American Indians with HIV/AIDS: Health and Social Service Needs, Barriers to Care, and Staisfaction with Services Among A Western Tribe

Background: Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA’s service utilization, unmet service needs, and ART adherence. Methods: PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence. Results: Only 12 (7.5%) participants reported they received all needed services. The ART non-adherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence. Conclusion: The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.

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THE THORNY ISSUE OF STATUS DISCLOSURE TO CHILDREN LIVING WITH HIV: THE CASE OF HIV POSITIVE CHILDREN LIVING IN A CHILD AND YOUTH CARE FACILITY IN JOHANNESBURG, SOUTH AFRICA

SOUTHERN AFRICAN JOURNAL OF SOCIAL WORK AND SOCIAL DEVELOPMENT ◽

10.25159/2415-5829/1350 ◽

2016 ◽

Vol 28 (1) ◽

pp. 53-68

Author(s):

Nkosiyazi Dube ◽

Linda Harms Smith

Keyword(s):

South Africa ◽

Social Service ◽

Youth Care ◽

Hiv Positive ◽

Hiv Status ◽

Service Workers ◽

Child And Youth Care ◽

Living With Hiv ◽

Status Disclosure ◽

Hiv Aids

There is a dilemma regarding HIV/AIDS disclosure to children born and living with HIV/AIDS in residential settings. Since the advent and accessibility of Anti-Retroviral Therapy, most children born HIV positive live longer and have healthier lives. Some of these children find themselves in Need of Care due to abandonment, orphanhood and neglect or abuse, and are placed in alternative care such as a Child and Youth Care Centre (CYCC). Social Service Workers are then faced with this dilemma around disclosure of their HIV status, due to the complexities around the consequences of such a disclosure, and the absence of clear policies in this regard. The study explored the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living in a CYCC in Ekurhuleni, South Africa. The findings indicate that HIV status disclosure is a complex but essential process as it reinforces children’s ability to adhere to medication and dispels anxiety and suspicion within themselves around their status. Recommendations relate to community education and awareness programmes, policy and practice changes and makes suggestions for future research.

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