American researchers have found that training rural women in India as social health activists to assist women infected with HIV/AIDS significantly improved their lives.
The program improved patients' adherence to antiretroviral therapy and boosted their immune-cell counts and nutrition levels.
The lay women were trained by the research team to serve as accredited social health activists, or ASHA, and their work was overseen by rural nurses and physicians.
These ASHA then provided counseling and support to the women with HIV/AIDS, as well as assistance aimed at removing the barriers they face in accessing health care and treatment.
Lead researcher Adey Nyamathi, distinguished professor and associate dean of international research and scholarly activities at the UCLA School of Nursing, said that for rural women living with AIDS in India, stigma, financial constraints and transportation challenges continue to exist, making lifesaving antiretroviral therapy difficult to obtain.
For the intervention study, women with HIV/AIDS in Andra Pradesh were randomly selected to participate either in the intervention, called AHSA-LIFE (AL), or in a control group.
Over a six-month period, the ASHA visited the women in the AL group to monitor the barriers they faced in accessing health care and adhering to their antiretroviral therapy and provided assistance to help mitigate these barriers.
The ASHA also provided counselling to help women develop coping strategies to deal with discrimination. The intervention group also received monthly supplies of high-protein foods, such as black gram and pigeon pea.
In addition, the women in the AL group participated in six education sessions covering a variety of topics, including learning about HIV and AIDS, adhering to antiretroviral therapy, overcoming barriers and dealing with the illness.
The courses also focused on improving coping, reducing the stigma of the disease, caring for family members and children, the basics of good nutrition and benefits of participating in a life-skills class.
Women in the control group also attended the education sessions, but they did not receive visits and supportive services from the ASHA. They received only standard protein supplementation, not the high-protein supplements of the intervention group.
Among the women in the AL group, the researchers found significant increases in therapy adherence and CD4+ T-cell levels, as well as significant reductions in internalized stigma, avoidance coping and depressive symptoms, compared with the control group.
The women in the AL group also showed significant increases in body mass index, muscle mass and fat mass, compared with the other women.
The pilot study holds promise for rural women and other populations afflicted by HIV/AIDS, Nyamathi said.
The study has been published in two journals: the Western Journal of Nursing Research, and AIDS Education and Prevention.