SOCIAL SUPPORT NETWORKS

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CHAPTER 2 LITERATURE REVIEW

INTRODUCTION

In the previous chapter, the researcher provided an orientation to the study, including background to the research topic, the research problem, the purpose and objectives of the study. The chapter also stated the significance of the study and defined the key variables in the study. This chapter contains the literature review. According to Cottrell and McKenzie (2010:42), literature review is a written summary of articles, books and other documents, which especially in quantitative research, is used to justify the importance of a study, place the study in historical perspective, refine the research questions, and identify appropriate methodology and instrumentation. A literature review puts one’s research into context by showing how it fits in a particular field. It also provides a framework for relating new findings to previous findings in the discussion section of a thesis. Without establishing the state of the previous research, it is impossible to establish how the new research advances the previous research (Blanche, Durrheim & Paiter 2006:40; Randolph 2009:2).
In this chapter, the researcher analyses, compares, and synthesises prior research related to the research topic, question, theory-base and key study variables. This analysis brings out gaps in the existing literature thereby establishing the foundation for the study. The information is organised along the main concepts in the study: social support; PLHIV support groups; HIV-related stigma; HIV status disclosure; adherence to anti-retroviral treatment; sexual risk behaviour and social support competencies.
To obtain the relevant literature, the researcher subscribed to FHI 360’s library services email listserv for two monthly updates called “HIV Awareness” and “Global HIV Updates”. FHI 360 subscribes to and obtains periodic articles from major HIV/AIDS and public health related journals, including The Journal of International AIDS Society, The American Journal of Public Health, The Lancet, and The New England Journal of Medicine. The two updates provide monthly compilations of citations and abstracts of articles related to HIV/AIDS prevention, care and treatment from a broad range of publications with a focus on the contexts of developing countries. The researcher selected the articles of interest using key concepts in the study as search words – social support, HIV status disclosure, ART adherence, HIV stigma and sexual risk behaviour. The researcher then requested for full texts of the selected articles from the FHI 360 library every month, and used these to complete the literature review.

EPIDEMIOLOGY OF HIV/AIDS

Global perspective

For over three decades, the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) commonly referred to as the HIV/AIDS epidemic have been among the defining issues facing scientists, health workers and governments, globally. The Joint United Nations Programme on HIV/AIDS (UNAIDS 2013:8-12, 42) estimates that since the beginning of the epidemic, almost 75 million people have been infected with HIV, about 36 million have died and 35.3 million people were living with HIV at the end of 2012. About 1.6 million people died of AIDS-related illnesses worldwide in 2012 alone.

HIV/AIDS in Africa and Sub-Saharan Africa

Although HIV/AIDS affects all continents, Sub-Saharan Africa remains the most severely affected region accounting for 71% of the PLHIV worldwide. Out of the 35.3 million PLHIV in 2012, about 25 million lived in sub-Saharan Africa. Given that this region accounts for only 10% of the world’s population, this disproportion of the HIV burden is of great concern. In 2012, nine countries in southern Africa accounted for less than 2% of the world’s population but represented 33% of the global HIV infections (DeCock, Jaffe & Curron 2012:1). Sub-Saharan Africa also accounted for 71% of all new infections and more than 90% of the children who acquired HIV infection in 2012 (UNAIDS 2013:4).

HIV/AIDS in Nigeria

According to the 2013 UNAIDS report on the global AIDS epidemic, HIV prevalence in Nigeria is estimated at 3.1% and in 2012, there were 3.4 million PLHIV, of which, 430,000 were children below five years. About 240,000 Nigerians died of AIDS-related illnesses in 2012. Nigeria alone accounts for 30% of the global mother-to-child transmission of HIV (PMTCT) burden (UNAIDS 2012:42). Also, of the estimated 15 million AIDS-caused orphans who live in Sub-Saharan Africa, Nigeria accounts for 2.2 million of them (17%) (UNICEF 2012:4).

CLINICAL PICTURE/ASPECTS OF HIV/AIDS

Origin and pathogenesis of HIV

Available literature shows that acquired immunodeficiency syndrome of humans is caused by two human immunodeficiency viruses types 1 and 2 (HIV-1 and HIV-2). Both types result from multiple cross-species transmissions of simian immunodeficiency viruses (SIVs) naturally infecting African primates. Scientists have traced the origins of HIV to chimpanzees in Cameroon (CDC 2014: 1; Sharp, Beatrice & Hahn 2011:1). It is believed that genetic changes occurred as the SIV crossed from monkeys to apes and from apes to humans (HIV). How humans acquired the ape precursors of HIV is not known. However, based on the biology of these viruses, transmission is thought to have occurred through cutaneous or mucous membrane exposure to infected ape body fluids. Such exposures most commonly occur in the context of eating bush meat (Peeters, Courgnaud, Abela, Auzel, Pourrut, Bibollet-Ruche, Loul, Liegeois, Butel & Koulagna 2002:3).
HIV pathogenesis has proven to be quite complex and dynamic with most of the critical events (e.g. transmission and the CD4⁺ T-cell destruction) occurring in mucosal tissues. Although the resulting disease can progress over years, scientists believe that many critical events happen within the first few weeks of infection when most people are unaware that they are infected. These events occur predominantly in tissues particularly along the gastrointestinal tract, where massive depletion of the CD4⁺ T cells occurs long before adverse consequences of HIV infection are otherwise apparent (Sharp et al 2011:2-4).
AIDS was first recognised as a new disease in 1981 when increasing numbers of young homosexual men in America succumbed to unusual opportunistic infections and rare malignancies (Greene 2007:2). To date, the disease has become a global pandemic affecting men and women, children and adults, homosexuals and heterosexuals, the rich and the poor.

Modes of transmission

HIV is transmitted from an HIV-infected person to another through body fluids, including blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids and breast milk. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream for transmission to possibly occur (CDC 2014:1). HIV spreads by sexual, percutaneous and perinatal routes. However, 80% of adults acquire HIV following exposure during sexual intercourse, thus HIV/AIDS is primarily a sexually transmitted disease (Cohen, Shaw, McMichael & Haynes 2011:2).

Symptomatology

Many people who are infected with HIV do not have any symptoms at all for 10 years or more. Some people who are infected with HIV report having flu-like symptoms two to four weeks after exposure. Other symptoms can include fever, enlarged lymph nodes, sore throat and rash. These symptoms can last from a few days to several weeks. During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others (CDC 2014:1).

HIV prevention

There are different ways to prevent HIV. As HIV is largely transmitted through sex, limiting the number of sexual partners is one of the most effective tools. Other tools include non-sharing of needles, using condoms correctly and consistently, and using biomedical interventions such as male circumcision, safe injections, safe blood transfusions, and pre-exposure and post-exposure prophylaxis. Recently, anti-retroviral therapy (ART) has been found to be an effective weapon for preventing HIV transmission from an infected to an uninfected sexual partner as well as from an infected mother to a child (Cohen et al 2011:12).

Treatment

Although there is no cure for HIV infection, ART can help PLHIV live long, healthy and productive lives. ART is the combination of several anti-retroviral medicines used to slow the rate at which HIV makes copies of itself in the body. A combination of three or more anti-retroviral medicines is more effective than using just one (monotherapy) to treat HIV/AIDS. The use of three or more anti-retroviral medicines, also commonly referred to as an anti-HIV « cocktail » is currently the standard treatment for HIV infection. So far, this treatment offers the best chance of preventing HIV from multiplying, which allows the body immune system to stay healthy. The goal of ART is to reduce the amount of virus in the body (viral load) to a level that can no longer be detected with current blood tests. Recently, scientists proved that ART is effective in prevention of HIV transmission (Cohen et al 2011:12).
Recent advances in ART for both HIV treatment and prevention have increased interest in psychosocial factors that influence treatment adherence and sexual behaviours of PLHIV. This is because studies have shown that the potential medical and public health impact of ART on reducing HIV incidence greatly depends on the extent to which PLHIV adhere to the prescribed daily dosing regimens of anti-retroviral medicines (UNAIDS 2012:32). The concern is that many patients enrolled for ART programmes in Africa do not adhere to their treatment prescriptions or interrupt their treatment along the way (UNAIDS 2012:56). In terms of HIV prevention, non-adherence to ART leads to a spike in viral load and increases the risk of person-to-person HIV transmission. Additionally, non-adherence to ART has been associated with risky sexual behaviours (Dessie & Deresa 2012; Kidder et al 2013:1; Ndziessi et al 2013:1).

CHAPTER 1 ORIENTATION TO THE STUDY 
1.1 INTRODUCTION
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 STATEMENT OF THE RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 DEFINITIONS OF TERMS
1.7 THEORETICAL FOUNDATIONS OF THE STUDY
1.8 RESEARCH DESIGN
1.9 SCOPE OF THE STUDY
1.10 STRUCTURE OF THE THESIS
1.11 CONCLUDING REMARKS
CHAPTER 2 LITERATURE REVIEW 
2.1 INTRODUCTION
2.2 EPIDEMIOLOGY OF HIV/AIDS
2.3 CLINICAL PICTURE/ASPECTS OF HIV/AIDS
2.4 SOCIAL SUPPORT NETWORKS
2.5 CONCEPTUAL FRAMEWORK OF THE STUDY
2.6 SOCIAL SUPPORT
2.7 SUPPORT GROUPS
2.8 HIV-RELATED STIGMA
2.9 HIV STATUS DISCLOURE
2.12 CONCLUSION
CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY 
3.1 INTRODUCTION
3.2 RESEARCH AIM AND OBJECTIVES
3.3 RESEARCH DESIGN
3.4 RESEARCH METHOD .
3.5 INTERNAL AND EXTERNAL VALIDITY OF THE STUDY .
3.6 ETHICAL CONSIDERATIONS
3.7 CONCLUSION
CHAPTER 4 ANALYSIS, PRESENTATION AND DESCRIPTION OF THE RESEARCH 
4.1 INTRODUCTION
4.2 RESEARCH RESULTS
4.3 OVERVIEW OF THE RESEARCH FINDINGS
4.4 CONCLUSION
CHAPTER 5 DISCUSSION AND INTERPRETATION OF STUDY FINDINGS 
5.1 INTRODUCTION
5.2 RESEARCH DESIGN AND METHOD
5.3 SUMMARY AND INTERPRETATION OF THE RESEARCH FINDINGS
5.4 CONCLUSION
CHAPTER 6  A CONCEPTUAL FRAMEWORK FOR DEVELOPING A MODEL FOR REVITALISING SOCIAL SUPPORT COMPETENCIES OF CAREGIVERS OF PEOPLE LIVING WITH HIV 
6.1 INTRODUCTION
6.2 THE MAIN FINDINGS
6.3 CLARIFYING THE CONCEPTS
6.4 CONCLUSION
CHAPTER 7 DESCRIPTION OF THE FINAL MODEL FOR REVITALISING SOCIAL SUPPORT COMPETENCIES TO ENHANCE POSITIVE BEHAVIOURALAL OUTCOMES AMONG PEOPLE LIVING WITH HIV 
7.1 INTRODUCTION
7.2 OVERVIEW OF THE MODEL .
7.3 PURPOSE OF THE MODEL
7.4 ASSUMPTIONS OF THE MODEL
7.5 CONTEXT OF THE MODEL
7.6 THEORETICAL DEFINITIONS OF THE CONCEPTS OF THE MODEL
7.7 RELATIONSHIP BETWEEN CONCEPTS
7.8 STRUCTURAL DESCRIPTION OF THE MODEL
7.11 EVALUATION OF THE MODEL
7.12 CONCLUSION
CHAPTER 8 CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS 
8.1 INTRODUCTION
8.2 CONCLUSIONS
8.3 LIMITATIONS OF THE STUDY .
8.4 RECOMMENDATIONS
8.5 PERSONAL REFLECTIONS
8.6 CONCLUDING REMARKS
LIST OF REFERENCES
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