Chronic Disease Self-Management Challenges among Rural Women Living with HIV/AIDS in Prakasam, Andhra Pradesh, India: A Qualitative Study

Benissa E Salem, Yvita Bustos, Chidyaonga Shalita, Jordan Kwon, Padma Ramakrishnan, Kartik Yadav, Maria L Ekstrand, Sanjeev Sinha, Adeline M Nyamathi, Benissa E Salem, Yvita Bustos, Chidyaonga Shalita, Jordan Kwon, Padma Ramakrishnan, Kartik Yadav, Maria L Ekstrand, Sanjeev Sinha, Adeline M Nyamathi

Abstract

Rural women living with HIV/AIDS (WLHA) in India experience challenges self-managing HIV/AIDS in their rural communities. The purpose of this qualitative study was to explore factors influencing their care and antiretroviral treatment (ART) adherence. Themes that emerged from the qualitative focus groups among WLHA (N = 24) in rural Prakasam, Andhra Pradesh, India, included: (1) coming to know about HIV and other health conditions, (2) experiences being on ART, (3) challenges maintaining a nutritious diet, (4) factors affecting health care access and quality, and (5) seeking support for a better future. Chronic disease self-management in rural locales is challenging, given the number of barriers which rural women experience on a daily basis. These findings suggest a need for individual- and structural-level supports that will aid in assisting rural WLHA to self-manage HIV/AIDS as a chronic illness.

Keywords: HIV/AIDS; India; antiretroviral therapy; rural women; self-management.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Chronic disease self-management challenges among rural women living with HIV/AIDS in Prakasam, Andhra Pradesh, India (N = 24).

References

    1. AVERT. HIV and AIDS in India. 2016. . Updated December 5, 2017. Accessed February 11, 2018.
    1. National AIDS Control Organization. State HIV Epidemic Fact Sheet. New Delhi, India: National AIDS Control Organization; 2014:1–88.
    1. National AIDS Control Organization. India HIV Estimations 2015 Technical Report. New Delhi, India: National AIDS Control Organization; 2015.
    1. Pandey A, Dhingra N, Kumar P, et al. Sustained progress, but no room for complacency: results of 2015 HIV estimations in India. Indian J Med Res. 2017;146(1):83.
    1. World Bank. HIV/AIDS in India. 2012. . Updated July 10, 2012. Accessed October 21, 2016.
    1. National AIDS Control Organization. State Epidemiological Fact Sheets. New Delhi, India: National AIDS Control Organization Government of India Ministry of Health and Family Welfare; 2017.
    1. National AIDS Control Organization. HIV Sentinel Surveillance: Technical Brief, India 2016-17. New Delhi, India: Ministry of Health and Family Welfare, Government of India; 2017.
    1. National AIDS Control Organization. District categorization for Priority Attention under NACP-III, 2007. New Delhi, India: National AIDS Control Organization; 2007.
    1. Andhra Pradesh State AIDS Control Society. Facts, Figures and Response to HIV/AIDS in Andhra Pradesh. New Delhi, India: Ajanta Offset & Packagings Ltd; 2005.
    1. Saggurti N, Mahapatra B, Swain SN, Jain AK. Male migration and risky sexual behavior in rural India: is the place of origin critical for HIV prevention programs? BMC Public Health. 2011;11(6):S6.
    1. Newmann S, Sarin P, Kumarasamy N, et al. Marriage, monogamy and HIV: a profile of HIV-infected women in South India. Int J STD AIDS. 2000;11(4):250–253.
    1. Paranjape R, Challacombe S. HIV/AIDS in India: an overview of the Indian epidemic. Oral Dis. 2016;22(S1):10–14.
    1. Saggurti N, Mahapatra B, Sabarwal S, Ghosh S, Johri A. Male out-migration: a factor for the spread of HIV infection among married men and women in rural India. PLoS One. 2012;7(9):e43222.
    1. Patel SN, Hennink MM, Hynes ME, et al. Pathways that affect wives’ HIV risk among serodiscordant couples in India: results from the positive Jeevan Saathi Study. Qual Health Res. 2016;26(11):1531–1542.
    1. Silverman JG, Decker MR, Saggurti N, Balaiah D, Raj A. Intimate partner violence and HIV infection among married Indian women. JAMA. 2008;300(6):703–710.
    1. Saggurti N, Verma RK, Jain A, et al. HIV risk behaviours among contracted and non-contracted male migrant workers in India: potential role of labour contractors and contractual systems in HIV prevention. Aids. 2008;22(suppl 5):S127–S136.
    1. Saggurti N, Schensul SL, Verma RK. Migration, mobility and sexual risk behavior in Mumbai, India: mobile men with non-residential wife show increased risk. AIDS Behav. 2009;13(5):921–927.
    1. Halli SS, Blanchard J, Satihal DG, Moses S. Migration and HIV transmission in rural South India: an ethnographic study. Cult Health Sex. 2007;9(1):85–94.
    1. Patel SN, Hennink M, Yount KM, et al. Relationship dynamics and challenges of safer sex in an HIV serodiscordant couple in India: a case review from the positive Jeevan Saathi Study. J HIV/AIDS Soc Services. 2016;15(3):319–329.
    1. Cooperman NA, Shastri JS, Shastri A, Schoenbaum E. HIV prevalence, risk behavior, knowledge, and beliefs among women seeking care at a sexually transmitted infection clinic in Mumbai, India. Health Care Women Int. 2014;35(10):1133–1147.
    1. Ghosh J, Wadhwa V, Kalipeni E. Vulnerability to HIV/AIDS among women of reproductive age in the slums of Delhi and Hyderabad, India. Soc Sci Med. 2009;68(4):638–642.
    1. Anuradha S, Joshi A, Negi M, Nischal N, Rajeshwari K, Dewan R. Factors influencing adherence to ART: new insights from a center providing free ART under the National Program in Delhi, India. J Int Assoc Provid AIDS Care. 2013;12(3):195–201.
    1. Dandona L, Sisodia P, Ramesh Y, et al. Cost and efficiency of HIV voluntary counselling and testing centres in Andhra Pradesh, India. National Med J India. 2005;18(1):26.
    1. Short WE, Viss B. Women living with HIV in India: looking up from a place of stigma, identifying nexus sites for change. Divers Equal Health Care. 2017;14(3):159–166.
    1. Thomas B, Nyamathi A, Swaminathan S. Impact of HIV/AIDS on mothers in Southern India: a qualitative study. AIDS Behav. 2009;13(5):989–996.
    1. Joseph EB, Bhatti MRS. Psychosocial problems and coping patterns of HIV seropositive wives of men with HIV/AIDS. Soc Work Health Care. 2005;39(1-2):29–47.
    1. Rahangdale L, Banandur P, Sreenivas A, Turan J, Washington R, Cohen CR. Stigma as experienced by women accessing prevention of parent to child transmission of HIV services in Karnataka, India. AIDS Care. 2010;22(7):836–842.
    1. Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-infected people in India. J Int Assoc Provid AIDS Care. 2013;12(2):103–109.
    1. Vlassoff C, Weiss MG, Rao S, Ali F, Prentice T. HIV-related stigma in rural and tribal communities of Maharashtra, India. J Health Popul Nutr. 2012;30(4):394–403.
    1. Nyamathi AM, Sinha S, Ganguly KK, et al. Challenges experienced by rural women in India living with AIDS and implications for the delivery of HIV/AIDS care. Health Care Women Int. 2011;32(4):300–313.
    1. Ramachandran S, Chandran AS, Chava N, Chole K, Das M. HIV/AIDS situation and response in Prakasam district: epidemiological appraisal using data triangulation 2010. 2016. . Accessed October 27, 2016.
    1. Reddy RK. Health Needs of North Coastal Prakasam Region, Andhra Pradesh, India. Hyderabad, India: Access Health International and Nimmagadda Foundation, Center for Emerging Market Solutions, Indian School of Business; 2011.
    1. Acosta-Michlik L, Galli F, Klein RJ, et al. How vulnerable is India to climatic stress? Measuring vulnerability to drought using the Security Diagram concept. Paper presented at: IHDP GECHS International Workshop “Human Security and Climate Change” 2005; Asker, Norway.
    1. Lorig K, González V. The integration of theory with practice: a 12-year case study. Health Educ Q. 1992;19(3):355–368.
    1. Nodhturft V, Schneider JM, Hebert P, et al. Chronic disease self-management. Nurs Clin North Am. 2000;35(2):507–518.
    1. Nyamathi A, Ekstrand M, Srivastava N, et al. ASHA-life intervention perspectives voiced by rural Indian women living with AIDS. Health Care Women Int. 2016;37(4):412–425.
    1. Ghosh S, Dutt D, Guha SK, Pal D, Hazra S. Magnitude and factors associated with depression among HIV positive patients in a tertiary care hospital at Kolkata: influence of coping strategies. Indian Journal of Hygiene and Public Health; 2015.
    1. Kaneez S. Depression and coping mechanism among HIV/AIDS patients under anti-retroviral therapy. Indian J Soc Psychiatry. 2016;32(2):149.
    1. Food Agriculture Organization of the United Nations. The State of Food Insecurity in the World, 2010: Addressing Food Insecurity in Protracted Crises. Rome, Italy: Food and Agriculture Organization of the United Nations; 2010.
    1. Swaminathan S, Padmapriyadarsini C, Yoojin L, et al. Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study. Clin Infect Dis. 2010;51(1):51–57.
    1. Weiser SD, Tsai AC, Gupta R, et al. Food insecurity is associated with morbidity and patterns of health care utilization among HIV-infected individuals in a resource-poor setting. AIDS (London, England). 2012;26(1):67.
    1. Nyamathi AM, William RR, Ganguly KK, et al. Perceptions of women living with AIDS in rural India related to the engagement of HIV-trained accredited social health activists for care and support. J HIV AIDS Soc Serv. 2010;9(4):385–404.
    1. Nyamathi A, Salem BE, Meyer V, Ganguly KK, Sinha S, Ramakrishnan P. Impact of an ASHA intervention on depressive symptoms among rural women living with AIDS in India: comparison of the ASHA-Life and Usual Care program. AIDS Educ Prev. 2012;24(3):280–293.
    1. Nyamathi A, Ekstrand M, Salem BE, Sinha S, Ganguly KK, Leake B. Impact of ASHA intervention on stigma among rural Indian women with AIDS. West J Nurs Res. 2013;35(7):867–883.
    1. Nyamathi A, Hanson AY, Salem BE, et al. Impact of a rural village women (ASHA) intervention on adherence to antiretroviral therapy in southern India. Nurs Res. 2012;61(5):353–362.
    1. Nyamathi A, Sinha S, Ganguly KK, Ramakrishna P, Suresh P, Carpenter CL. Impact of protein supplementation and care and support on body composition and CD4 count among HIV-infected women living in rural India: results from a randomized pilot clinical trial. AIDS Behav. 2013;17(6):2011–2021.
    1. Srivastava N, Nyamathi AM, Sinha S, et al. Women living with AIDS in rural Southern India: perspectives on mental health and lay health care worker support. J HIV AIDS Soc Serv. 2017;16(2):170–194.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357.
    1. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educa Inform. 2004;22(2):63–75.
    1. Web application for managing, analyzing, and presenting qualitative and mixed method research data [2016]. Version 7.0.23 Los Angeles, CA: SocioCultural Research Consultants, LLC; 2016.
    1. Saldaña J. The Coding Manual for Qualitative Researchers. Los Angeles, CA: Sage Publications; 2013.
    1. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15(1):85–109.
    1. Bhatia MS, Munjal S. Prevalence of depression in people living with HIV/AIDS undergoing ART and factors associated with it. J Clin Diagn Res. 2014;8(10):WC01–WC04.
    1. Kittler PG, Sucher K, Nahikian-Nelms M. Food and Culture. Belmont, CA: Wadsworth/Cengage Learning; 2012.
    1. Galhena DH, Freed R, Maredia KM. Home gardens: a promising approach to enhance household food security and wellbeing. Agriculture Food Security. 2013;2(1):1.
    1. Nyamathi A, Salem BE, Zhang S, et al. Nursing case management, peer coaching, and hepatitis A and B vaccine completion among homeless men recently released on parole: randomized clinical trial. Nurs Res. 2015;64(3):177–189.
    1. Salem BE, Ma-Pham J, Chen S, Brecht ML, Antonio AL, Ames M. Impact of a community-based frailty intervention among middle-aged and older prefrail and frail homeless women: a pilot randomized controlled trial. Community Ment Health J. 2017;53(6):688–694.

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