Hongxin Zhao

Chinese HIV-positive patients and their healthcare providers: contrasting Confucian versus Western notions of secrecy and support.

In this qualitative study, 29 HIV-positive, Chinese patients reported highly favorable impressions of their healthcare providers, who were seen as providing important medical-related, financial, and emotional support. Generally, the patient-provider relationship positively impacted the participants and their ability to maintain their health and was especially critical when patients were isolated from familial sources of support due to intense AIDS stigma. Often family members were informed of an HIV diagnosis before the patient, revealing tensions between Confucian principles of collectivism and familial authority and increasingly prevalent Western ideals of individual autonomy and the privileged status of personal health information.

Conceptualizing antiretroviral adherence in Beijing, China

Abstract International health experts agree that China is on the verge of an AIDS crisis. In response, the Chinese government initiated the “Four Frees and One Care” policy in 2003 to decrease economic barriers and increase access to antiretroviral therapies for people with HIV. However, long-term treatment success requires not only access, but high rates of medication adherence. This qualitative interview study with 29 persons receiving HIV care at Beijings Ditan Hospital identified barriers to and facilitators of medication adherence. The interviews were guided by an a priori conceptual model of adherence with four components: access, knowledge about medications, motivation, and proximal cues to action. Barriers to adherence were related to stigma and fear of discrimination; the medications themselves (including side-effects and complicated dosing regimens); and other economic issues (i.e. costs of transportation, lab tests and hospitalizations). Facilitators included participants’ strong will to live, use of electronic reminders and family support. These results support the conceptual model and suggest that successful interventions must minimize stigma as it negatively affects all components of the model for adherence.

Attitudes Toward Antiretroviral Therapy and Complementary and Alternative Medicine in Chinese Patients Infected With HIV

&NA; HIV is an emerging health issue in China, and effective antiretroviral therapy (ART) is now available throughout the country. Complementary and alternative medicine (CAM) includes traditional Chinese medicine (TCM) and has been used in Chinese society for more than 5,000 years. In the West, CAM use is widespread among HIV‐infected individuals; however, rates of CAM use among HIV‐infected individuals in China are unknown. This qualitative study explores issues related to attitudes toward ART and CAM in HIV‐infected individuals in Beijing, China. Semistructured, in‐depth interviews were used to explore attitudes, experiences, and perceptions about ART and CAM among people living with HIV (PLWH). Results indicate that Chinese PLWH have both positive and negative attitudes toward ART and CAM, which led many to report taking CAM not only for daily discomforts but to counteract the side effects of ART. This study shows that social, cultural, and governmental factors coalesced to shape Chinese PLWH attitudes toward ART and CAM.

In sickness and in health: a qualitative study of how Chinese women with HIV navigate stigma and negotiate disclosure within their marriages/partnerships

Abstract In China, there are currently an estimated 180,000 women between 16 and 45 years of age living with HIV. However, we know very little about their lived experiences. Given the spread of the AIDS epidemic in China and the burden it exerts on quality of life, there is an urgent need to understand how HIV affects Chinese women, particularly in the context of their marriages. How do they negotiate the extreme stigma of their illness in making decisions about disclosure and social support, especially in the context of their family life? We recruited 26 Chinese women with HIV in Beijing and Shanghai for in-depth interviews employing a phenomenological approach. We examined the process and outcomes of disclosure within the course of the womens search for social support. Women in HIV-discordant relationships often experienced a termination of their marriage after disclosure, yet others exhibited remarkable resilience, finding new strength through the challenge of their illness. Findings underscore the need for accessible and culturally acceptable interventions for Chinese women with HIV who face considerable stigma in their search for support.

Antiretroviral therapy (ART) side effect impacted on quality of life, and depressive symptomatology: A mixed-method study

Antiretroviral therapy (ART) is known for its side effects. In this paper, we describe ART side effects as experienced by Chinese HIV+ individuals. This study presents two stages of a research project, combining qualitative in-depth interviews (29 HIV+ participants) with quantitative statistical data analysis (N = 120). All data was collected between July 2005 to March 2008 at Beijings Ditan Hospital. Consent was obtained from each participant for the qualitative interview and again for the quantitative survey. During in-depth interviews, Chinese HIV+ patients reported experiencing digestive discomfort, skin rashes, numbness, memory loss, nightmares, and dizziness, which not only brought them physical discomfort, but also interrupted different dimensions of their social lives. Furthermore, multiple regression analyses revealed that those who reported more severe side effects also experienced greater depressive mood after controlling for other clinical and psychosocial factors. ART side effects are one of the primary reasons causing HIV+ individuals to delay or stop taking life-saving medication; therefore, clinical interventions are critically needed to assist HIV+ individuals in managing ART side effects. ART side effects reinforced existing negative attitudes toward ART and lead to lower ART adherence. Future research should focus on developing culturally sensitive interventions to enhance HIV+ self-management, to alleviate physical and psychological burden from ART and HIV.

Please Don't Make Me Ask for Help: Implicit Social Support and Mental Health in Chinese Individuals Living with HIV

China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.

Factor analyses of a social support scale using two methods

PurposeEvaluation and comparison of the factor structure of the Medical Outcomes Study Social Support Survey (MOS-SSS) using both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) with two samples of people living with HIV/AIDS in China.MethodsSecondary analyses were conducted with data from two comparable samples of 320 people living with HIV/AIDS from the same hospital using the same inclusion criteria. The first sample of 120 was collected in 2006, and the second sample of 200 was collected in 2012. For each sample, CFA was first performed on the original four-factor structure to check model fit, followed by EFA to explore other factor structures and a subsequent CFA for model fit statistics to be compared to the original four-factor CFA.ResultsIn both samples, CFA on the originally hypothesized four-factor structure yielded an acceptable model fit. The EFA yielded a two-factor solution in both samples, with different items included in each factor for the two samples. Comparison of CFA on the a priori four-factor structure and the new two-factor structure in both samples indicated that both factor structures were of acceptable model fit, with the four-factor model performing slightly better than the two-factor model.ConclusionFactor structure of the MOS-SSS is method-dependent, with CFA supporting a four-factor structure, while EFA yielded a two-factor structure in two separate samples. We need to be careful in selecting the analytic method when applying the MOS-SSS to various samples and choose the factor structure that best fits the theoretical model.

Challenges of cross-cultural research: Lessons from a U.S.-Asia HIV collaboration

Many Asian countries have scaled up their research to combat human immunodeficiency virus (HIV). HIV experts from the West have teamed up with these countries to assist in designing research protocols and providing necessary training. In this paper, we document the formation and maintenance of international and interdisciplinary HIV research collaboration among cross-disciplinary researchers working in the United States, Taiwan, and China. We conducted international social-behavioral HIV studies in several major metropolitan areas in Asia. Culturally sensitive issues that could be attributed to social and disciplinary differences have emerged throughout the collaboration process, including questions of who should be the research leader, where should resources be allocated, how should tasks be shared, which topics are valuable for investigation, and what survey questions are allowable. There is now a window of opportunity for greater international and interdisciplinary collaboration; however, for such collaboration to flourish, team dynamics in international research collaboration should be carefully identified and managed before studies are begun.

Facilitators of and barriers to HIV self-management: Perspectives of HIV-positive women in China

AIMS The aim is to explore perceived facilitators of and barriers to HIV self-management for HIV-positive Chinese women. BACKGROUND Little is known about self-management among HIV-positive Chinese women in China. Understanding the experiences of this population is needed to promote self-management. METHODS 27 in-depth interviews were conducted in Beijing and Shanghai. Facilitators included families being supportive after disclosure, patients learning how to live with HIV, antiretroviral therapy (ART) adherence, and rediscovering the meaning of life. Several barriers were also identified, including lack of support, stigma, fatigue, and financial difficulty. RESULTS HIV disclosure is essential to obtaining necessary support. Ironically, disclosing to family members who stigmatize the disease may invite unwelcome responses. Helping HIV-positive women to decrease self-stigma and develop an effective way to disclose, if they choose to, is important. CONCLUSION Future interventions should focus on disclosure strategies development and self-management to prevent isolation, enhance social support, and decrease self-stigma.

Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis

ABSTRACT Context: In China, the social stigma of both substance use and HIV remains major barrier. HIV-positive individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV-positive Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives. Objectives: We examine the mediation relationship among substance use, anxiety, and self-management efficacy. Method: A cross-sectional study design was used. In total, 137 HIV-positive individuals were recruited from two premier Chinese hospitals: Beijing’s Ditan Hospital and Shanghai’s Public Health Clinic Center (SPHCC). Results: HIV-positive substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety were mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recency effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy. Conclusion: It is useful for healthcare providers to assess substance use behaviors in HIV-positive individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.