Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam : a multi-method approach

The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009). ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen. Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence. Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect. Further, no study has quantitatively assessed the factors influencing ART adherence. In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors. The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs). Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction. The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity. Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey. The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence. Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to do so. The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample. Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29%. Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p<0.0001). The good agreement between the two measures in the current study is consistent with those found in previous research and provides evidence of cross-validation of the estimated adherence levels. The qualitative study was also valuable in suggesting important variables for the survey conceptual framework and instrument development. The survey confirmed significant correlations between two measures of ART adherence (i.e. dose adherence and time adherence) and many factors identified in the qualitative study, but failed to find evidence of significant correlations of some other factors and ART adherence. Non-adherence to ART was significantly associated with untreated depression, heavy alcohol use, illicit drug use, experiences with medication side-effects, chance health locus of control, low quality of information from HCPs, low satisfaction with received support and poor social connectedness. No multivariate association was observed between ART adherence and age, gender, education, duration of ART, the use of adherence aids, disclosure of ART, patients’ ability to initiate communication with HCPs or distance between clinic and patients’ residence. This is the largest study yet reported in Asia to examine non-adherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling and treatment for patients with depressive symptoms, heavy use of alcohol and substance use. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by regularly providing information on ART and assisting patients to maintain social connectedness with their family and the community. This study highlights the benefits of using a multi-method approach in examining complex barriers and facilitators of medication adherence. It also demonstrated the utility of the ACASI interview method to enhance open disclosure by people living with HIV/AIDS and thus, increase the veracity of self-reported data.

Social outcomes in the construction industry : the case of the Western Australia ‘Percent for Art’ policy

Social outcomes, in particular intangible social outcomes, are generally difficult to achieve in the construction industry due to the predominantly episodic, fragmented and heavily regulated nature of construction that presupposes a tendency towards mainstream construction processes and design. The Western Australian ‘Percent for Art’ policy is recognized for stimulating social outcomes, by creating richer and more aesthetically pleasing social environments through the incorporation of artwork into public buildings. A case study of four Percent for Art projects highlights the role of the Artwork Selection Committee in incorporating artwork into construction. A total of 20 semi-structured interviews were conducted with committee members and policy officers. Data analysis involved a combination of pattern coding and matrix categorization, and resulted in the identification of the committee’s three key elements of collaborative communication, democratic decision-making and project champions. The findings suggest these key elements foster the interaction, communication and relationships needed to facilitate feedback, enhance relationships, create cross-functional teams and lower project resistance, which are all necessary to overcome constraints to social outcomes in construction. The findings provide greater insight into the mechanisms for achieving social outcomes and a basis for future discussion about the processes for achieving social outcomes in the construction industry.

Putting on a show : the theatricality of sport

This exhibition catalogue essay discusses the work of artists in the Basil Sellars Art prize at the Ian Potter Gallery in Melbourne. It considers sport's theatre within parameters such as theatre itself; rules and recursive elements; creases in the cultural fold; transformances; and the performers themselves. The artists' articulation of these themes is discussed in detail.

Andrzej Zielinski : pulp digital fictions

This is a review of painter Andrzej Zielinski's exhibition at gallery 9 in Sydney. It highlights the artist's expressionistic style and strong colour sense as well as his association with American painterly traditions. The artist application of acrylic modelling paste and his paintings also gives them a sculptural and architectural dimension, and on a conceptual level play with notions of mimesis and material form.

Psychedelic Culture

This exhibition catalogue essay provides an introduction to psychedelic culture during the postwar period. It describes the early use of LSD in psychiatric circles and its conception as a psychotomimetic substance. It then considers its use by literary figures such as Aldous Huxley and followers of the Beat Generation. Timothy Leary's role as an LSD philosopher is also explained as is the rise of the Hippies and the ensuing counterculture. This culture produced a range of cultural forms such as music, fashion, graphic design and other visual arts that were informed by hallucinations experienced under the influence of LSD. It concludes with a description of the end of the Hippie movement in the 1970s.

State of the art and future challenges for information literacy research

This short paper focuses on strategic issues and important research questions.

Jams, jelly beans and the fruits of passion - art book (26 Pages)

Statement: Jams, Jelly Beans and the Fruits of Passion Let us search, instead, for an epistemology of practice implicit in the artistic, intuitive processes which some practitioners do bring to situations of uncertainty, instability, uniqueness, and value conflict. (Schön 1983, p40) Game On was born out of the idea of creative community; finding, networking, supporting and inspiring the people behind the face of an industry, those in the mist of the machine and those intending to join. We understood this moment to be a pivotal opportunity to nurture a new emerging form of game making, in an era of change, where the old industry models were proving to be unsustainable. As soon as we started putting people into a room under pressure, to make something in 48hrs, a whole pile of evolutionary creative responses emerged. People refashioned their craft in a moment of intense creativity that demanded different ways of working, an adaptive approach to the craft of making games – small – fast – indie. An event like the 48hrs forces participants’ attention onto the process as much as the outcome. As one game industry professional taking part in a challenge for the first time observed: there are three paths in the genesis from idea to finished work: the path that focuses on mechanics; the path that focuses on team structure and roles, and the path that focuses on the idea, the spirit – and the more successful teams put the spirit of the work first and foremost. The spirit drives the adaptation, it becomes improvisation. As Schön says: “Improvisation consists on varying, combining and recombining a set of figures within the schema which bounds and gives coherence to the performance.” (1983, p55). This improvisational approach is all about those making the games: the people and the principles of their creative process. This documentation evidences the intensity of their passion, determination and the shit that they are prepared to put themselves through to achieve their goal – to win a cup full of jellybeans and make a working game in 48hrs. 48hr is a project where, on all levels, analogue meets digital. This concept was further explored through the documentation process. All of these pictures were taken with a 1945 Leica III camera. The use of this classic, film-based camera, gives the images a granularity and depth, this older slower technology exposes the very human moments of digital creativity. ____________________________ Schön, D. A. 1983, The Reflective Practitioner: How Professionals Think in Action, Basic Books, New York

From the margin to the centre : towards an art strategy for the ethnic enclaves in the city

Sunnybank represents a distinctly Australian take on the classic ‘Chinatown’ – or indeed other ethic community enclaves such as ‘little Italy’, ‘little Bombay’, ‘little Athens’ and so on. In the Northern Hemisphere these tended to grow up in the dense working class neighbourhoods of industrial cities, especially in port cities like Liverpool, London, New York and San Francisco. The existing Chinatowns of Sydney and Melbourne, and to some extent Brisbane’s Fortitude Valley, are of this variety. In the late 1970s, with the growth of suburbanisation and the de-industrialisation and consequent dereliction of the ‘inner city’, these ethnic communities were one of the few signs of life in the city. Apart from the daily commute into the CBD, business with the city council or a trip to the big shopping streets these areas were one of the few reasons for visiting city centres stigmatised by urban decay and petty crime.

The art of re-industrialisation in Shanghai

This paper deals with the development of ‘art clusters’ and their relocation in the city of Shanghai. It first looks at the revival of the city’s old inner city industrial area (along banks of Suzhou River) through ‘organic’ or ‘alternative’ artist-led cultural production; second, it describes the impact on these activities of the industrial restructuring of the wider city, reliant on large-scale real estate development, business services and global finance; and finally, outlines the relocation of these arts (and related) cultural industries to dispersed CBD locations as a result of those spatial, industrial and policy changes.

Clichés, communication and the meaning of existence

This catalogue essay discusses the work of contemporary Brisbane artist Grant Stevens. It provides a survey of his video work and discusses the artist's use of cliche and other mediated formulas to explore the nature of media and its impact on consciousness in the early 21st century.

Grounded Media: Expanding the Scope of Ecological Art Practices Within New Media Arts Culture

‘Grounded Media’ is a form of art practice focused around the understanding that our ecological crisis is also a cultural crisis, perpetuated by our sense of separation from the material and immaterial ecologies upon which we depend. This misunderstanding of relationships manifests not only as environmental breakdown, but also in the hemorrhaging of our social fabric. ‘Grounded Media’ is consistent with an approach to media art making that I name ‘ecosophical’ and ‘praxis-led’ – which seeks through a range of strategies, to draw attention to the integrity, diversity and efficacy of the biophysical, social and electronic environments of which we are an integral part. It undertakes this through particular choices of location, interaction design,participative strategies and performative direction. This form of working emerged out of the production of two major projects, Grounded Light [8] and Shifting Intimacies [9] and is evident in a recent prototypical wearable art project called In_Step [6]. The following analysis and reflections will assist in promoting new, sustainable roles for media artists who are similarly interested in attuning their practices.

Wilkins Hill : on the cusp of meaning

If contemporary artworks are often considered to be puzzles or riddles, then Wilkins Hill take this to a new level. Their recent exhibition Windows impersonating other windows, confronts viewers with an extremely ludic configuration: a spa bath full of almonds, towel racks placed before photos of Martin Heidegger distorted in neat grids, a video of a water tower in a Hamburg park, wooden cut-out speech bubbles and monitors that continuously play interviews with the artists themselves. What does it all mean?

Two ways : between tradition and innovation

Can art be simultaneously modern and traditional? This short piece examines the perplexities involved in seeking to address both cultural parameters at once in indigenous art of Australia.

"Introduction"

Does heat have a cooling effect on culture? Sweat argues the reverse: culture thrives in the subtropical zones. While acknowledging that the subtropical generates ambivalence—being cast as alternately idyllic or hellish—Sweat nonetheless seeks to develop the specific voices of subtropical cultures. The uneasy place of this sweaty discourse is explored across art, literature, architecture, and the built environment. In particular, Sweat focuses on the most commonly experienced situation, the everyday house. While it addresses subjects from Japan, Brazil, and France, Sweat centres on Brisbane, Queensland—long in the shadow of Sydney and Melbourne in the Australian cultural psyche—due to its enduring and self-conscious attention to subtropical living.