Browsing by Author "Brandt, Rene"
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- ItemOpen AccessDoes HIV matter when you are poor and how ? : the impact of HIV/AIDS on the psychological adjustment of South African mothers in the era of HAART(2007) Brandt, Rene; Wild, Lauren; Dawes, AndrewThe study investigated the psychological adjustment of HIV -infected South African mothers living in poverty in the era of HAART. One hundred and eighty adult women living in long-term poverty who were the primary caregiver of at least one child under 18 years were administered a structured questionnaire. The sample comprised infected women (n=130), some but not all of whom were on antiretroviral therapy, as well as a comparison group of non-infected women from the same community (n=50). Of those who were receiving antiretroviral therapy (n=80), half had just commenced treatment and half had been on treatment for six months. In addition, five women were selected as case studies and followed up with in-depth interviews for six months. Data were analysed using analysis of variance, planned comparisons and multiple regression, and narrative analysis respectively. Results showed that HIV status had a significant, independent impact on levels of depressive symptoms but not anxiety. HIV positive women exhibited significantly more symptoms of depression and anxiety than seronegative women, regardless of their stage of disease. An irregular household income, poorer perceived physical health and the use of avoidant coping predicted higher levels of depressive symptoms amongst infected women, while less active coping and greater avoidant coping predicted higher levels of anxiety. Avoidant coping was the best predictor of levels of depression and anxiety amongst women, independent of HIV status. When assessed at six months after commencing treatment, antiretroviral therapy had had no impact on anxiety. However, levels of depression were lower than amongst women who had just commenced treatment. Qualitative data of women's own accounts supported the role of HIV in psychological distress, but pointed to poverty as an underlying narrative through which women's experiences of living with HIV were continually filtered. While HIV was sometimes the source of disruption and disturbance, it typically lacked salience in the presence of HAART and for women who were relatively asymptomatic, particularly given the substantive poverty-related stressors that women faced on an ongoing basis. Key findings indicated that HIV status contributed to the mental health burden experienced by women living in poverty, and that longer-term use of antiretroviral therapy was associated with reduced depression. Since avoidant coping was the best predictor of poor psychological adjustment, it may be an appropriate focus for future targeted mental health interventions for this population group. However, the fact that poverty had considerable, and even greater, salience for women at times, should also inform the planning and provision of services.
- ItemOpen AccessIs it all chaos, loss and disruption? The narratives of poor, HIV-infected South African women(2008) Brandt, ReneThe purpose of this article is to employ a qualitative research approach to explore whether the lives of poor HIV-infected South African women are predominated by chaos, loss and disruption. Five women were each interviewed three times over a six-month period. Data was analyzed using a narrative lens as well as the theory of illness narratives. The narratives revealed that some disruption was associated with women's initial diagnoses. However, they were typically not preoccupied with HIV unless they were actively ill and not receiving antiretroviral therapy, and even for these women, wellbeing shifted over time. Moreover, women had denial-based coping strategies that kept HIV and chaos marginalized. Competing narratives concerned with poverty were typically dominant and served as a constant through which women's experiences were filtered. The case studies suggest that both mental health services and poverty alleviation are important components of appropriate health care for poor HIV-infected women.
- ItemRestrictedThe mental health of people living with HIV/AIDS in Africa: A systematic review(National Inquiry Services Centre, 2008) Brandt, ReneThis paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twenty-seven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults had some form of psychiatric disorder, with depression the most common individual problem. PLWHA tended to have more mental health problems than non-infected individuals, with those experiencing lower levels less likely to be poor and more likely to be employed, educated and receiving ART. Being female, experiencing poor health, receiving poor quality health services, and a lack of material and emotional support from family and friends were associated with greater psychiatric morbidity. While some key findings emerged, the knowledge base was diverse and methodological quality uneven, thus studies lacked comparability and not all findings were equally robust. Further, more rigorous research is needed in order to put mental health services for PLWHA in Africa on the healthcare agenda. Priorities for future research should include replicating findings regarding common mental health problems amongst PLWHA, issues for HIV-infected women, and the longer-term mental health needs of those on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART which can be targeted in interventions.
- ItemRestrictedThe mental health of people living with HIV/AIDS in Africa: a systematic review(National Inquiry Services Centre (NISC), 2009) Brandt, ReneThis paper reviews published quantitative research on the mental health of HIV-infected adults in Africa. Twenty-seven articles published between 1994 and 2008 reported the results of 23 studies. Most studies found that about half of HIV-infected adults sampled had some form of psychiatric disorder, with depression the most common individual problem. People living with HIV or AIDS (PLHIV) tended to have more mental health problems than non-HIV-infected individuals, with those experiencing less problems less likely to be poor and more likely to be employed, educated and receiving antiretroviral treatment (ART). Being female, experiencing poor health, receiving poor-quality health services, and a lack of material and emotional support form family and friends were associated with greater psychiatric morbidity. While some key findings emerged from the studies, the knowledge base was diverse and the methodological quality uneven, thus studies lacked comparability and findings were not equally robust. Furthermore, more rigorous research is needed to put mental health services for PLHIV in African on the healthcare agenda. Priorities for future research should include replicating findings regarding common mental health problems among PLHIV, important issues among HIV-infected women, and the longer-term mental health needs of thsoe on ART. Research is also needed into predictors of mental health outcomes and factors associated with adherence to ART, which can be targeted in interventions.