health. The sample included 27 women who participated in one of four focus group sessions. Participants represented women from both rural and urban settings in the South. Subjects talked about and described the ways in which they took care of themselves. Content analysis was used to code the data and to determine major categories of activities. Seven categories were identified: special dietary and nutrition practices, choosing not to use medically prescribed therapies, spiritual reliance and rituals, staying active, cognitive strategies, self-education, and adopting healthy life styles. These findings support the value of developing a holistic approach to health care of women infected with HIV.

Barriers to health-seeking behaviors for women infected with HIV.

There is a growing need to develop services for women with human immunodeficiency virus (HIV) infection, despite the reluctance of many to seek help. Yet, there is limited knowledge of the forces that act as barriers to health-seeking behaviors among these women. In the analysis of this focus group study of 46 women with HIV, eight distinct categories of perceived barriers to care were identified. These were: Lack of knowledge on the part of health care providers, fear of negative treatment, insensitivity of health care providers, fear by providers, lack of patient education, lack of confidentiality, lack of honesty, and blaming the victim. The women's descriptions of their experiences with health care providers are presented and discussed in the context of the potential impact of such behaviors on women's willingness to accept or continue treatment for HIV infection.

The poster presentation as an educational tool.

The authors describe their experiences in using the poster presentation to develop undergraduate nursing students in the scholarly role of professional nursing practice. The posters were used as a means for students to communicate their accomplishments in implementation and evaluation of an innovative clinical project. Methods for development, exhibition, and evaluation of the poster project are described.

Perceptions of stigma in women infected with HIV.

This qualitative focus group study explored perceptions of stigma in HIV-seropositive women. The sample included 19 HIV-positive women who participated in one of four focus group sessions. Participants were asked to talk about and describe their perceptions of how others think about and respond to them and other HIV-infected individuals. Content analysis was used to code the data and identify participant perceptions. Four themes representing distinctly different perceptions of stigma were identified: distancing, overgeneralizing stereotypes, social discomfort, and pity. The implications of the findings for intervention and future research are discussed.