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Rural women living with HIV/AIDS (WLA) in India face multifarious challenges which affect access to antiretroviral regimens and management of HIV/AIDS. The purpose of this pilot study, using cluster randomization, is to compare the effectiveness of the Asha-Life (AL) intervention, delivered by HIV-trained village women, Asha (Accredited Social Health Activists), with a usual care group on reduction of internalized stigma and avoidant coping among 68 WLA in rural India over a 6-month period. The findings demonstrated that participation in the AL intervention was associated with significant reductions in internalized stigma and the use of avoidant coping strategies at follow-up. The findings of our study are promising in terms of the role rural village women (Asha) may play in reducing internalized stigma and avoidant coping in the lives of rural WLA in India.

Although depression may be commonly experienced by persons living with AIDS, it may be challenging for health care providers to identify persons who are suffering from depression symptoms, particularly if they are living in the more isolated rural areas of India. The purpose of this study is to assess correlates of depression among women living with AIDS in rural Andhra Pradesh, India. A total of 68 rural women living with AIDS (WLA) completed baseline data and were assessed by means of structured instruments. Regression modeling revealed that disclosure avoidance and making at least six health care visits in the last six months were all associated with depression. Further, living with a spouse was associated with lower depressive symptom scores. Stigma was not found to be associated with depression. Understanding correlates of depression can lead the way toward designing culturally-tailored interventions that can mitigate disclosure avoidance and improve the health of women. A more comprehensive health focus may be needed to empower the women to seek quality care for both physical health, as well as mental health, symptomatology.

The long-term effects of two culturally competent AIDS education programs with different content on the risk behavior and AIDS-related knowledge of 410 homeless African American women 2 years after program completion were examined. Participants were members of a larger cohort of impoverished African American and Latina women recruited in Los Angeles from 1989 to 1991. Of a subsample of 527 African American women selected randomly for a 2-year follow-up interview, 410 (78%) were located and agreed to participate. Women participating in both AIDS education programs reported reduced HIV risk behaviors and demonstrated greatly improved AIDS knowledge at 2-year follow-up (p < .001). Women in a specialized program were less likely than those in a traditional program to report noninjection drug use at 2 years. Women in the traditional program had significantly better AIDS knowledge at follow-up (p < .001). These findings suggest that educational programs can produce sustained benefits among impoverished women.

This research examined the impact of including a supportive person on the outcomes of two culturally sensitive AIDS education programs, an education-only (traditional) program and a program combining education with self-esteem and coping enhancement (specialized). Research participants in this quasi-experimental study included 241 homeless women, who were randomly assigned by residence (drug treatment program or shelter) to one of four treatment groups. The outcomes measured at baseline, 6, and 12 months were risk behaviors, cognitive factors, and psychological functioning. Study results demonstrated significant improvements at both 6 and 12 months for the entire sample in all psychological, behavioral and cognitive outcome variables except active coping. Women in the specialized program improved more on AIDS knowledge and reduction in non-injection drug use than did those in the traditional program, but their active coping scores declined. Participation of a supportive person did not appear to have any effect on outcome.

Objectives: Measures of acquired immunodeficiency syndrome (AIDS)-related knowledge that have good psychometric properties are needed to evaluate the impact of educational interventions, particularly among impoverished populations. Few measures that satisfy these requirements are available. The authors describe the psychometric characteristics and composition of a subset of 21 AIDS knowledge items from the questionnaire used by the National Center for Health Statistics., Methods: The study was conducted with a convenience sample of women and their significant others or close friends in nine homeless shelters and 11 residential drug recovery programs in the skid row area of Los Angeles from 1991 to 1993. Trained nurses and outreach workers collected data from 486 predominately African-American adults before delivery of well-established, culturally sensitive AIDS educational intervention. A subset of 334 participants were re-interviewed 6 months later., Results: A total scale score was calculated from a one-factor solution, and two subscale scores were formed based on a two-factor solution. One subscale was composed of primarily cognitive items, whereas the second subscale contained mainly transmission-related items. The internal consistency reliability of the overall scale was 0.89; the two subscales had alphas of 0.80 and 0.92. The measures have face validity, and support for convergent validity was found. Further, even though AIDS knowledge in the sample was relatively high, all three measures showed marked improvement in the subsample of respondents who were re-interviewed after receiving AIDS-related educational information., Conclusions: These measures show promise for assessing AIDS knowledge and the efficacy of AIDS education programs in vulnerable populations. The findings reported here, however, are preliminary. Test-retest reliability needs to be examined, and additional studies are needed with samples that are more culturally diverse and include socially isolated individuals.

1. Among impoverished and homeless individuals, little is known about the impact of social support, defined as emotional, informational, and tangible help that may have health-sustaining and stress-reducing functions. 2. A lack of positive social support, unemployment, and the prevalence of poor physical health and psychological distress may contribute to the extreme vulnerability of indigent populations. 3. Information is needed about the social support network of homeless and impoverished women related to personal and behavioral variables, particularly illegal drug use and risky sexual activity, and mental health status.

This paper evaluates and contrasts the effectiveness of two culturally sensitive AIDS education programs developed by the UCLA AIDS Nursing Network and delivered to 213 impoverished Latina homeless or drug-addicted women in Los Angeles. The Comprehensive Health Seeking and Coping Paradigm guided the program, which was implemented by specially trained Latina nurses and outreach workers. A quasi-experimental design was employed where women were randomized by site into Specialized (N = 82) and Traditional (N = 131) programs. Repeated measures ANOVAS and log-linear models were used to evaluate improvement over a two-week period for women in both groups and to identify interactions with program type. Two-week posttest analyses were also conducted to assess program effectiveness, controlling for baseline values of the measure in question, nonequivalency between groups at baseline, and selected demographic characteristics, including acculturation. Results indicated that women in both AIDS education programs improved significantly in cognitive, behavioral, and psychologic outcomes.

This study describes distress symptomatology and levels of job-related exhaustion in a sample of 153 hospital nurses currently caring for AIDS patients. While the level of emotional exhaustion in the sample was not alarmingly high, these nurses did report symptoms of distress. Levels of emotional exhaustion were related to a variety of personal demographic, AIDS-specific, and job-related factors. These factors included: age, income, years of practice on the unit, recent change in shift, type of unit, discomfort caring for AIDS patients, willingness to continue caring for AIDS patients, number of AIDS patients cared for, job tension, job influence, and enthusiasm about returning to work. Regression analysis indicated, however, that six general job-related factors accounted for about 46% of the variation in emotional exhaustion. These results suggest that general job-related factors such as 8-hour shifts, changing shifts, level of job tension, and other factors characterizing all hospital care are particularly worthy of future study.

The efficacy and differential effects of specialized (S) and traditional (T) AIDS education programs on cognitive, behavioral, and psychological outcomes were investigated. The sample consisted of 858 impoverished African-American and Latina women (S = 448, T = 410). At baseline, women in the traditional group reported significantly higher distress, greater knowledge of AIDS, and less problem-focused coping. Significant improvements over the 2-week intervention interval were found for participants of both AIDS education programs for appraisal of threat, concerns, knowledge, and attitudes about AIDS, emotion-focused coping, number of sexual partners, IV and non-IV drug use, depression, and distress. However, multivariate analysis indicated that the traditional group had slightly better posttest scores on concerns, emotion-focused coping, knowledge of AIDS, and number of partners than the specialized group. The specialized group reported greater use of problem-focused coping. These differences do not detract from the substantial improvement found for both groups, but they do reinforce the conclusion that the specialized program was not more effective than its standard counterpart.

Objectives: The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation., Methods: Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs., Results: Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women., Conclusions: The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern.

Decisions to hospitalize persons with AIDS (PWAs) and the subsequent nursing process and outcomes associated with this hospitalization are of major concern to nurse administrators. Although decisions to hospitalize may be out of their control, events occurring during hospitalization that affect the quality of nursing care received are clearly the nurse administrator's responsibility. This report addresses a major issue concerning the care of PWAs: the decision to establish a dedicated AIDS unit. The effect upon both quality care and nursing care costs is discussed.

The authors assessed patients' satisfaction with their nursing care in seven hospitals. Five of the hospitals utilized the special care unit (SCU) method of delivering care to AIDS or oncology patients; three had SCUs for AIDS patients. All seven of the hospitals had integrated units (IUs) where general medical, oncology, and/or AIDS patients were received in various proportions. Satisfaction with nursing care was measured with the Risser Patient Satisfaction Instrument. Patient satisfaction with nursing care was shown to be a function of delivery method; AIDS and oncology patients on SCUs expressed greater satisfaction with their care than medical, oncology, or AIDS patients on IUs (p less than .001). Patient satisfaction with nursing care was greater among whites than nonwhites. Also, some major sociodemographic and case mix variables, such as age, employment status, and diagnosis, were not associated with patient satisfaction directly; in other instances, the associations initially seen did not hold when delivery method (SCU vs. IU) and race were controlled for in a linear regression analysis.

Three major trends are driving the widespread need for continuing education in AIDS. First, with the spread of AIDS, increasing numbers of health care professionals are becoming involved in the care and treatment of AIDS, ARC and HIV positive individuals. Second, as the disease spreads beyond current AIDS epicenters, more persons with minimal information are required to have a baseline working knowledge of AIDS. Finally, the reluctance of many health care professionals to care for HIV-positive individuals, along with already existing staff shortages, limits access to care and makes the provision of responsive educational programs even more important. Generic programs to educate health professionals frequently lack sufficient specificity and sensitivity to address the needs of health professionals with varying levels of knowledge and role responsibility. This paper briefly summarizes the literature on the similarities and differences in knowledge and attitudes across and within professional groups. In addition, it presents specific research designed to provide initial direction for considering the circumstances under which health professionals, particularly nurses and physicians, may or may not profit from generic programs aimed at mixed levels and types of health care provider.

This study examined the stresses of hospitalization in AIDS patients and assessed the extent to which two different inpatient delivery systems differed with respect to perceived stresses in these patients. Patients from four AIDS dedicated special care units (SCU's) and five AIDS integrated units (IU's) in eight acute care hospitals were surveyed using a modified version of the Volicer Hospital Stress Rating Scale. Stresses related to loss of independence, separation from loved ones and problems with medications were experienced equally by both groups of patients. However, SCU patients had lower total hospital stress scores than IU patients in terms of the number of stresses experienced (p = 0.008) and how bothersome these stresses were perceived to be (p = 0.02). Additionally, patients on IU's more frequently experienced and were bothered by factors associated with ambiguity about their care and condition and feelings of abandonment and impersonal or discriminatory treatment.

The researchers sought to explore and describe the demographic, cognitive, psychosocial, and behavioral factors associated with the continued risky behavior of a convenience sample of homeless and drug-addicted women two to four weeks after they had completed an AIDS education program. The sample included 942 crack users and 767 women who had multiple sex partners. Analyses revealed that impoverished women who maintained multiple sexual partners were less likely to be in drug recovery programs than in homeless shelters. They were more likely to share needles and be involved sexually with male injection drug users compared with impoverished women who did not maintain multiple sexual partners. Persistent crack users were older than those who reported cessation of crack use, were more often African American, and were more likely to have sex partners who were injecting drug users. Women who demonstrated less improvement in depression and distress scores, concerns, use of affective coping, appraisal of threat, and social support were more likely to maintain crack use and multiple partners. The study's implications for the design of intervention programs aimed at risk reduction based on ethnicity are discussed.