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.

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.

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.

The story of the sixties...a pile-up on the freeway of advanced art

When does 1960s art begin and end? Certainly, aside from a few affinities, the decade’s artistic output does not exactly correspond to its popular conception as the ‘Swinging Sixties’. While it was rare that psychedelic art was truly challenging, the decade saw a number of perceptions change regarding the aims, boundaries and possibilities of experiencing art. Thus, this era has come to represent a watershed or crisis in modernist art. While in the Australian context many of these nascent trends were properly realised in the 1970s – with the full force and impact of post-object art – other challenges were first articulated in the 1950s. So, like any other demarcation of a decade, its limits and boundaries are porous.

On secrets, lies, and fiction : girls learning the art of survival

This chapter’s interest in fiction’s relationship to truth, lies, and secrecy is not so much a matter of how closely fiction resembles or mirrors the world (its mimetic quality), or what we can learn from fiction (its epistemological value). Rather, the concern is both literary and philosophical: a literary concern that takes into account how texts that thematise secrecy work to withhold and to disclose their secrets as part of the process of narrating and sequencing; and a philosophical concern that considers how survival is contingent on secrets and other forms of concealment such as lies, deception, and half-truths. The texts selected for examination are: Secrets (2002), Skim (2008), and Persepolis: The Story of a Childhood (2003). These texts draw attention to the ways in which the lies and secrets of the female protagonists are part of the intricate mechanism of survival, and demonstrate the ways in which fiction relies upon concealment and revelation as forms of truth-telling.

Engaging the metaphorical city : Brisbane male fiction 1975-2007

Brisbane writers and writing are increasingly represented as important to the city’s identity as a site of urban cool, at least in marketing and public relations paradigms. It is therefore remarkable that recent Brisbane fiction clings strongly to a particular relationship to the climatic and built environment that is often located in the past and which seemingly turns away, or at least elides, the ‘new’ technologically-driven Brisbane. Literary Brisbane is often depicted in the context of nostalgia for the Brisbane that once was—a tropical, timbered, luxuriant city in which sex is associated with heat, and, in particular, sweat. In this writing sweat can produced by adrenaline or heat, but in particular, in Brisbane novels, it is the sweat of sex that characterises the literary city. Given that Brisbane is in fact a subtropical city, it is interesting that metaphors of a tropical climate and vegetation occur so frequently in Brisbane stories (and narratives set in other parts of the state) that writer Thea Astley was prompted at one point to remark that Queensland writing was in danger of developing into a tropical cliché.

The rest flies down the wind : complexities of late style in the work of Christina Stead

Examining the late style of a writer is like skirting around quicksand. End-of-career reflection can subvert long standing critical accounts; revisionist publishing histories or newly minted archival work can do likewise. And, as Nancy J. Troy suggests, an artist’s last thoughts are rarely planned as such (15). In the case of Christina Stead any consideration of late style is made more difficult because, chronologically speaking, her ‘late’ works were written some 20 years before her death in 1983. Thus chronology can be deceptive, as Nicholas Delbanco points out in Lastingness: The Art of Old Age. Stead’s last novel, I’m Dying Laughing The Humourist, was completed, at least in rough draft form in 1966, when Stead was 64, but friends and readers suggested many changes. The book was published posthumously in 1986. Stead’s work is receiving increasing critical attention so a discussion of her ‘late style’ is important, particularly given that her fiction seems to refuse so many attempts at category-making. This perspective reveals two interesting aspects of her late work: first her consistent engagement with the problems of age for women, and in particular women writers, and second, the consequence of a life-long attention to the representation of dialogic sound in her novels, a preoccupation that results in what can be termed an aural signature. My discussion refers to Edward Said’s and Nicholas Delbanco’s ideas about late style by way of a focus on selective biographical issues and Stead’s engagement with radical politics before moving to an examination of what can be called an aural signature in several novels. Her fiction demonstrates one of the agreed markers of late style: she was constantly looking forward and looking back through innovation in form and content.

Review of "Christoph Schlingensief : art without borders" edited by Tara Forrest and Anna Teresa Scheer

Christoph Schlingensief: Art Without Borders, edited by Tara Forrest and Anna Teresa Scheer, is the first English-language collection of essays about this extraordinary German artist. As Forrest and Scheer suggest in their introduction, ‘access to Schlingensief’s highly challenging productions has been hampered by the fact that very little has been published on his oeuvre in the English-speaking world’. This collection aims to introduce English-speaking artists, scholars and academics to Schlingensief’s extensive, experimental, and at times highly controversial body of work across film, theatre, television, live art and activism...

New maps of learning for quality art education : what pre-service teachers should learn and be able to do

It would be a rare thing to visit an early years setting or classroom in Australia that does not display examples of young children’s artworks. This practice serves to give schools a particular ‘look’, but is no guarantee of quality art education. The Australian National Review of Visual Arts Education (NRVE) (2009) has called for changes to visual art education in schools. The planned new National Curriculum includes the arts (music, dance, drama, media and visual arts) as one of the five learning areas. Research shows that it is the classroom teacher that makes the difference, and teacher education has a large part to play in reforms to art education. This paper provides an account of one foundation unit of study (Unit 1) for first year university students enrolled in a 4-year Bachelor degree program who are preparing to teach in the early years (0–8 years). To prepare pre-service teachers to meet the needs of children in the 21st century, Unit 1 blends old and new ways of seeing art, child and pedagogy. Claims for the effectiveness of this model are supported with evidence-based research, conducted over the six years of iterations and ongoing development of Unit 1.