Non-clinical outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

The impacts of antiretroviral therapy on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of antiretroviral therapy (ART) on these non-clinical indicators in developing countries and assess the state of research on these topics. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 12 full-length articles, 7 abstracts, and 1 presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reported so far. Studies from developing countries have not yet assessed non-clinical outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, both positive and adverse non-clinical outcomes need to be empirically measured and qualitatively explored in order to support patient adherence and maximize treatment benefits.

A Catechumenate for the Korean Methodist Church: Ressourcement, Formation and a Response to Secularism and Korean Traditional Religions

Research by Korean sociologists of religion indicates that Korean Protestantism has lost much of the spiritual vitality of preceding generations and that it increasingly shows the influences of Korean shamanism, Neo-Confucianism, and Western secularism and consumerism. Suggestions in the areas of homiletics and Christian social ethics have been offered to help steer the Korean Protestant churches away from these worldviews toward a more biblically-based course. Drawing upon and expanding these earlier studies and proposals, the current work recommends another method for developing a biblically-based, spiritually-revitalized, baptismally-shaped and ministry-committed Protestantism in Korea: a pre-baptismal adult catechumenate, in this case one designed for the context of the Korean Methodist Church. In order to produce a renewed catechumenal structure for Korean Methodism, adult catechumenal processes as well as baptismal theologies and rites are examined and analyzed from three principal sources: the first five centuries of the Christian church, and especially the mystagogical literature of the fourth century; the Roman Catholic Rite of Christian Initiation of Adults developed after the Second Vatican Council; and the United Methodist Church in the United States, both texts officially authorized by the denomination's General Conference and unofficial materials, among them resources for an adult catechumenate in the Come to the Waters series. In addition, previous and current practices of preparation for baptism in the Korean Methodist Church are identified and critiqued. From these findings a set of principles is put forward that guide the proposed catechumenal structure.

An Examination of a Church-Based Recovery Program on the Quality of Physical and Spiritual Life of Mentally Ill Persons in Korea

This study explores the effectiveness of a Church-based recovery program for the mentally ill in Korea where many Christian communities view mental illness as evidence of sin. Building on theological and psychological literature, an empirical study was conducted with participants in the alternative program of the Han-ma-um community. Data analysis revealed that this program, which views mental disorders as illness rather than sin, helps participants build self-respect and enables families to provide support as they move toward recovery. Based on this empirical examination, recommendations for refinement and expansion of the program and avenues for future research are proposed.

Rambo's Interdisciplinary Approach to Religious Conversion: The Case of St. Augustine

This dissertation illustrates the merits of an interdisciplinary approach to religious conversion by employing Lewis Rambo’s systemic stage model to illumine the process of St. Augustine’s conversion. Previous studies of Augustine’s conversion have commonly explored his narrative of transformation from the perspective of one specific discipline, such as theology, history, or psychology. In doing so, they have necessarily restricted attention to a limited set of questions and problems. By bringing these disciplines into a structured, critical conversation, this study demonstrates how formulating and responding to the interplay among personal, social, cultural, and religious dimensions of Augustine’s conversion process may eventuate in the consideration of issues previously unarticulated and thus unaddressed. Rambo (1993) formulates a model of religious change that consists of what he calls context, crisis, quest, encounter, interaction, commitment, and consequences. Change is explained by drawing upon the research and scholarship of psychologists, sociologists, anthropologists, and religionists, in conjunction with the contributions of theologians. This study unfolds in the following chapters: I. Introduction; II. Literature review of scholarship about conversion, with emphasis on explication of Rambo’s model; III. A description of the case of Augustine, drawn from a close reading of the Confessions; IV. Literature review of scholarship about Augustine’s conversion; V. Interdisciplinary interpretation of Augustine’s conversion; and VI. Implications for scholars of conversion, and for pastoral caregivers, as well as recommendations for future research. This dissertation demonstrates how Augustine’s conversion experience was deeply influenced by 1) psychological distress and crisis; 2) the quest to know himself and the divine; 3) interactions with significant others; 4) participation in Christian communities; 5) philosophical and cultural changes; and 6) the encounter with the divine. As such, this study reveals the value of interpreting Augustine’s conversion as an evolving process constituted in multiple factors that can be differentiated from one another, yet clearly interact with one another. It examines the implications of constructing an interdisciplinary approach to Augustine’s conversion narrative for both the academy and the Christian community, and recommends the use of Rambo’s model in studies of other cases of religious change.

Christian Witness on the Plateau Vivarais-Lignon: Narrative, Nonviolence, and the Formation of Character

This dissertation analyzes the theological and ethical convictions that led the people of the Plateau Vivarais-Lignon to shelter thousands of refugees between 1939 and 1945. It does so by examining the themes of narrative identity, hospitality, character formation, nonviolence, and the contextual witness of church tradition. Though a number of studies have been published about the rescue activity in this region of France during World War II, none have thoroughly analyzed the theological nature of this activity. Using the Plateau Vivarais-Lignon as a case study in theological ethics, the dissertation draws on historical sources as well as the work of contemporary theologians and ethicists to understand, interpret, and analyze the witness of this community. After situating its rescue and resistance work within the Huguenot narrative of persecution and exile, I examine the theological convictions of the Reformed pastor of Le Chambon-sur-Lignon, André Trocmé, who played a key role in making the Plateau a place of refuge during the Holocaust. The study highlights the importance of narrative in the actions of this community and discusses the relationship between narrative, character, and ethics. It then examines the nonviolent commitments of key leaders of the rescue effort, using this analysis as a springboard to engage in broader theological reflection about the ethics of nonviolence. After examining the radical hospitality practiced on the Plateau in light of biblical narratives and Reformed history, I investigate the counter-cultural nature of Christian hospitality. The study concludes by analyzing the nature and witness of the church in light of the legacy of the Plateau Vivarais-Lignon. The dissertation suggests that increased academic and ecclesial attention be given to the relationship between narrative and character, the counter-cultural shape of Christian hospitality, and the active nature of nonviolence. It presents an in-depth analysis of the theological and ethical convictions of the people of the Plateau Vivarais-Lignon, arguing that their witness has ongoing significance for communities of faith as they grapple with how to form disciples, relate to the wider society, welcome strangers, and communicate God's shalom in a world of violence.

Systematic Review of Supported Housing Literature 1993 – 2008

Supported housing for individuals with severe mental illness strives to provide the services necessary to place and keep individuals in independent housing that is integrated into the community and in which the consumer has choice and control over his or her services and supports. Supported housing can be contrasted to an earlier model called the “linear residential approach” in which individuals are moved from the most restrictive settings (e.g., inpatient settings) through a series of more independent settings (e.g., group homes, supervised apartments) and then finally to independent housing. This approach has been criticized as punishing the client due to frequent moves, and as being less likely to result in independent housing. In the supported housing model (Anthony & Blanch, 1988) consumers have choice and control over their living environment, their treatment, and supports (e.g., case management, mental health and substance abuse services). Supports are flexible and faded in and out depending on needs. Results of this systematic review of supported housing suggest that there are several well-controlled studies of supported housing and several studies conducted with less rigorous designs. Overall, our synthesis suggests that supported housing can improve the living situation of individuals who are psychiatrically disabled, homeless and with substance abuse problems. Results show that supported housing can help people stay in apartments or homes up to about 80% of the time over an extended period. These results are contrary to concerns expressed by proponents of the linear residential model and housing models that espoused more restrictive environments. Results also show that housing subsidies or vouchers are helpful in getting and keeping individuals housed. Housing services appear to be cost effective and to reduce the costs of other social and clinical services. In order to be most effective, intensive case management services (rather than traditional case management) are needed and will generally lead to better housing outcomes. Having access to affordable housing and having a service system that is well-integrated is also important. Providing a person with supported housing reduces the likelihood that they will be re-hospitalized, although supported housing does not always lead to reduced psychiatric symptoms. Supported housing can improve clients’ quality of life and satisfaction with their living situation. Providing supported housing options that are of decent quality is important in order to keep people housed and satisfied with their housing. In addition, rapid entry into housing, with the provision of choices is critical. Program and clinical supports may be able to mitigate the social isolation that has sometimes been associated with supported housing.