HIV/AIDS: Positive Living and Resilience

HIV/AIDS Services
HIV BACKGROUND
Globally, an estimated 34 million people were living with HIV/AIDS in 2010.  14.2 million HIV positive people in need of drugs but 8 million of them cannot access it. Individuals were commonly infectedw ith HIV/AIDS in their most productive years (15-49). The scourge adverselly affects development.  The sub-Saharan African remained the greatest affected. An estimated 68% were living with HIV/AIDS in 2010.  For the last decade, committed political leadership, social change, innovation and rapid injection of new resources transformed the HIV success into a vanguard of global health success, and there came a new face of hope, resilience, courange, and responsibility.   Among the key findings from the progress report 2011 “Global HIV Response” were the need for updates on epidemc, interventions on preventions, scaling up treatment and care of people living with HIV/AIDS, scaling up services for key populations at a higher risk of HIV infection, scale up services for women and children, towards elimination of mother to child transmission, and improving maternal and child deaths in the contexts of HIV.   2011 indicated drastic improvement in the response to interventions by 21% since 1997, and deaths by 21% since 2005.  But, as of 2012; the situation in, particularly, Uganda has been very disappointing. HIV infections shot up again from 6.4% in 2005 to 7.3% in 2011, and females from 7.5% to 8.3%, and from 5% to 6.1%. HIV infection was higher in urban areas compared to rural.  The Uganda AIDS Commission reiterated the impact of leadership of the present government as very critical in the reduction of prevalence rates between 1992 (18%) and 2001 (6.2). The question remains, what went wrong? Was it leadership fatigue? Was it blurring of the message edge? Or is the population itself not taking responsibility?
Services:
HIV/AIDS is central element in reproductive health work in recent years. Reproductive health alone envisages a state of complete physical, mental and social wellbeing in all matters relating to health.  It deals with the reproductive process, functions and system at all stages of life.  And it implies that people are able to have satisfying and safe sex and that they have the capability to reproduce and freedom to decide if, when and how often to do so. Implicit in this condition are the right of men’s and women’s to be informed and to have access to safe, effective, affordable and acceptable methods of their choices for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women’s to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. Reproductive health also includes sexual health, the purpose of which enhancement of life and personal relations, are not merely counselling and care related to reproduction and sexually transmitted disease.

Finally, our experience increasingly shows that there is a link between reproductive health and security since contraction of any of the illness amounted to compromise personal safety which is aggravated violence on the basis of being vulnerable by gender, age. Ignorance of society and poor national leadership leads into production of children who become social costs and social misfit, whose goals get met through further violence with the society and who fall break the cycle of lack of information on reproductive health and increased vulnerability, with which to safeguard themselves from future reproductive health conditions, lack of personal, social, and national or regional peace. Peace can be attained only when there is access to information, knowledge of safety measure, access of facilities, knowledge of using facilities empowering to the society. In my work, guarantee communities with these assured the country of peace and security.

IMI IDENTIFIED PREDISPOSITIONS:
Vulnerability of children, Mental Health and HIV
Child abuse verses repression, projection verses limited protection and values, narsism and deviant, iressitibility, crash verses irressititability, denial, child hood,and living illusive life, avoidant, aggression, irritability, violence (including sex-related), displacement, projection, rationalisation, represion and defensiveness. IMI RECOMMENDED ACTIONS: forcefully take for treatment, experience truth, give hope , self imagery of life after, selfwareness and mastering life of personal wellbeing, mastering life with HIV, self discpline, development of hobbies, finding supportive groups/clubs, seeking support and selfhelp literature, finding and participation in productive work, self discipline, nursing and working on wishes and dreams -as well as walking them.

HIV WITHIN THE FRAMEWORK OF FAMILY MENTAL HEALTH
The project centers on family conflicts (or family mental health issues) which, if mismanaged, potentially, spills over into the wider community. It goes further to trace individual concerns (inner conflicts) that families consciously or unconsciously perpetuate –which, if not given due attention, like a time-bomb, blows up into serious social costs like substance abuse, aggressive and risky behaviors, increased HIV/AIDS prevalence, low productivity, poverty and looming ignorance to solve those problems. It is, thus, pertinent to address such problems from the environment around the root (individuals at family level) in order to achieve sustainable peace in the wider community (global peace).
HOW YOU CAN BE INVOLVED
As client
As volunteer
As service activity sponsor
As client sponsor
As fundraiser
As donor/funder
As ambassador
As development partner
As friend
Visit us
Visit our blog www.integratedmhi.blogspot.ug
Visit our facebook page: www.facebook.com/integratedmentalhealthinitiative
HOW YOU CAN REACH US
Telephone: +256774336277 or +256752542504
Email: waiswajacobo@yahoo.co.uk or dishma.imhs@gmail.com 

HIV/AIDS Children Care Discussion

By Waiswa Jacob, waiswajacobo@yahoo.co.uk
DISCUSSING RESULTS, CONCLUSION AND RECOMMENDATION
Introduction:

The sample constituted age ranges of young people between 16-24. The majority 55.3% were between 23-24 years. Prevalence was high in females than males -represented by 77.7% compared to the 22.3% respectively.

Discussion
There were significant relationships between the variables; (Positive Living and Resilience), (Spirituality and Positive Living), and (Spirituality and Resilience). This meant that if the three variables were best utilized by ALWAs -as part of their lifestyle, they would be of high benefit to them in the struggle against HIV/AIDS. They could as well be vital for; effective health-care services delivery and mutual satisfaction between ALWAs and their care-givers. Practitioners, however, would need to practice mastery and responsibility to achieve overall success (Rutter, 1985).

For ALWAs, nurturing optimism would be the norm -since it was associated with strong immune system and long life (Weil, 2007). Consequently, positive attitudes about life (hope) would be formed in the lives of ALWAs, and help to boost health, happiness and satisfaction (Scott, 2007). Having achieved that, the possibility of ALWA living a natural lifespan or reach highest peaks achievable in life, could be held strongly. However, this requires having hope and courage (positivelivingonline.com, February 23rd, 2007).

Longer or not: the questions fall to the entire humanity to answer; regardless of whether sections of the populations have HIV/AIDS or not. The question of death could be answered by stating that; everyone must die and we all have to enjoy the present with anticipation of the best life could give as a governing principle for all. But, for PL and RE, the kind of death would be a decent and dignified one. However, successful life and decent death would result only if life was lived principally (Covey, 1989). Such principles as: fairness, integrity, nurturance etc were suggested. However, doing so would require of ALWAs to accept their situation and looking beyond it. That is; the pains and suffering (Zohar and Marshall , 2000:pg15).

In addition, death is natural, whose timing is only helped by healthy actions that would postpone it to many years ahead. For example; trusting personal abilities, accepting the situation and having trust in God (Scott, 2007). Like any other life challenge, one could fight it and eventually win or lose depending on their traits (positivelivingonline.com, December 1st, 2006). Struggling to survive is everyone’s obligation -involving relentless “fight” in anticipation of the best in life. This would not exclude ALWAs (project resilience, 1999). This would be achieved through; being respectful of others, not dwelling on problems and focusing on life positives (project resilience, 1999).

Health care managers could consider fostering RE, PL and SP through approaches like; personality, family, social, economic or educational, environmental or ecological and spiritual ones; for answers to shape survival needs of ALWAs - to wards blissful lives. Forming institutional structures to direct ALWAs’ health-living could be developed based on the noted approaches. This would significantly influence well-being (PL and RE) - (Henderson and Milstein, 1996, p.2.), while their (ALWAs) nurturance would be very vital to its achievement (well-being) - (Zimmerman, May 1994, p. 4).

Institutional structural design ought to be inclined to allow resources and support extraction for ALWAs in particular and HIV/AIDS issues in general (Grotberg, 1995). An ecological frame-work, to o, would provide a basis for the quality of life desired since decisions are made in line with ecological resources (Mwaka, 1991). Already, Garbarino (1993) stressed that the primary importance of a family was to help children become resilient or at least be able to deal with adversity. If the health management system was to be made relevant, the studied variables would have to be brought in to ‘play’ -through nurturing the above mentioned approaches and ensuring their sustainability for the benefit of ALWAs.

Unfortunately, Resilience has been marked right only in areas adolescent and/or child education (Frey, 1987) and conflict -as noted among the works of KSSP in northern Uganda (Glen, Obonyo and Annan, 2001). But, even the much emphasized PL aspects are not adequately utilized -because numbers of HIV+ people visiting health centers every clinical day are so overwhelming (Atuhaire: May 23rd, 2007 pg 14). The ratio of healthy workers to clients (in Kampala Health Centers) -seen every clinical day was to o small to cover the high number of all clients received.

About 10:200, of which 3/10 were doc to rs, 6/10 as peer trainers and 1 counselor. However, the number of clients, who arrived for treatment varied from one health center or AIDS clinic to another. In addition, the same personnel were rotated around other to wn health centers, twice a week for each center. They (clients) come as early as 7am and leave at 4pm. And, between the stated times, they were waiting to access doc to rs, counselors and ARVs -without lunch or breakfast being given to them. Yet, many of them (clients) came from upcountry to receive improved services in to wns (Waiswa, 2007).

In addition, when client’s health improves, they would tend to lose conscience that they have HIV/AIDS that requires seeking treatment as a permanent exercise. Subsequently, they get tempted to abandon treatment, (Nyanzi: Oc to ber 17th, 2007, Daily Moni to r pg 4) –an act that undermines PL and RE. Those found to be concordant, would be held in disbelief that both must share a specific HIV status rather than just one of them. As a consequence, the HIV+ person as would the HIV negative one might tend to ignore the need for protection against infection and/or re-infection. And, would tend to find condom use unrealistic as married partners, thereby; making the HIV negative partner, be at full risk of contracting the virus.

There were also cases where a partner, who discovers his or her status as HIV+, fails to inform the untested partner whilst ensuring normal intimacy –accompanied with sex. The reason given was fear of losing a loving partner through rejection and separation, while under extreme cases, discovery of HIV status as HIV+ by one partner, could lead to violence or even murder (Egadu: Oc to ber 16th, 2007, Daily Moni to r pg 4). Before climaxing in to death or fights, a wave of counter-accusations about responsibility for spreading the virus would be the main feature in the relationship. However, TASO partnered with its clients to prevent HIV/AIDS spread through having them know their roles and responsibilities –including the one of not being sexually reckless (Kakooza: Media Plus, 2007).

Worthy noting also, could be the homosexuals concerns. They are key members of the community in need of concern when dealing with issues regarding ALWAs in particular and HIV/AIDS in general. Throughout data collection, there were no confirmed related-groups found and interviewed to give whole-some conclusions about PL, SP and RE. US’ Center for Disease Control (CDC) continues to report high levels of infection among homosexuals and the bi-sexual. In fact, there are an estimated 40,000 new HIV infections yearly with 70% of these being among men. Of those men who are infected 60% cases were through homosexual sex (Traditional Values Coalition: Special Report, May 2007). In Uganda , homosexual cases have taken root but, the National HIV/AIDS Frame-work does not cater for them. Vic to r Mukasa, a homosexual advocate, ridiculed Uganda ’s success in HIV/AIDS fight because the national HIV/AIDS programme excludes them, Mukasa (2006-05-18).

Like the saying “everyone for himself and God for us all”, families and communities, people get divided when required to support and care for HIV/AIDS people. This is so, because of stigma. This would put the lives of ALWAs at stake. Families and communities could not therefore, be relied upon for care and support. No wonder, over years, numerous NGOs have sprung up to fill the gap like; TASO, AIC, Mild-may etc. Yet, family care and community support are very vital in boosting RE and PL (Kimberly, 1998). At institutional level, those chattered to oversee care for HIV persons, highly promote stigma under the pretext of confidentiality and protection from harm. They are very sensitive non-client visi to rs. Besides, they use PLWA as a vehicle for employment and soliciting donor money rather than focusing on their well-being (Bogere, Oc to ber 2007). Unlike those managed by peers (those with HIV caring for others with same HIV status), who tend to be genuine, the HIV negative care-givers tend to easily lose empathy during care.

Notable cases are about those who error (due to sensory misgivings) at responding to roll-calls during clinical days. They would be given new appointments without treatment till the next clinical day (one to three month [s] later). Having noted that; there ought to be a review of organizations and their functional processes aimed at creating enabling environment to nurture not only RE but also PL, (Zimmerman, May 1994 pg 4). Risky jobs and harsh environments could lead to risky behaviors, from which ALWAs contract HIV/AIDS. In Nebbi District, HIV was highest in prisoners and soldiers –with infection increase of 7% (Okello: December 4th, 2007, Daily Moni to r pg 13).

Economic challenges, to o, could tend to dictate quality of SP, PL and RE. Most important to note is that sex continues to be the cheapest exchange-for money modes to survive economic hardships. In Kayunga, 52% of the women engage in pre-marital sex as a way to get money and necessities of life. And, of late, employers reportedly abused their offices by offering jobs in exchange for sex –a practice which exploits mainly females, (Muzaale: Wednesday, Oc to ber 7th, 2007, Daily Moni to r pg 15). These violate values of PL, SP and RE. It is the working ALWAs that are more favored to live healthy lives than unemployed ones. This is so, because they can afford a balanced diet everyday as well as other life essentials necessary for health-living.

Malawi ’s NAPHAM covers the unemployment gap in its programmes. For example, they have a poultry farm that provides alternative nutrition as well as employment to its members (Guardian Unlimited, 2007). Like NAPHAM members, employed ALWAs in Uganda would have the motivation to explore relationship with the Divine as well as attempt to please him by works (like, making an offer to ry in Church or Zakat practiced by Moslems).

But again, having to work hard everyday for a living; leaves no room for adequate resting. 7-8 hours of sleep-time, is there fore, a luxury. Work pressure would easily wear them up (deteriorate through; stress, fatigue and body-immunity suppression) - (Licenblat, 2007). As if to reinforce the point, (Genesis, 2:1-3) shows that; God rested after his creation work. And; who would be ALWAs not to rest? They thus, ought to create time to rest, relax, and meditate upon goodness in life. Yet, adequate sleeping and resting would be vital ingredient of PL, SP and RE strengthening.

Still to note, ALWAs either misuse SP or not at all utilize it. For example; some churches encouraged their members not to take ARVs –saying prayer alone heals, while others -who are successfully living-positively, do not apply fully the Divine requirements. TASO’s advisory committee chairman, Rev. Willy Olango, expressed concern about some churches discouraging HIV/AIDS patients from taking drugs (Ocowun: September 16th, 2007, The New Vision; as extracted from: healthnet.org).

No wonder; according to Dr. Fred Kigozi (head of Butabika Hospital ), people with mental health-related problems, who visited religious and traditional healers, hardly got cured. But, also, ALWAs would be co-crea to rs with God by both consulting him and taking drugs (Philippians, 4:8-9). Therefore, underutilizing drug treatment by ALWAs would potentially undermine SP, PL and RE.

Conclusion
A lot has been said and done about PL with a few inadequacies that could be corrected to achieve its desired goal, while a lot more needs to be done by researchers on the question of RE in line with its influences on good health and longer life for ALWAs –with it, as an independent variable. It is a study that would be very necessary at such a time when various remedy technologies are being craved for to manage and control HIV/AIDS.

Whereas SP being everybody’s area of retreat, preoccupation, occupation or concern, its consumers have tended to use it independent of positive living, though satisfying its relationship with RE. As a result, it has rendered individual life-struggle efforts limited and making life end predictable only over a short life span. Still, from the use of SP, some faithful go as far as discouraging followers from taking ARVs, which is a serious danger. It would be considered criminal and perpetua to rs taken responsible. It is, therefore, very important that positive living and spirituality are made a policy or legislation: to wholly become part of the health management system and for the much desired comprehensive health-services delivery and consumer satisfaction - to wards fostering assurances for long and “normal” life.

Future researchers in the field of HIV/AIDS would find the research area interesting if they encountered it with patience and endurance during respondent-centered interaction. It would, therefore, be most appropriate for post-graduates with research only courses as their academic requirement, as this would fully milk-out HIV/AIDS research needs successfully. It is a task which would require commitment and time -through a period negotiating with heads of HIV/AIDS services or institutions, their approval, and data collection itself.

All in all, prevention is better than cure. Abstinence, Being Faithful, and Use of Condoms (ABC Strategy) could be strengthened side by side with the search for HIV/AIDS cure.

Recommendations
There is need to increase efforts to wards the search for an AIDS cure while making ABC not only a preventive strategy against HIV/AIDS, but also, a cultural practice.

There is need for periodical reviews of institutions that deal in HIV/AIDS issues, their operation and consumer satisfaction.

The aspects of: SP, RE and PL need to be closely applied as well as ensure and moni to r their effective utilization among ALWAs.

There is need to promote self-help groups and avail them with funding and technical infrastructure to fight HIV/AIDS and poverty - to be able to sustain the benefits of SP, RE and PL.

There is need to promote education, sports and games, handcraft-making and other co-curricular activities -for ALWAs’ economic and therapeutic benefits.

There is need to encourage disclosure, as part of PL and way to fight stigma as well as make it (encouraging disclosure) a government policy for all HIV/AIDS service providers.

As a matter of government policy, is the need to encourage easy means for HIV/AIDS researchers to access PLWAs -since research information soon becomes part of the knowledge-base vital in the management of HIV/AIDS.