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Study Shows Community Support Positively Impacts the Health and Quality of Life for Woman in India Living with HIV/AIDS

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Results from an ongoing five-year National Institutes of Health-funded study, which carefully engaged the community to design the program, indicate increased social support for women living with HIV/AIDS could improve adherence to antiretroviral therapy and mitigate internalized stigma associated with the disease. 

Founding Dean and Distinguished Professor Adey Nyamathi, PhD, ANP, FAAN, from the UCI Sue & Bill Gross School of Nursing, is the lead investigator for the study titled, “ASHA Improving Health and Nutrition of Indian Women with AIDS and their Children.”  Nyamathi has been lead investigator in more than a dozen NIH-funded research grants related to populations experiencing significant health and social disparities. 

As part of the NIH grant, Nyamathi and her team have designed a comprehensive program wherein nurses, physicians, psychologists and social workers provide group sessions to rural women living with AIDS. A key addition to the research team is a network of village women known in India as ASHA (Accredited Social Work Activists) whom the research investigators have trained specifically in HIV/AIDS. These village women collaborate as part of the research team and visit the women in their homes to demonstrate low cost and healthy nutrition previously discussed in their group classes, as well as encourage the importance of social support and adherence to antiretroviral therapy. While all 600 women in the study receive the ASHA support, the impact of nutrition education or nutrition training or both is also assessed.

Recently, researchers found a strong and positive association between increased social support, and higher quality of life and CD4+ T cell counts (the standard measurement of active/virulent disease) of study participants. Their findings were illustrated by the severe lack of social support currently available and the high levels of depression and internalized stigma that exist among this population in India.

“Social support is the key to improving antiretroviral therapy adherence, which subsequently improves the CD4 levels, and positively impacts the physical and mental health of these women,” said Nyamathi. “By enhancing their overall quality of life, we can also work to diminish the internalized stigma they suffer.”

Preliminary data are also revealing that the Asha support plus nutrition supplementation or nutrition training have each resulted in a significant improvement in CD4 levels from baseline; however, the two combined has resulted in a significant interactive effect on CD4 change.

These most recent results were published in the Journal of the Association of Nurses in AIDS Care (JANAC), in an article titled, “Quality of Life Among Women Living With HIV in Rural India.”

Among the women living with AIDS in rural Andhra Pradesh, India, more than half were widowed and without any formal education. The experience of internalized stigma related to HIV/AIDS was high and most participants reported having no individuals on whom they could depend for social support. 

“Rural women living with AIDS in India continue to face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health,” said Nyamathi. “We find they are generally underweight and malnourished, and their adherence to antiretroviral therapy is less than 50 percent.”

Currently, Nyamathi and her multidisciplinary team of investigators are exploring the need and the possibility of adding diagnostic testing for cervical cancer to the services provided by the research team.

Other findings resulting from the NIH R01 grant (NIMH098729) were recently published in AIDS and Behavior in an article titled, “Relationships Among Adherence and Physical and Mental Health Among Women Living with HIV in Rural India;” in Health Care for Women International in an article titled, “ASHA-Life Intervention Perspectives Voiced by Rural Indian Women Living with AIDS;” and in the Journal of HIV/AIDS & Social Services, in an article titled, “Women Living with AIDS in rural Southern India: Perspectives on mental health and lay health care worker support.”