Addis Ababa, Ethiopia
Addis Ababa, Ethiopia

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Lifson A.R.,University of Minnesota | Workneh S.,Ethiopian Office | Hailemichael A.,Ethiopian Office | Demissie W.,Ethiopian Office | And 2 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2015

Social support significantly enhances physical and mental health for persons with human immunodeficiency virus (HIV). We surveyed 142 rural Ethiopian HIV patients newly enrolled in care for perceived social support and factors associated with low support levels. Using the Social Provisions Scale (SPS), the mean summary score was 19.1 (possible scores = 0-48). On six SPS subscales, mean scores (possible scores = 0-8), were: Reliable Alliance (others can be counted on for tangible assistance) = 2.8, Attachment (emotional closeness providing sense of security) = 2.9, Reassurance of Worth (recognition of competence and value by others) = 3.2, Guidance (provision of advice or information by others) = 3.2, Social Integration (belonging to a group with similar interests and concerns) = 3.5, and Nurturance (belief that others rely on one for their well-being) = 3.6. In multivariate analysis, factors significantly associated with lower social support scores were: lower education level (did not complete primary school) (p =.019), lower total score on knowledge items about HIV care/treatment (p =.038), and greater number of external stigma experiences in past three months (p <.001); greater number of chronic disease symptoms was of borderline significance (p =.098). Among rural Ethiopian patients newly entering HIV care, we found moderate and varying levels of perceived social support, with lowest scores for subscales reflecting emotional closeness and reliance on others for tangible assistance. Given that patients who have recently learned their diagnosis and entered care may be an especially vulnerable group, programs to help identify and address social support needs can provide multiple benefits in facilitating the best possible physical, emotional and functional quality of life for people living with HIV. © 2015 Taylor & Francis.


PubMed | University of Minnesota, 2 Ethiopian Office and 3 Global Program
Type: Journal Article | Journal: Journal of the International Association of Providers of AIDS Care | Year: 2015

Retention in care is a major challenge for HIV treatment programs, including in rural and in resource-limited settings. To help reduce loss to follow-up (LTFU) for HIV-infected patients new to care in rural Ethiopia, 142 patients were assigned 1 of 13 trained community health support workers (CHSWs) who were HIV positive and from the same neighborhood/village. The CHSWs provided HIV and health education, counseling/social support, and facilitated communication with the HIV clinics. With 7 deaths and 3 transfers, the 12-month retention rate was 94% (95% CI = 89%-97%), and no client was LTFU in the project. Between enrollment and 12 months, clients had significant ( P .001) improvements in HIV knowledge (17% increase), physical and mental quality of life (81% and 21% increase), internalized stigma (97% decrease), and perceived social support (24% increase). In rural and resource-limited settings, community-based CHSW programs can complement facility-based care in reducing LTFU and improving positive outcomes for HIV-infected people who enter care.


Lifson A.R.,University of Minnesota | Workneh S.,Ethiopian Office | Hailemichael A.,Ethiopian Office | Demissie W.,Ethiopian Office | And 2 more authors.
Journal of AIDS and Clinical Research | Year: 2014

Background: Health facilities in rural, resource limited settings face multiple challenges responding to a growing demand for HIV treatment, including lack of adequate numbers of trained health workers. Many programs have used community health support workers (CHSWs) to provide specific services related to HIV care, and to complement facility-based treatment. Methods: In rural southern Ethiopia, 13 HIV-positive CHSWs were assigned to 142 newly diagnosed HIV patients from the same community to provide: education on HIV treatment and health promoting behaviors; counseling and social support; and linkage to the HIV Clinic. Results: Lessons learned in planning and implementing CHSW programs for PLWH include the benefits of: involving local health bureaus, clinicians, and the community; careful recruitment processes and selection criteria for CHSWs; use of local PLWH as CHSWs to facilitate relationships with HIV-positive clients; initial and on-going training of CHSWs with didactic information and counseling skills; clearly defined responsibilities and regular, supportive supervision with constructive feedback; emphasizing importance of client confidentiality; and financial compensation for CHSWs. Conclusion: Use of CHSWs can be an effective strategy to support the HIV health care system, and offers a strong complement to facility-based care in rural and other resource-limited settings. However, such programs may be most successful if they attend to the multiple issues described above in planning and implementation. © 2014 OMICS Publishing Group.


PubMed | International Center for Care and Treatment Program, Ethiopian Office, Second Street, Global Program and 2 more.
Type: Journal Article | Journal: Addiction science & clinical practice | Year: 2017

Khat, a plant native to East Africa, has psychoactive constituents similar to amphetamine. Chronic khat use can lead to psychological dependence with multiple physical and mental health harms, complicating clinical management of people living with HIV. In two Ethiopian cities where khat is common, we evaluated prevalence and correlates of khat use among patients new to HIV care.During 2013-2014, we surveyed 322 patients recently enrolled in HIV clinics in Dire Dawa and Harar about khat use, demographics, smoking and alcohol use, clinical illness, food insecurity, and social support. We analyzed factors associated with khat use in the past year, as well as heaviest use of khat (based on greatest number of hours used in a typical month).242 (75%) respondents reported lifetime khat use; 209 (65%) reported khat use during the previous year. 54% of khat users started before age 19years. Although 84% believed that using khat every day is dangerous for health if you have HIV, khat was used in the previous year a median of 5h/days and 30days/month; 21% said they felt a need to cut down or control their khat use but had difficulty doing so. Those using khat were more likely to report smoking (46%) and alcohol use (49%) compared to non-khat users (1 and 31% respectively). Those reporting heaviest khat use (180h/typical month) were more likely to rate their health status as poor, have an underweight BMI (18.5kg/mKhat use was common among HIV patients entering care, and associated with symptoms of poorer physical health. Over half started khat use when they were young. Although most believed khat is harmful for HIV patients, a number of respondents reported some difficulty controlling their drug use. In settings where khat is legal and widely utilized, developing interventions for responsible use represent an important health priority as part of comprehensive care for people living with HIV.


Lifson A.R.,Second Street | Demissie W.,Ethiopian Office | Tadesse A.,Ethiopian Office | Ketema K.,World Health Organization | And 5 more authors.
BMC International Health and Human Rights | Year: 2012

Background: Whether scale-up of HIV prevention and care will reduce negative attitudes and discriminatory practices towards persons living with HIV/AIDS (PLWH) is uncertain. An HIV knowledge and attitude survey was conducted in a rural Ethiopian community where HIV prevention and treatment was being rapidly scaled up. Data were analyzed to identify prevalence of and factors associated with stigma-associated attitudes towards PLWH. Methods. We surveyed 561 adults from 250 randomly selected households in the rural town of Arba Minch and surrounding villages about positive or negative attitudes towards PLWH, as well as demographic characteristics, and knowledge about HIV transmission and treatment. Results: Eighty percent of respondents agreed with1 negative statements indicating blame or shame towards PLWH and 41% agreed with1 negative statements associated with distancing themselves from PLWH. However, only 14% expressed negative responses about whether PLWH should receive support from their communities. In multivariate analysis, a greater number of negative attitudes towards PLWH was significantly (p<0.05) associated with: female gender (Odds Ratio [OR]=1.51), living in a rural village (vs. town neighborhood) (OR=3.44), not knowing PLWH can appear healthy (OR=1.78), lack of knowledge about perinatal transmission (OR=1.49), lack of knowledge about how HIV is not transmitted (e.g. casual contact) (OR=2.05), lack of knowledge about HIV treatment (OR=1.80), and not personally knowing a PLWH (OR=1.41). Conclusions: In a rural Ethiopian setting in which rapid scale-up of HIV treatment occurred, many respondents still characterized HIV as associated with shame or blame, or indicated PLWH would be isolated or discriminated against. HIV stigma can hamper both prevention and treatment programs. We identified multiple issues which, if addressed, can help promote a more positive cycle in which PLWH are appreciated as members of ones own community who are affirmatively interacted with and supported. Stigma reduction programs should address knowledge gaps such as fears of casual contact contagion, and lack of awareness of medical interventions to help prevent HIV disease, as well as building upon community-based attitudes of the importance of supporting and showing compassion for PLWH. © 2012 Lifson et al.; licensee BioMed Central Ltd.


Lifson A.R.,Second Street | Demisse W.,Ethiopian Office | Ketema K.,World Health Organization | Tadesse A.,Ethiopian Office | And 4 more authors.
Journal of the International Association of Providers of AIDS Care | Year: 2013

Goals of universal "test and treat" will never be fully realized if testing acceptance remains low, including rural areas, where HIV is increasingly recognized. We surveyed 250 randomly selected households from a rural Ethiopian town (Arba Minch) and surrounding villages about HIV testing experience, knowledge, and attitudes. Of the 558 adults, 45% were never HIV tested. Those never tested for HIV were more likely to be (P <.05) ≥45 years, rural villagers, and unaware of the benefits of antiretroviral therapy treatment and that persons with HIV can appear healthy; they were more likely to believe HIV-infected persons would be stigmatized and unsupported by their communities. Of those never tested, 70% were interested in HIV testing if offered. Despite recommendations that all persons be HIV tested, almost half of the adult residents in this rural community were never tested. Programs to increase HIV testing must include measures to address stigma/discrimination and knowledge deficits including benefits of early diagnosis and treatment. © The Author(s) 2013.


Lifson A.R.,Second Street | Demissie W.,Ethiopian Office | Tadesse A.,Ethiopian Office | Ketema K.,World Health Organization | And 5 more authors.
Journal of the International Association of Providers of AIDS Care | Year: 2013

Inability to retain HIV-infected patients in care undermines the benefits of starting millions in low-income countries on antiretroviral therapy (ART). In a hospital HIV clinic in rural southern Ethiopia, we conducted focus groups of HIV-infected men and women to learn more about experiences with and barriers to attending clinic appointments. Respondents reported multiple barriers, including those that were patient related (eg, misunderstandings about ART, mistaken belief in AIDS cures, and drug/alcohol use), clinic related (eg, negative provider interactions, lack of familiarity with patients' medical situation, and overcrowding), medication related (eg, side effects), social (eg, stigma and discrimination and lack of support), and situational/resource related (eg, distance to clinic, lack of funds, competing domestic/work priorities, and lack of food). Based on the lessons learned from these focus groups, we implemented a community intervention to improve retention, using trained community support workers who provide patient education, counseling, social support, problem-solving assistance, needed referrals, and improved communication/linkage to the patients' HIV clinic. © The Author(s) 2012.

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