College of Behavioral & Social Sciences

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    Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 – 2011: a retrospective cohort study
    (Springer Nature, 2014-12-17) Mee, Paul; Wagner, Ryan G; Gómez-Olivé, Francesc Xavier; Kabudula, Chodziwadziwa; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Byass, Peter; Tollman, Stephen M
    In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.
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    Prevalence of dysphagia and cognitive impairments in adults with HIV/AIDS in the acute care setting: An epidemiological study
    (2011) Walker, Theresa; Sonies, Barbara; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are life-threatening conditions. This virus causes the suppression of the immune system, allowing opportunistic infections and diseases to attack the body. Due to these opportunistic infections, individuals with HIV/AIDS are susceptible to conditions such as dysphagia (difficulty swallowing), odynophagia (painful swallowing), and cognitive impairment (e.g., HIV dementia). The co-morbidity of these conditions is not clearly documented in the literature. Therefore, in this study, the prevalence of dysphagia (with and without cognitive impairment) in the HIV/AIDS population was determined by a review of 300 medical charts from patients admitted to a metropolitan hospital. Possible associations between the conditions and several demographic variables (e.g., age, CD4 cell count, recommended diet) were also explored. Twenty-one percent of the charts of patients with HIV/AIDS reported confirmed dysphagia and/or complaints of odynophagia. Of that 21%, only about five percent also had a documented cognitive impairment. This study supports previous prevalence estimates of dysphagia and odynophagia and reports prevalence of concurrent dysphagia and cognitive impairment, a potentially challenging complex. Lower CD4 counts were associated with the presence of dysphagia in this population. Individuals with dysphagia and cognitive impairments were more likely to be older and were more likely to be recommended a restrictive diet consistency. Implications and recommendations for future study of this population are discussed.
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    The Intersection of HIV Infection with HIV/AIDS Beliefs among African Americans
    (2007-08-02) Walton, Heather M.; Fassinger, Ruth E.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This dissertation describes a qualitative study of 15 African American, HIV-positive individuals who were clients in a day treatment program at an HIV clinic in the Washington, DC, area. Data were collected through semistructured interviews; grounded theory methodology was used to generate a theory of how the participants gave meaning to HIV. The theoretical model included Personal Context, Support and Education, Socio-cultural Meaning, and Personal Meaning, all of which related to the formation of a global meaning regarding HIV. The emergent theoretical model and its components are presented, and the implications of the study for research, practice, and advocacy are discussed.
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    Nonrandom Mixing Models of HIV Transmission
    (Springer-Verlag, 1989) Kaplan, Edward H.; Cramton, Peter; Paltiel, A. David
    Models of HIV transmission and the AIDS epidemic generally assume random mixing among those infected with HIV and those who are not. For sexually transmitted HIV, this implies that individuals select sex partners without regard to attributes such as familiarity, attractiveness, or risk of infection. This paper formulates a model for examining the impact of nonrandom mixing on HIV transmission. We present threshold conditions that determine when HIV epidemics can occur within the framework of this model. Nonrandom mixing is introduced by assuming that sexually active individuals select sex partners to minimize the risk of infection. In addition to variability in risky sex rates, some versions of our model allow for error (or noise) in information exchanged between prospective partners. We investigate several models including random partner selection (or proportionate mixing), segregation of the population by risky sex rates, a probabilistic combination of segregation and random selection induced by imperfect information (or preferred mixing), and a model of costly search with perfect information. We develop examples which show that nonrandom mixing can lead to epidemics that are more severe or less severe than random mixing. For reasonable parameter choices describing the AIDS epidemic, however, the results suggest that random mixing models overstate the number of HIV infections that will occur.