Spirituality, social capital and service: Factors promoting resilience among Expert Patients living with HIV in Ethiopia

Abstract

People living with HIV (PLHIV) in Ethiopia and other developing nations face numerous challenges to their health and well-being, including poverty, limited healthcare infrastructure, and high levels of societal stigma. Despite these challenges, resilient trajectories have been observed even within such resource-limited settings. In Ethiopia, such resilience is exemplified by the ‘Expert Patients’, HIV-positive lay health workers who function as adherence counsellors, health educators, outreach workers and community advocates. We conducted a multi-method qualitative study with 20 Expert Patients in Addis Ababa, Ethiopia in order to understand pathways to resilience in this select population. Participants described 3 key mechanisms of resilient coping: (1) The use of spirituality and faith-based practices to manage psychological difficulties associated with living with HIV; (2) Utilisation of social capital from family and community networks as a buffer against the psychological and economic consequences of societal stigma; and (3) Serving others as a mechanism for finding optimism and purpose in life. Interventions designed to facilitate and/or augment these social processes in the wider community may be promising strategies for improving health among PLHIV in Ethiopia and other resource-limited settings.

Resilience and HIV: a review of the definition and study of resilience

“…Qualitative studies of resilience among PLWH highlight the limitations of existing quantitative studies and extant measures (Bartone, Ursano, Wright, & Ingraham, 1989;Connor & Davidson, 2003;Wagnild & Young, 1993). Qualitative findings indicate that among PLWH, mastery for management of HIV is important but absent from most resilience measures (Emlet, Tozay, & Raveis, 2011;Hussen et al, 2014;Kaplan et al, 2014;Teti, French, Bonney, & Lightfoot, 2015). Other studies suggest that interpersonal resilience components (e.g., HIV support groups and relationships with healthcare professionals) are important but are excluded from most measures (Emlet et al, 2011;Hussen et al, 2014;Kaplan et al, 2014;Teti et al, 2015), or need further development as evidenced by the limited inclusion of social support specific for PLWH in the reviewed studies (Molassiotis et al, 2002;Sodergard et al, 2006).…”

“…Qualitative findings indicate that among PLWH, mastery for management of HIV is important but absent from most resilience measures (Emlet, Tozay, & Raveis, 2011;Hussen et al, 2014;Kaplan et al, 2014;Teti, French, Bonney, & Lightfoot, 2015). Other studies suggest that interpersonal resilience components (e.g., HIV support groups and relationships with healthcare professionals) are important but are excluded from most measures (Emlet et al, 2011;Hussen et al, 2014;Kaplan et al, 2014;Teti et al, 2015), or need further development as evidenced by the limited inclusion of social support specific for PLWH in the reviewed studies (Molassiotis et al, 2002;Sodergard et al, 2006). Neighborhood social capital (e.g., availability of clinics that distribute equipment and financial vouchers, and availability of supportive organizations for PLWH) may also be critical to fostering positive adaptation to adversities (Emlet et al, 2011;Hussen et al, 2014;Kaplan et al, 2014;Tariq et al, 2016;Teti et al, 2015), yet these components have been excluded from the most used resilience measures.…”

Brothers Building Brothers by Breaking Barriers: development of a resilience-building social capital intervention for young black gay and bisexual men living with HIV

“…Studies based in several sub-Saharan African countries have described how social capital can improve HIV care engagement in very concrete ways. For example, social network contacts can educate one another about HIV, provide transportation assistance to get to appointments, or simply endorse health-promoting norms that make an HIV-positive individual feel better about engaging in care (Hussen et al, 2014;Ware et al, 2009). Second, observational studies in the US are mixed, but largely support the idea of a similarly positive relationship between social capital and HIV-related outcomesincluding HIV symptom management and ART adherence (Phillips et al, 2013;Ransome et al, 2018;Webel et al, 2015).…”

Analysis of resilience and sexual behavior in persons with HIV infection

“…In recent studies, it can be observed that spirituality has helped PLHIV to cope with HIV (Ironson, Kremer, & Lucette, 2016;Pecoraro et al, 2016). Other studies have indeed shown that spirituality is a resource used to overcome the challenges presented by HIV (Hussen et al, 2014;Szaflarski, 2013). Spirituality in overcoming adverse events could therefore play an important role among persons with HIV infection/AIDS, particularly among heterosexuals.…”