Skip to main content

Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning, Meaningfulness of Life, Seroconcordance, Social Support and Considering the Need for Integrated Care

Abstract

As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Abdool Karim, S. S. (2015). Overcoming impediments to global implementation of early antiretroviral therapy. New England Journal of Medicine, 373(9), 875–876.

    Article  PubMed  Google Scholar 

  2. 2.

    Alwin, D. F., & Hauser, R. M. (1975). The decomposition of effects in path analysis. American Sociological Review, 40, 37–47.

    Article  Google Scholar 

  3. 3.

    Anema, A., Vogenthaler, N., Frongillo, E. A., Kadiyala, S., & Weiser, S. D. (2009). Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities. Current HIV/AIDS Reports, 6(4), 224–231.

    Article  PubMed  Google Scholar 

  4. 4.

    Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759–769.

    Article  PubMed  Google Scholar 

  5. 5.

    Biesma, R. G., Brugha, R., Harmer, A., Walsh, A., Spicer, N., & Walt, G. (2009). The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control. Health Policy and Planning, 24(4), 239–252

  6. 6.

    Brandt, R. (2009). Putting mental health on the agenda for HIV+ women: a review of evidence from sub-Saharan Africa. Women and Health, 49(2–3), 215–228.

    Article  PubMed  Google Scholar 

  7. 7.

    De Waal, A., & Whiteside, A. (2003). New variant famine: AIDS and food crisis in southern Africa. The Lancet, 362(9391), 1234–1237.

    Article  Google Scholar 

  8. 8.

    Dezutter, J., Casalin, S., Wachholtz, A., Luyckx, K., Hekking, J., & Vandewiele, W. (2013). Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitation Psychology, 58(4), 334.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device*. Journal of Marital and Family Therapy, 9(2), 171–180.

    Article  Google Scholar 

  10. 10.

    Gillespie, S. (2008). Poverty, Food Insecurity, HIV Vulnerability and the Impacts of AIDS in sub-Saharan Africa. IDS Bulletin, 39(5), 10–18.

    Article  Google Scholar 

  11. 11.

    Goodman, M. L., Seidel, S. E., Kaberia, R., & Keiser, P. H. (2015). How can we improve healthcare access and general self-rated health among orphans and vulnerable children? Findings from a Kenyan cross-sectional study. International Journal of Public Health, 60(5), 589–597.

    Article  PubMed  Google Scholar 

  12. 12.

    Hafner, T., & Shiffman, J. (2013). The emergence of global attention to health systems strengthening. Health Policy and Planning, 28(1), 41–50.

    Article  PubMed  Google Scholar 

  13. 13.

    Honoré, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinski, J., & Koh, H. K. (2011). Creating a framework for getting quality into the public health system. Health Affairs, 30(4), 737–745.

    Article  PubMed  Google Scholar 

  14. 14.

    Huddleston-Casas, C., Charnigo, R., & Simmons, L. A. (2009). Food insecurity and maternal depression in rural, low-income families: a longitudinal investigation. Public Health Nutrition, 12(08), 1133–1140.

    Article  PubMed  Google Scholar 

  15. 15.

    Johnston, S., Kendall, C., Hogel, M., McLaren, M., & Liddy, C. (2015). Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care. PLoS ONE, 10(9), e0136757.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Joint United Nations Programme on HIV/AIDS (UNAIDS). (2014). The gap report. Geneva: UNAIDS.

    Google Scholar 

  17. 17.

    Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., & DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26(4), 315–332.

    Article  PubMed  Google Scholar 

  18. 18.

    Lawn, J. E., Rohde, J., Rifkin, S., Were, M., Paul, V. K., & Chopra, M. (2008). Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise.The Lancet, 372(9642), 917-927.

    Article  Google Scholar 

  19. 19.

    Li, L., Liang, L. J., Lee, S. J., Iamsirithaworn, S., Wan, D., & Rotheram-Borus, M. J. (2012). Efficacy of an intervention for families living with HIV in Thailand: A randomized controlled trial. AIDS and Behavior, 16(5), 1276–1285.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Magnussen, L., Ehiri, J., & Jolly, P. (2004). Comprehensive versus selective primary health care: Lessons for global health policy. Health Affairs, 23(3), 167–176.

    Article  PubMed  Google Scholar 

  21. 21.

    Mamlin, J., Kimaiyo, S., Lewis, S., Tadayo, H., Jerop, F. K., Gichunge, C., et al. (2009). Integrating nutrition support for food-insecure patients and their dependents into an HIV care and treatment program in Western Kenya. American Journal of Public Health, 99(2), 215.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Masanjala, W. (2007). The poverty-HIV/AIDS nexus in Africa: A livelihood approach. Social Science and Medicine, 64(5), 1032–1041.

    Article  PubMed  Google Scholar 

  23. 23.

    McCoy, D., Chopra, M., Loewenson, R., Aitken, J.-M., Ngulube, T., Muula, A., et al. (2005). Expanding access to antiretroviral therapy in sub-saharan Africa: avoiding the pitfalls and dangers, capitalizing on the opportunities. American Journal of Public Health, 95(1), 18–22.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Naidu, V., & Harris, G. (2005). The impact of HIV/AIDS morbidity and mortality on households—a review of household studies. South African Journal of Economics, 73(s1), 533–544.

    Article  Google Scholar 

  25. 25.

    National AIDS Control Council (2014a) Kenya AIDS Response Progress Report: Progress towards Zero. Retrieved from: http://www.unaids.org/sites/default/files/country/documents/KEN_narrative_report_2014.pdf 22 January 2016.

  26. 26.

    National AIDS Control Council. (2014b). Kenya AIDS Strategic Framework 2014/2015 – 2018/2019. Ministry of Health, Kenya. Retrieved from: http://www.nacc.or.ke/images/KASF_F_web.compressed.pdf.

  27. 27.

    Ncama, B. P., McInerney, P. A., Bhengu, B. R., Corless, I. B., Wantland, D. J., Nicholas, P. K., et al. (2008). Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa. International Journal of Nursing Studies, 45(12), 1757–1763.

    Article  PubMed  Google Scholar 

  28. 28.

    Piot, P., Abdool Karim, S. S., Hecht, R., Legido-Quigley, H., Buse, K., Stover, J., et al. (2015). Defeating AIDS—Advancing global health. The Lancet, 386(9989), 171–218.

    Article  Google Scholar 

  29. 29.

    Park, C. L. (2010). Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257.

    Article  PubMed  Google Scholar 

  30. 30.

    Rohde, J., Cousens, S., Chopra, M., Tangcharoensathien, V., Black, R., Bhutta, Z. A., & Lawn, J. E. (2008). 30 years after Alma-Ata: Has primary health care worked in countries? The Lancet, 372(9642), 950–961.

    Article  Google Scholar 

  31. 31.

    Rose, D., & Oliveira, V. (1997). Nutrient intakes of individuals from food-insufficient households in the United States. American Journal of Public Health, 87(12), 1956–1961.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Simbayi, L. C., Kalichman, S., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science and Medicine, 64(9), 1823–1831.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Smith, R., Rossetto, K., & Peterson, B. L. (2008). A meta-analysis of disclosure of one’s HIV-positive status, stigma and social support. AIDS Care, 20(10), 1266–1275.

    Article  PubMed  Google Scholar 

  34. 34.

    Sorsdahl, K., Slopen, N., Siefert, K., Seedat, S., Stein, D. J., & Williams, D. R. (2011). Household food insufficiency and mental health in South Africa. Journal of Epidemiology and Community Health, 65(5), 426–431.

    Article  PubMed  Google Scholar 

  35. 35.

    Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of counseling psychology, 53(1), 80.

    Article  Google Scholar 

  36. 36.

    Thurman, T. R., Kidman, R., Nice, J., & Ikamari, L. (2015). Family functioning and child behavioral problems in households affected by HIV and AIDS in Kenya. AIDS and Behavior, 19(8), 1408–1414.

    Article  PubMed  Google Scholar 

  37. 37.

    Tsai, A. C., Bangsberg, D. R., Frongillo, E. A., Hunt, P. W., Muzoora, C., Martin, J. N., & Weiser, S. D. (2012). Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Social Science & Medicine, 74(12), 2012–2019.

    Article  Google Scholar 

  38. 38.

    Vozoris, N. T., & Tarasuk, V. S. (2003). Household food insufficiency is associated with poorer health. The Journal of Nutrition, 133(1), 120–126.

    CAS  PubMed  Google Scholar 

  39. 39.

    Walsh, J. A., & Warren, K. S. (1979). Selective primary health care: an interim strategy for disease control in developing countries. New England Journal of Medicine, 301(18), 967–974.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., et al. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition, 94(6), 1729S–1739S.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Weiss, H. A., Hankins, C. A., & Dickson, K. (2009). Male circumcision and risk of HIV infection in women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 9(11), 669–677.

    Article  PubMed  Google Scholar 

  42. 42.

    World Health Organization, & World Health Organization. (1978). Alma Ata Declaration. Geneva: World Health Organization.

    Google Scholar 

  43. 43.

    Yu, D., Souteyrand, Y., Banda, M. A., Kaufmann, J., & Perriens, J. H. (2008). Investment in HIV/AIDS Programs: Does it help Strengthen Health Systems in Developing Countries? Globalization and Health, 4, 8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Michael L. Goodman.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to report.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Goodman, M.L., Serag, H., Gitari, S. et al. Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning, Meaningfulness of Life, Seroconcordance, Social Support and Considering the Need for Integrated Care. J Community Health 41, 989–997 (2016). https://doi.org/10.1007/s10900-016-0181-y

Download citation

Keywords

  • Overall wellness
  • HIV
  • Women
  • Kenya
  • Mediation analysis