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.

Solo Show

Solo Show is a to-scale model Metro Arts’ gallery, in which it was exhibited. Set upon a timber frame, the model depicts a miniature ‘installation’ within the ‘space’: a foam block that obstructs one of the gallery’s walkways. Developed and produced for a group exhibition that explored the relationship between humour and art, this work explores and pokes fun at ideas of the institution, scale and the artist ego as well as communicating feelings of emergence, insecurity and hesitancy. The work was included in the group show 'Lean Towards Indifference!' at MetroArts, Brisbane, curated by art collective No Frills.

me as al, you as bobby, me as bobby, you as al

In ‘me as al, you as bobby, me as bobby, you as al’, appropriated footage is looped and supplemented with superimposed text, creating a scenario where Robert De Niro and Al Pacino endlessly stalk each other, with their readied-guns chased by hovering words. These titans of Hollywood screen acting represent opposing approaches to the construction of filmic identity, and as the text labels loosely adhere to one weapon and the next, the action on screen becomes an investigation of the subjective and objective potential within screen surrogate constructions of personalized identity. The work was included in the group show 'Vernacular Terrain' (curated by Lubi Thomas and Steven Danzig) for the Songzhuang Art Museum, Beijing.

Explosive Revelations

‘Explosive Revelations’ employs the device of the Hollywood-style explosion to expose the constructed and futile nature of the moving image. Pointless, impotent explosions bloom and fade, punctuating a non-existent narrative – they promise the spectacle of violence but destroy nothing and disappear without a trace. The video itself is sourced from a stock footage supplier that provides users with a selection of explosions that can be inserted into movies by masking out the background. However, the footage is not used as intended, leaving them instead as merely explosions erupting on top of a black background, fizzling out into non-existence. The work was included in the 2008 'Light in Winter' program at Federation Square, Melbourne, directed by Robyn Archer.

ArtConnexions series

The exhibition consists of a series of 9 large-scale cotton rag prints, printed from digital files, and a sound and picture animation on DVD composed of drawings, sound, analogue and digital photographs, and Super 8 footage. The exhibition represents the artist’s experience of Singapore during her residency. Source imagery was gathered from photographs taken at the Bukit Brown abandoned Chinese Cemetery in Singapore, and Australian native gardens in Parkville Melbourne. Historical sources include re-photographed Singapore 19th and early 20th century postcard images. The works use analogue, hand-drawn and digital imaging, still and animated, to explore the digital interface’s ability to combine mixed media. This practice stems from the digital imaging practice of layering, using various media editing software. The work is innovative in that it stretches the idea of the layer composition in a single image by setting each layer into motion using animation techniques. This creates a multitude of permutations and combinations as the two layers move in different rhythmic patterns. The work also represents an innovative collaboration between the photographic practitioner and a sound composer, Duncan King-Smith, who designed sound for the animation based on concepts of trance, repetition and abstraction. As part of the Art ConneXions program, the work travelled to numerous international venues including: Space 217 Singapore, RMIT Gallery Melbourne, National Museum Jakarta, Vietnam Fine Arts Museum Hanoi, and ifa (Institut fur Auslandsbeziehungen) Gallery in both Stuttgart and Berlin.

Citizen Coombs Wins!

Citizen Coombs Wins! appears to be a standard arcade game placed within the gallery. Mortal Kombat is displayed on the screen inviting the viewer to press play. The ‘player’ selects their character and awaits the commencement of the game; at first move however, the player dies – sound and text informs them that ‘Citizen Coombs Wins!’. By altering the expected play of the game, this work exploring notions of play, control, the institution and expectation. This work seeks to invite, engage and repel the viewer in order to question, critique and play with the role of the artist and the viewer within the context of the institution. The work was included in the international group show 'Ceci n'est pas une Casino!', curated by Kevin Muhlen and Jo Kox for the Casino Luxembourg and later toured to Villa Merkel, Esslingen, Germany.

Dancelines series

Dancelines was a body of work commissioned by Bangarra Dance Company and The Arts Centre, Melbourne. The artist was invited to produce a body of work that responded to the dance company's production of 'Boomerang'. The result was a body of photographs that applied the artist's interest in layering as a photographic technique and her interest in indigenous subjectivity and sprituality. The works drew correspondences between Rheannan Port, the subject's, own biography and character and the artist's voluminous archive of iamges of the natural world. The result complemented and formalised the collaborative processes that the artist had previously only explored in the video medium. The work was shown at the George Adams Gallery of the Arts Centre as part of Melbourne 2006 Commonwealth Games Arts Festival. 'Rheannan Port, #1' was selected for the 2006 Archibald Photographic Portrait Prize, at the Art Gallery of New South Wales. The work was reviewed in The Age newspaper.

Infrared and Raman spectroscopic studies of archaeological materials

The use of vibrational spectroscopic techniques to characterise historical artefacts and art works continues to grow and to provide the archaeologist and art historian with significant information with which to understand the nature and activities of previous peoples and civilizations. In addition, conservators can gain knowledge of the composition of artworks or historical objects and so are better equipped to ensure their preservation. Both infrared and Raman have been widely used. Microspectroscopy is the preferred sampling technique as it requires only a very small sample, which often can be recovered. The use of synchrotron radiation in conjunction with IR microspectroscopy is increasing because of the substantial benefits in terms of improved spatial resolution and signal-to-noise ratio. The key trend for the future is the growth in the use of portable instruments, both IR and Raman, which are becoming important because they allow non-destructive measurements to be made in situ, for example at an archaeological site or at a museum.

Waterfall : Nature and Culture

Many people take pleasure in visiting waterfalls and much has been written on the subject. Numerous accounts of Niagara Falls were published after Hennepin's late seventeenth-centure descriptions, particularly from the early nineteenth century, but is was only later that other waterfalls became the subject of books. George Holley's Niagara and Other Famous Cataracts of the World, published in 1883, and John Gibson's Great Waterfalls, Cataracts and Geysers, published in 1887, are early examples of global accounts of major falls. Most books about waterfalls are guides to the falls of a particular country, state or region. Apart from a few slim illustrated volumes, few books have been puslished on the world's waterfalls since Edward Rashleigh's Among the Waterfalls (1935). Most of these are slim pictorial volumes, some aimed at the children's market. Geologist Richard Maxwell Pearl published a series of waterfall articles in his journal Earth Science between 1973 and 1975, apparently with the intention of turning them into a book, but this never materialized. My book, the culmination of more than a decade of waterfalls research, is comprehensive in its approach, but is not intended to describe as many of the world's waterfalls as possible. This is far from my aim, and readers may be disappointed at my omission of falls they feel deserved mention. What I have attempted to do is celebrate the delights of these beautiful wonders of nature by considering them from many points of view, emphasizing the roles that they play in the human experience. To be as representative as possible, I draw on examples of waterfalls from all over the world, some famous, many not. North and South America, Europe, Africa, Asia and Oceania and, with recent global warming, the Earth's polar regions, all feature in the discussion. Even though there are already enough books and articles about Niagara Falls to fill a large library, it has been impossible to avoid making frequent reference to this great cataract, which has been so important in the history of travel and tourism, power generation, urban development and art. Amoung the issues that I consider is the human impact on waterfalls, particularly the effects of hydropower schemes and tourism development. Also considered are artificial waterfalls, which have long been features of the designed landscape. Their contemporay role is poignantly exemplified in the design of the National September 11 Memorial, in which the footprints of the Twin Towers are traced by walls of waterfalls. A geographer and urban and regional planner by training, I have ventured into many other fields of knowledge that are outside my areas of expertise. I apologize for any errors that I may have made in my book and invite correction.

Jogging alongside or bumping off? oral history and fiction in dialogue

This paper emerges from my practice-led PhD thesis investigating the ways fiction writers can enter a dialogue with the project of oral history in Australia. In this paper, I survey the current literature in order to identify the status of fiction within the practice of oral history in Australia. I argue that oral historians and fiction writers are, among other things, both concerned with understanding subjectivity. I consider how one of the specific qualities of fiction, that of character, can provide a space to explore subjectivity, and rely on my own writing practice in order to demonstrate how oral history theory can enrich fictive writings. This paper, while positioned in the field of oral history, exists within a wider debate around how the past can legitimately be represented; I argue oral historians and fiction writers can enter a dialogue around shared concerns.

Ruptures in the production of girlhood : teenage flows and multiplicities [Abstract]

This paper examines the paradoxical and ubiquitous nature of Butler’s heterosexual matrix, and opens it up to an alternative Deleuzian analysis. Drawing on stories and art works produced in a collective biography workshop on girls and sexuality this paper extends previous work on the subversion of the heterosexual matrix undertaken by Renold and Ringrose (2008). The paper moves, as they do, from a molar to a molecular analysis, but extends that work by re-thinking the girl/subject in terms of Deleuze and Guattari’s endlessly transforming multiplicities where “the self is only a threshold, a door, a becoming between two multiplicities” (Deleuze and Guattari, 1987: 249)

The Cyndi Lauper affect : bodies, girlhood and popular culture [Abstract]

Using a collective biography method informed by a Deleuzian theoretical approach (Davies & Gannon, 2009), this paper analyses embodied memories of girlhood becomings through affective engagements with resonating images in media and popular culture. In this approach to analysis we move beyond an impasse in some feminist cultural studies where studies of popular culture have been understood through theories of representation and reception that retain a sense of discrete subjectivity and linear effects. In these approaches, analysis focuses respectively on decoding and deciphering images in terms of their normative and ideological baggage, and, particularly with moving images, on psychological readings (Coleman, 2011; Driscoll, 2002). Understanding bodies and popular culture through Deleuzian notions of ‘becoming’ and ‘assemblage’ opens possibilities for feminist researchers to consider the ways in which bodies are not separate to images but rather, are known, felt, materialised and mobilised with/through images (Coleman, 2008, 2009, 2011). We tease out the implications of this new approach to media affects through two memories of girls’ engagements with media images, reconceived as moments of embodied being within affective flows of popular culture that might momentarily extend upon the ways of being and doing girlhood.

Cutting on action : interference strategies in contemporary art practice

The domestication of creative software and hardware has been a significant factor in the recent proliferation of still and moving image creation. Booming numbers of amateur image-makers have the resources, skills and ambitions to create and distribute their work on a mass scale. At the same time, contemporary art seems increasingly dominated by ‘post-medium’ practices that adopt and adapt the representational techniques of mass culture, rather than overtly reject or oppose them. As a consequence of this network of forces, the field of image and video production is no longer the exclusive specialty of art and the mass media, and art may no longer be the most prominent watchdog of mass image culture. Intuitively and intentionally, contemporary artists are responding to these shifting conditions. From the position of a creative practitioner and researcher, this paper examines the strategies that contemporary artists use to engage with the changing relationships between image culture, lived experience and artistic practice. By examining the intersections between W.J.T. Mitchell’s detailed understanding of visual literacy and Jacques Derrida’s philosophical models of reading and writing, I identify ‘editing’ as a broad methodology that describes how practitioners creatively and critically engage with the field of still and moving images. My contention is that by emphasising the intersections of looking and making, ‘reading’ and ‘writing’, artists provide crucial jump cuts, pauses and distortions in the medley of our mediated experiences.

Contemporary Australia : women, Queensland Art Gallery/Gallery of Modern Art, Brisbane 21 April–22 July 2012

'Contemporary Australia: Women' is the second in a series of triennial exhibitions at the Gallery of Modern Art in Queensland, providing a survey of contemporary art practices across the country. This exhibition's focus on women artists comes in the wake of a number of high profile international exhibitions looking at women artists in both contemporary and historical contexts. This review situates the exhibition within this field and considers its significance.

David M. Thomas : a party disguised as work or work disguised as a party

This article discusses David M. Thomas' 2012 exhibition at Boxcopy. Thomas' exhibition conflates the space of the studio with that of the gallery. In doing so, he draws out complex relationships between production and presentation, subjectivity and sociality. This article focuses on these aspects of Thomas' creative exploration of identity and its mutability through art making.