Browsing by Author "Gramelspacher, Anna Maria"

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    Disclosure of HIV status to children in resource-limited settings: a systematic review
    (2013-05) Vreeman, Rachel C; Gramelspacher, Anna Maria; Gisore, Peter O; Scanlon, Michael L; Nyandiko, Winstone M
    Introduction Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact. Methods MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. Results Thirty-two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one-time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART) improved post-disclosure but the emotional and psychological effects of disclosure were variable. Conclusions Most studies show that a minority of HIV-infected children in resource-limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age- and culture-appropriate disclosure in resource-limited settings.
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    “You will have changed profoundly”: A letter writing exercise for 4th Year medical students
    (Medical Humanities Group at UCMS and GTBH, 2022-08-04) Beckman, Emily; Head, Katharine J.; Gramelspacher, Anna Maria; Medical Humanities, Liberal Arts
    Introduction: Reflective writing, an exercise where students respond to a prompt in writing and then read their writing aloud in class, is a core component of Narrative Medicine. Student writings often reveal truths about their own experiences moving through medical education, including the identity transformation they experience. Method: The purpose of this study was to ask fourth year medical students (N=15) enrolled in Narrative Medicine elective courses at two large U.S. Midwestern medical schools to reflect on their medical school experience. The students were asked to write a letter in response to the following prompt: “if you could tell your 1st day of medical school self anything, what would it be?” Results: Through thematic analysis, the authors identified three major themes in these letters, including student reflections of medical school as a journey, identity transformation and identity management within medical school, and the value of important relationships and the role they play in the medical student experience. Discussion: We conclude the paper with a discussion on what we can learn from these student letters, calling for more attention to the vulnerability of students as they progress through medical school and more research on the kinds of transformation students experience. Medical students can be vulnerable, and the system that has been created for them to develop into empathetic, skilled physicians often contributes to that vulnerability. Therefore, institutions should not only allow students to reflect and give voice to their experience, but also encourage a reimagining of certain aspects of medical education.