Jennifer Beard

Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review.

Abstract The impacts of antiretroviral therapy (ART) on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of ART on these economic and quality of life indicators in developing countries and assess the state of research on these topics. We searched Ovid/Medline, PubMed, Psych Info, Web of Science, Google Scholar, and the abstract database of the International AIDS Society Conference and the Conference on Retroviruses and Opportunistic Infections. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 21 publications, including 14 full-length articles, six abstracts, and one presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health, and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reportrd so far. Most studies from developing countries have not yet assessed economic and quality of life outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. Findings were limited geographically, with an emphasis on sub-Saharan Africa and adult treatment. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, research on pediatric and differential gender economic and quality of life outcomes will become increasingly urgent, as will systematic evaluation of ART programs.

Smoking patterns among Chinese rural-urban migrant workers.

OBJECTIVES To estimate smoking prevalence and identify correlates of smoking initiation among rural-urban migrant workers. STUDY DESIGN Subjects were 4198 rural-urban migrant workers, aged 18 years and older, residing in three Chinese cities. METHODS Participants were identified through multistage quota sampling. They were asked about their migration history, pre-migration and post-migration smoking status, employment and home life. Analyses were conducted using Chi-squared test and multiple logistic regression. RESULTS Overall, smoking prevalence was higher subsequent to migration (28.4%) compared with before migration (20.8%) (P<0.01). Initiation of daily smoking was associated with gender [odds ratio (OR) 0.02]; high school or greater education (OR 0.48; vs elementary school or lower); having a monthly personal income of 1000-1999 Yuan (OR 2.60), 2000-2999 Yuan (OR 3.08) or > or =3000 Yuan (OR 4.04) (vs <500 Yuan US

Vulnerability of orphan caregivers vs. non-orphan caregivers in KwaZulu-Natal

1=7.5 Yuan); and history of migration to three cities (OR:1.65) or four or more cities (OR 2.80) (vs one city). Initiation of occasional smoking was only associated with gender (OR 0.11). Solitude was the primary situational trigger for smoking initiation. CONCLUSIONS A migratory lifestyle is associated with smoking initiation. Findings could inform the design of tobacco control programmes that would target Chinese rural-urban migrant workers as a special population.

PEPFAR’s Support For Orphans And Vulnerable Children: Some Beneficial Effects, But Too Little Data, And Programs Spread Thin

Abstract Using data from a cohort of schoolgoing children, their households and caregivers (the Amajuba Child Health and Wellbeing Project, ACHWRP) in KwaZulu-Natal, South Africa, we compared demographic characteristics, care burden, health, physical function and social capital of caregivers of orphans (n = 300) with those of non-orphans (n = 298). This analysis presents cross-sectional findings from questions for caregivers that were added for the studys second round, conducted between September 2005 and June 2006. Caregivers of all children were overwhelmingly women (87%). Compared to non-orphan caregivers, caregivers of orphans were on average older (49.5 vs. 45.2 years, p = 0.0002), had fewer years of education (6.7 vs. 7.8 years, p = 0.0042) and were less likely to be married or cohabiting (29% vs. 46%; p < 0.0001). Caregivers of orphans reported caring for more children than those of non-orphans (4.8 vs. 3.8 children, p < 0.0001). A larger proportion of orphan caregivers reported having cared for an ill adult in the previous year (28% vs. 19%), and for that adult to have been a biological child (p = 0.0531). There was a high prevalence (55%) of self-reported poor health among all caregivers; caregivers of orphans were more likely to report poor general health and chronic illness. Although there was a high prevalence of functional impairment (self-reported inability to perform primary activity) among all caregivers (59%), there was no difference between groups. In terms of social capital, although similar proportions of orphan and non-orphan caregivers reported having friends outside the household, orphan caregivers were less likely to have a source of a small emergency loan [51% vs. 63%; adjusted odds ratio: 0.60 (0.41–0.88)]. Our results suggest that orphan caregivers are indeed more vulnerable, and that their particular limitations and needs must be considered when developing strategies for assisting vulnerable households to ensure better support for both caregivers and the children in their care.

Longitudinal evaluation of the psychosocial well-being of recent orphans compared with non-orphans in a school-attending cohort in KwaZulu-Natal, South Africa

Sixteen million children in developing and middle-income countries have been orphaned by HIV/AIDS, and at least another million children per year are rendered vulnerable by parental HIV/AIDS-related illness. Since 2003 the US government has provided approximately

It's all about making a life: poverty, HIV, violence, and other vulnerabilities faced by young female sex workers in Kumasi, Ghana

1.6 billion to give four million of these children care and support through the Presidents Emergency Plan for AIDS Relief (PEPFAR). We conducted five studies to evaluate the effectiveness of PEPFARs interventions for such children in East Africa and southern Africa. We found evidence of beneficial changes in school enrollment rates and on the psychosocial well-being of children. However, we could not demonstrate empirically the impact of most of the PEPFAR initiatives that we examined, primarily because of a lack of baseline data and clear outcome and impact indicators. We also found that many programs were spread so thin across a vulnerable population that little in the way of services actually reached beneficiaries, which raises questions about whether PEPFAR funds are sufficient, or if the program is attempting to do much with too few resources. We offer several recommendations, including better measuring the effect of programs for orphans and vulnerable children by collecting baseline data and conducting well-designed, rigorous outcome and impact evaluations.

Predictors of women's attitudes toward world health organization framework convention on tobacco control policies in urban China.

To assess differences in psychosocial well-being between recent orphans and non-orphans, we followed a cohort of 157 school-going orphans and 480 non-orphans ages 9–15 in a context of high HIV/AIDS mortality in South Africa from 2004 to 2007. Several findings were contrary to the published evidence to date, as we found no difference between orphans and non-orphans in anxiety/depression symptoms, oppositional behavior, self-esteem, or resilience. Female gender, self-reported poor health, and food insecurity were the most important predictors of childrens psychosocial well-being. Notably, girls had greater odds of reporting anxiety/depression symptoms than boys, and scored lower on self-esteem and resilience scales. Food insecurity predicted greater anxiety/depression symptoms and lower resilience. Perceived social support was a protective factor, as it was associated with lower odds of anxiety/depression symptoms, lower oppositional scores, and greater self-esteem and resilience. Our findings suggest a need to identify and strengthen psychosocial supports for girls, and for all children in contexts of AIDS-affected and economic adversity.

Early impacts of orphaning: Health, nutrition, and food insecurity in a cohort of school-going adolescents in South Africa

Objectives:This study aimed to identify social, economic, structural, and individual-level vulnerabilities of female adolescents who sell sex in Kumasi, Ghana. Methods:Twenty-four in-depth interviews and 4 focus group discussions were conducted with female sex workers of age 18–20 years who had been involved in sex work for at least 2 years. Total sample size was 48. Findings:One-third of participants started sex work before age 15. Knowledge of HIV was accurate and most reported having intentions to use condoms consistently with clients; however, factors such as higher payments, drug and/or alcohol use, fear of violence, and police harassment affected condom use. They perceived violence and rape at the hands of clients as their greatest risk. They also reported abuse and exploitation by police. Respondents voiced strong concerns that girls and teens involved in sex work are at higher risk of unsafe sex, exploitation, and abuse than their older and more experienced counterparts. Unprotected sex with boyfriends was also common. Discussion:The pathway to sex work followed a similar pattern for many study participants who left their rural homes for Kumasi in search of economic opportunity. While adolescents who sell sex appear to be abundant in Kumasi, they have been missed by HIV prevention and harm reduction programming. The findings from this study informed the design and implementation of a young female sex worker peer educator pilot program. Key elements of that program are presented, and recommendations for future program evaluation are made.

Orphans and Vulnerable Children Affected by Human Immunodeficiency Virus in Sub-Saharan Africa

BACKGROUND In 2005 China ratified the WHO Framework Convention on Tobacco Control (FCTC) and committed to implement tobacco control legislation and policies. Wide variation in smoking prevalence between men and women in China and the high exposure of women to secondhand smoke suggest that each component of the FCTC should be analyzed from a gender perspective. This study describes womens attitudes toward and predictors of support for four key FCTC measures in China. METHODS Cross-sectional data were collected from 1,408 women in two urban cities on demographics, smoking behavior, and attitudes toward key tobacco control measures. RESULTS Seventy percent of the study women (n = 1,408) were exposed to secondhand smoke at home, work, or other public places. Support for the four FCTC measures of interest was as follows: 92.5% supported banning smoking in public places, 79.2% supported increasing the cigarette tax, 92% supported stronger health warnings on cigarette packages, and 87.1% favored banning tobacco advertising. The predictors for supporting each of these measures included socioeconomic, attitudinal, and behavioral factors. CONCLUSION Urban Chinese women appear to support implementation of key WHO FCTC measures. Predictors of womens attitudes toward the key FCTC measures varied. The formulation process resulting from the tobacco control policy should consider these women-specific predictors in order to facilitate successful implementation of FCTC.

Undernutrition among infants less than 6 months of age: an underestimated public health problem in India.

We recruited a cohort of 157 recent orphans and 480 non-orphans aged 9–15 in a region of high HIV/AIDS mortality in South Africa using stratified cluster sampling to determine the impact of recent parental death on health and food insecurity of school-going orphans compared to non-orphans over time. Between September 2004 and June 2007, household heads, caregivers, and children were interviewed at three annual intervals. Bivariate associations and multivariate models were assessed using generalized estimating equations (GEE). In the health domain, compared to non-orphans, double orphans were more likely to report worse health status and being very ill in the previous 12 months. For those who reported being very ill, maternal or paternal orphans were more than twice as likely not to seek care than non-orphans; no differences were found for double orphans. For nutrition and food insecurity, maternal or paternal orphans were more likely not to have eaten dinner and to have gone to bed hungry the previous night compared to non-orphans; no differences were found for double orphans. Overall, recent school-aged orphans were disadvantaged in health and food insecurity within two years after the death of a parent, compared to their non-orphaned counterparts, but the disparities were smaller than expected. No changes in health, nutritional status, or food insecurity were apparent over the three study rounds. Longer term effects into adulthood may well be more pronounced and warrant careful longitudinal investigation.