Where Does Fear Lead Us: Antiretroviral Treatment Adherence in Maputo

This research aims to deepen knowledge on the role of fear on ART adherence of patients who live in Maputo district in Mozambique, including differences on age, gender and schooling level, on their previous knowledge about HIV and ART and on the impact of the discrimination experiences on the ART adherence. The participants are 602 ART patients living in Maputo district between 21 and 56 years old. The findings reveal that more men than women have interrupted the treatment. Those who did it at least once have more than 39 years old. There are more reports of non-interruption of the treatment on patients who have never been to school or who have been in the high school or more advanced studies. Those who reported that have never interrupted the treatment have more previous knowledge about HIV and the treatment;have never been discriminated and have less fear of being marginalized by being HIV+. Most of those who have interrupted the treatment have already been discriminated by nurses or friends. As fear is automatically processed in our brain, specific contexts of fear related to ART where studied as well as the impact of the fear of those contexts on the behaviors of adherence or of treatment interruption. The results reflect the need to develop national educational policies regarding emotional awareness, adequate emotional support and coping strategies in the context of Fear and of ART adherence. New policies need to address gender and age differences as well as health education access to ART patients, attempting to the stigma and the fear of discrimination as a present element of influence on ART adherence. The study also validates the role of health professionals as high responsible elements on the health of the ART individuals.

Individual factors related to chronic condition in Portuguese adolescents: Highlights from the HBSC/WHO study

Background: Adolescence includes a period (10 to 19 years) of profound biopsychosocial changes, constituting potentially difficult challenges, which may become more pronounced in the presence of a chronic condition and its limitations. Responses are not homogeneous and can be quite variable, depending on various specific individual factors. Research comparing adolescents with or without chronic illness, or comparing across different conditions, has been contradictory, not confirming a direct relationship between the degree of suffering and the chronic condition. Objective: To characterize and assess the impact of 1) having a chronic condition (CC) and 2) how CC affects school participation;and its association with life satisfaction and perception of wellness, controlling for demographic factors: age, gender and family socioeconomic status (SES). Methods: 5050 Portuguese adolescents with an average age of 14 years participated in the Health Behaviour in School-aged Children/WHO (HBSC). Results: The majority of the adolescents with CC reported that their conditions did not affect school participation. Adolescents with CC who indicated that CC affected school participation felt more frequently unwell and presented lower life satisfaction. Being a boy, younger and having high family socio economic status (SES) were identified as predictors of higher life satisfaction;on the other hand, being a girl, older, having lower SES, living with CC and feeling that CC affects school participation are predictors for feeling more frequently unwell. Conclusions: These adolescents showed an increased vulnerability, presenting internalized symptoms and lower life satisfaction. Furthermore, when there was simultaneous occurrence of living with CC and that CC affected school participation, the impact was even higher. Thus, it is crucial that future interventions should include the identified predictors, combined with “listen to the voice” of adolescents, throughout the adaptation process.