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Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness
- Authors:
- WAINBERG Milton L., et al
- Journal article citation:
- Social Science and Medicine, 65(2), July 2007, pp.296-308.
- Publisher:
- Elsevier
As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, the authors conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. The authors sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behaviour in this population. The authors conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients’ risk behaviours; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients’ sexual behaviour, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients’ sexual networks. Further, ethnography identified the Brazilian concept of “social responsibility” as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.
Reframing HIV adherence as part of the experience of illness
- Authors:
- GOLUB Sarit A., INDYK Debbie, WAINBERG Milton L.
- Journal article citation:
- Social Work in Health Care, 42(3/4), 2006, pp.167-188.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Understanding and enhancing adherence to HIV medications has been identified as a major challenge. The purpose of this study was to explore patterns and determinants of non-adherence among individuals receiving HIV care in a medical clinic. Seven focus groups were conducted with 42 HIV positive patients, and verbatim transcripts of focus group sessions were analyzed through a combination of ethnographic and content analysis. Of the participants currently on combination therapy, 68% reported at least one recent instance of non-adherence. The most commonly cited reasons for non-adherent behaviour were grouped into four categories: (1) problems with side effects; (2) conflicts with daily life activities; (3) feelings of aversion toward the medications themselves; and (4) deliberate alterations to the prescribed regimen. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).