INTRODUCTION
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Antenatal HIV testing has higher penetration rates than testing in the general population in low- and middle-income countries (LMIC) [103]. Pregnant women are then the first family members to get an HIV diagnosis: first identified is often interpreted as the first infected. Wives are blamed for bringing HIV to the family and destroying the husband and children [86]. Mothers hide babies’ illnesses from their families, sending children to grandparents in their tribal villages, out of their partner’s sight, or using mixed breastfeeding methods to maintain expectations of extended family members [23].
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After 25 years, 20% of the LMIC’s populations have been tested for HIV [103]. Couples’ testing is often not available in many places and yet has been found to be effective and less stigmatizing than individually targeted testing [100]. Typically, each individual provides voluntary informed consent and receives individual counseling. Husbands do not share their HIV status with their wives and wives have no incentive to disclose to their husbands. Family secrets are created by the health care system, with its focus on individual rights [85].
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Among the five million persons on ART, most are only one of several family members with HIV [4]. The impacts of ART are sometimes diluted by sharing medications among family members when only one family member is engaged in treatment.
Interventions and contextual factors for FAH in the US, Thailand, and South Africa
Program | Risk factors | Population prioritiesa
| Settings | Delivered by | Format | Sessions | Positive intervention impacts |
---|---|---|---|---|---|---|---|
NYC Project TALC 1994–2000 | Sexual transmission; polydrug use, IDU or partners of IDU | Preparing for death, custody plans, caregiving by child, substance use | ASO run by local government | Masters level psychologists or trainees | Mother groups, adolescent groups, family sessions | 24 at 1.5–2 h weekly or 12 half-day weekend sessions | 6-year follow-up; substance use, sex risks, and mental health symptoms for parents and adolescents; adolescent school graduation, employment, pregnancies, and coping with parentification; grandchildren’s home environments |
LA Project TALC 2004–2008 | Sexual transmission; partner risks unknown | Managing HIV as chronic illness, family functioning | HIV clinics, ASOs, CBOs | Masters level psychologists or trainees | Mother groups, adolescent. groups, family sessions | 16 at 1.5–2 h weekly | 18-month follow-up; mother self-monitoring health status, children reduce substance use (less mental health symptoms for HIV-positive compared to HIV-negative neighborhood comparison sample) |
Thailand Family to Family 2007–2010 | Sexual transmission, IDU | Multigenerational caregiving, impact on parent of adult PLH | Primary care clinics in hospitals | Clinic staff | Parent and family member multifamily groups | 12 at 1.5–2 h weekly | 12-month follow-up; general health, physical health, mental health, quality of life |
South Africa Mentor Mothers Clinic-Based 2008–2011 | Pregnant women in high prevalence area | PMTCT, alcohol, nutrition, child development | Primary care clinic | Mentor mothers (peer CHW) | Small groups of mothers | 8 at 1.5 h | 12-month follow-up; disclosure at hospital, postpartum depression, child grant registration, health quality of life, well-baby checkups, developmental milestones, infant single feeding methods, HIV prevention knowledge, condom use |
South Africa Mentor Mothers Home Visits 2008–2012 | Pregnant women in high prevalence area (includes HIV-positive and at-risk) | PMTCT, alcohol, nutrition, child development | Home visits (for MCH) | Mentor mothers (peer CHW) | Mother and family | 8 at ~40 min | 18-month follow-up; only baseline data is completed at time of this publication; follow-up data collection is ongoing |
Common factors
Common principles
Common processes
Common practices
Common factors | |
Establish a framework to understand behavior change | “Normalize” challenges facing HIV-affected families |
Convey issue-specific and population-specific information | Address four domains |
Maintaining healthy mind | |
Maintaining healthy body | |
Maintaining healthy family relations | |
Improving social and community integration | |
Build cognitive, affective, and behavioral self-management skills | Rehearse and practice identifying and self-regulating feelings in HIV-related situations, thinking patterns in difficult situations, and social skills |
Address environmental barriers to implementing health behaviors | Access to ongoing health care |
Access to transportation | |
Provide tools to develop ongoing social and community support | Interventions designed as drop-in sessions |
District hospitals’ monthly support groups for HIV-affected families | |
Common practice elements | |
Relaxation and ice breaking activities | Meditation, singing, and dancing |
Feeling thermometer | Tied to Buddhism advocating self-awareness |
Effective tool to understand current state (feelings) | |
Feel–Think–Do (FTD) model | Promoting positive cycle of cause and effect |
Buddhist philosophy of linking feelings, thoughts, and actions | |
Tokens (rewards) | Yellow color represents loyalty and respect to the king |
Stars represent culturally accepted symbol for rewards | |
Facilitate expression of kindness and joy | |
Role-playing in pair sharing | Practice challenging hypothetical scenarios |
Effective dyadic exercise to act out situational challenges | |
Rehearse a variety of problem-solving scenarios with different participants |