Women and Girls

A cluster, randomized, controlled clinical trial conducted in “an impoverished part of southwest Uganda that has been severely affected by the HIV epidemic” found that group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. The link between HIV and depression was outside the scope of this study, but will be the subject of a future study. Mean reduction in depression severity was 17.47 points for the intervention groups and 3.55 for controls. Mean reduction in dysfunction was 8.08 for the intervention groups and 3.76 for the controls. Following the intervention, only 6.5% of those in the intervention groups met the criteria for major depression, compared to 54.7% of the control groups. Prior to the intervention, 86% of the intervention group and 94% of the control group met the criteria for major depression. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. A local person who had received two weeks of intensive training led groups. The group leader reviewed each participant’s depressive symptoms. The participant was then encouraged to describe the week’s events and link these to symptoms. The group leader then facilitated support and suggestions for change from other group members. The trial compared group counseling to whatever is the usual treatment (which was not delineated). Fifteen villages were randomly selected for studying men and 15 were randomly selected for studying women. In each village, adult men or women believed by themselves and other villagers to have depression-like illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. A total of 108 men and 116 women completed the study. Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. People confirmed of danger of suicide were not enrolled in the study but referred to a psychologist (Bolton et al., 2003).

YRGCare in Chennai, India, a nonprofit HIV counseling, testing and treatment center found that HIV-positive individuals reported that couple and family counseling was beneficial in addition to individual counseling for reducing stigma within the household. In all, 13,000 patients have received counseling. Since 1993, 5,657 patients living with HIV/AIDS have been followed and provided with medical and psychosocial care. Among those, 754 couples accessed couples counseling and 698 accessed family counseling. Disclosure, pressure to have children by family members unaware of their serostatus, discrimination, and hiding medication that can alert others to their serostatus were issues addressed.

A study evaluated the efficacy of an individualized psycho-education (PE) program in reducing psychological distress and risky sexual behavior and enhancing self-disclosure associated with an HIV diagnosis among attendees of a walk-in non-governmental voluntary counseling and testing (VCT) center in Nigeria. Researchers found that at four weeks post-intervention, significant reductions on all measures as well as reduction in risky sexual practices were observed in the treatment group compared with the wait-list group. Treatment group members were also significantly more likely to disclose their serostatus and accept their HIV status as a way of coping, compared with the wait-list group. Ninety-four consecutive individuals were asked to complete a pre- counseling, baseline questionnaire detailing their sociodemographic characteristics, psychopathology, sexual practices, self-disclosure intention and coping behaviors. They were screened for HIV and post-test counseled. Sixty-seven individuals (72.2%) who tested positive were consecutively randomly assigned to one of two groups: a PE program (four 60-minute weekly manual driven sessions) (N=34) and a wait-list (WL) control group (N=33). The major outcome measures used were the Crown Crisp Experiential Index (CCEI), the Beck Depression Inventory (BDI) , self-report sexual practices in past three months, self-disclosure intention and the brief COPE (Olley, 2006).

Thirty in-depth interviews with HIV-positive women in Vietnam who participated in a support group starting in 2004 that were interviewed again after two years, along with 23 husbands and 18 mothers-in-laws, found that a support group provided a major source of emotional support to the HIV-positive mothers, with most of the thirty women learning how to do peer support work, run a business or keep a job. “I have come to life again and don’t suffer from an inferiority complex any longer’ noted a 23 year old HIV-positive woman (p. 147). Through the support group, women access information and services, both for themselves and their children. Peer counselors accompanied the HIV- positive women to health facilities in groups of five. Mothers-in-law also learned to change as the HIV-positive women themselves accessed information, services and support: “In the beginning, I had no idea how HIV is transmitted. All of us were very afraid of it…Now I feel so sympathetic to my son and daughter-in-law. I wish I had not been so awful to them” (p. 148). Prior to the support group, their families would not have meals with them, forbade them to touch their own baby and kept the mother’s HIV-positive status a secret from neighbors. Mothers acutely felt stigmatized by health providers. During PMTCT counseling, “nearly all the information given to infected women during counseling was aimed at protecting other people from infection…Very little was explained about the potential risks to their own health or how they could keep healthy” (p.145). Only six of 30 women were given postnatal appointments by health facilities. Women were blamed by in-laws for ‘not being able to protect their husband form social evil behaviors’ or for ‘being a source of transmission to a beloved grandchild’ (p. 145). Families would not spend money on the HIV-positive mother’s care: “Anyway they will die in the future…It’s a fatal disease. So it’s better to use money properly” said one mother-in-law (p. 146). Training was provided to the support group in communication skills.

A study from 2003 to 2005 in South Africa with 186 women and 64 men, all HIV-positive, found that the 27% (52 women and 15 men) who joined a support group had scored better on physical and mental health items than those who did not join a support group. Almost 90% rated that the support group had a positive impact in their lives. The support group also helped with disclosure and had made them more able to access services and information related to HIV/AIDS. The support group may also have made participants feel more in control of their lives, going from being passive recipients of help to becoming active agents.

Evaluation of the mothers2mothers (m2m) program in, South Africa found that the m2m program provided a strong continuum of care to the women and infants. Compared to non-participants, m2m participants had greater psychosocial well-being and greater use of PMTCT services and outcomes. Postpartum program participants were significantly more likely to have disclosed their status to someone than non-participants, and to have done so prior to delivery. M2m seeks to reduce PMTCT, empower pregnant and postpartum women to improve their health and the health of their babies, fight stigma and encourage and support disclosure. The program offered education and psychosocial support to HIV-positive pregnant women and new mothers, assisted women to access PMTCT services, and followed up to ensure care of mothers and infants after delivery (Baek et al. 2007).

In-depth interviews conducted from 2000 to 2001 with ten pregnant women in Thailand following their HIV diagnosis found that peer support groups were critical for women when they were ready to share their struggles with others.

A qualitative study in rural and per-urban Malawi explored the acceptability of a caregiver’s training and support group for Malawian women. Twenty women caregivers were recruited for in-depth interviews. Questions address the actions that could be conducted in the group, the reasons to participate, the barriers to participation, and the benefits of a caregiver group. Reponses from women show that a caregiver support group would be acceptable to Malawian women. Rural and peri-urban women said a group could take action by sharing household chores, finding material resources, and developing business ideas to generate income. Barriers to the group were community “gossiping”, and husband and family disapproval. Benefits of the group were the opportunity to learn and share information, share patient care, and offer emotional support. In addition, women expressed the hope that direct access to antiretroviral treatment could be obtained through the group. This group of Malawian women caregivers felt they could benefit greatly from a caregiver support group. While the caregiving demands are vast, these women have many skills and abilities to care for patients and a support group could enhance the sharing of treatment, care, and support to alleviate the impact of HIV/AIDS for families.

A study in South Africa based on interviews with 317 pregnant HIV-positive women found that women reported benefiting from a structured support group. Program material for the support group meetings was based on a needs assessment. The meetings provided information on HIV; the emotional experience of being HIV-positive; sharing coping with difficult situations, using role plays; planning for disclosure; what they wanted from their partners; dealing with stigma; and goal setting and future planning. Masters level psychology students facilitated the support groups. Interviewers following the support group sessions found that the women found the support group valuable: “It was a shelter to hide away where I could talk freely. I can tell others now. Now I am stronger, I can stand on my own” . Another woman stated: “It was a positive picture of HIV. I did not feel alone and embarrassed anymore” (Visser et al., 2005: 339). Role-playing was especially helpful. In addition, the introduction of human rights helped women to realize “that they were not at fault, but that other people discriminated unjustly against them” (Visser et al., 2005: 340).

A qualitative study of interviews with 75 HIV-positive people (43 females, 32 males) from 20 countries, including Australia, Botswana, India, Kenya, South Africa, Thailand, Uganda, Zambia, and Zimbabwe, conducted between 1997 and 1999, found that women were more likely to seek peer support than men and that peer support groups were “lifelines”.

A study of six home-based care programs in South Africa (year not specified) found that a range of 10 expressed needs of program beneficiaries were met by household members alone, by household members and outside help, and by outside help alone, with some unmet need, particularly for financial aid. The six programs represented programs that work in rural areas and informal settlements. Data were collected through a household survey of 374 clients, focus group discussions with 59 program beneficiaries and 53 caregivers, financial records and service statistics, and interviews with financial officers, program managers and caregivers. The largest expressed need was for emotional/spiritual support through counseling (over 80%), following by physical care, nursing care, chores and information (from 55-70%), transportation, financial aid, family care and legal aid (from 20-35%), and sanitation (around 5%). Beneficiaries looked to outside help particularly for counseling, nursing care, information, transportation, family care and legal aid. They looked least to outside help for household chores. Even with outside help, the study found that household caregivers spent more time per week assisting the person living with HIV/AIDS then the outside caregiver. The qualitative component of the research found that respondents indicated that they had unmet needs related to financial aid, access to medical care and emotional care..

A cross-sectional study in Kenya with 1,123 OVC, ages 8-14, and 771 guardians (2007) found that guardians with a community health worker (CHW) doing regular home visits over an average of ten months reported lower rates of perceived social marginalization, better family functioning and more positive attitudes towards OVC under their care than guardians without a CHW. Further, guardian and child reports suggest more positive psychosocial wellbeing among OVC living in homes visited by a CHW . (Abstract)

A study of Africare’s Male Empowerment Project in Zimbabwe from 2003 to 2004 which trained 80 male home care volunteers to provide basic nursing care, infection control, and psychosocial support found that the trained male caregivers reduced the workload of the primary caregivers, who were primarily women. Clients felt that the simple fact that “‘someone cared enough to visit’ was motivation enough for living” (p. 10). Over 80 percent gathered firewood and over 60 percent assisted with gardening and fetching water. Clients and caregivers were found to be supportive of the program, with primary caregivers and clients giving credit to the voluntary caregivers for improving the mental health and physical well being of the clients. While voluntary caregivers assisted with basic household chores, skills that are not traditionally assigned to men such as feeding were less readily undertaken. This project proved successful in increasing men’s acceptance of providing care to people living with AIDS. The study used a questionnaire prior to the intervention and then 18 months later, two focus groups and five in-depth interviews. The male volunteers received training, covering topics such as HIV transmission and prevention, communication on sensitive topics, life planning, basic nursing care and end of life care. Lack of salary presented problems for the men who were looking to offset the time that could have been spent in income generation. Frequent in-service training and monitoring was recommended for home-based care..

A Horizons project in rural Zambia assessed the strategy of building young people's capacity to provide care and support to people living with HIV and AIDS. Members of youth anti-AIDS clubs in schools and communities were trained as adjunct caregivers, using a locally developed curriculum that allowed them to explore and challenge gendered notions of caregiving, and that emphasized networking with existing resources. Results show that caregiving increased among males (47% to 82%) and females (41% to 78%). Both sexes provided similar caregiving services, including help with household chores and personal care tasks. Youth also undertook activities with children to decrease their isolation, help them stay in school, and reach additional services. While clients and caregivers reported positive aspects of the programme, both reported frustration with the youths' inability to meet material needs. This study demonstrates that trained youth already involved in anti-AIDS efforts can meet a range of care needs and be valuable assets to their community. It also highlights the importance of communicating clearly what youth can and cannot do, ongoing monitoring and support of youth caregivers, and involving community leaders to give youth credibility and access to local resources..

A study based on interviews with 654 people (72% women) receiving HAART through home-based care in rural Uganda found that most reported positive social outcomes, such as increased family support. Home-based care may have advantages in decreasing barriers due to transport, along with the ability to provide for multiple family members.