Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Migration,Poverty, and Risk of HIV Infection: An Application of Social Capital Theory

A majority of current HIV/AIDS interventions are designed primarily after individual-based public health models and pay little attention to the socioeconomic environment in which HIV transmission occurs. This article focuses on outlining how migration acts as a conduit for disease transmission in South Africa and then proposes a macro-level prevention model based on social capital theory, thus then supplementing current prevention literature. It is based on the argument that social disruption and stresses from migration lead to sexual interactions during the migration periods that amplify the risk of HIV transmission among migrants.     

A Survey of AIDS Knowledge and Attitudes Among Prostitutes in an International Border Community

Prostitutes are a high risk population engaged in high risk behavior for the transmission of HIV Disease (AIDS). This paper presents the results of a survey to evaluate the knowledge, attitudes and behaviors of prostitutes about HIV Disease (AIDS). This survey was conducted in an International Border Community. A total of sixty women participated in this survey. The sources of information on AIDS and its accuracy were explored. The impact of this knowledge on behavior was identified. The most important finding is that the prostitutes are not utilizing risk reduction behaviors while having sexual relationships with their clients. The survey found that fifty-four percent of the participants did not use condoms on a regular basis. And an alarming ten percent did not use condoms at all. The results of this survey have implications for social workers and public health workers who must develop strategies to work effectively with this high risk population.     

An Approach to Community Outreach Practice in the 21st Century

ABSTRACT

This article presents the findings of a study about knowledge, attitudes and beliefs about AIDS held by older Hispanic adults. Members of the convenience sample provided responses that identify concerns about effective practice in outeach and information provision to older adults with regard to risky sexual practices. Intervention to prevent the spread of HIV/AIDS among older adults needs to be culturally competent and to be attuned to social practices, traditions, community concerns, and generational perspectives with regard to serious health problems related to sexual behavior. The sample composition was primarily Hispanic (97.4%); Catholic, (92.1%) and female (84.2%) with a mean age of 73.7 years. Approximately 28.2% of those surveyed stated that they felt that AIDS was an important problem for older adults. The majority, (76.3%) were aware of locations where health information and services were available if AIDS were a problem. Even though the majority indicated knowledge that AIDS is spread through sexual intercourse, more than one third, (36.8%) thought that sexually active adults 55 and over never use condoms. A discussion of the implications for disease prevention programs and community practice is presented emphasizing the importance of empowerment strategies in health promotion programs and the strengthening of multidisciplinary collaborative efforts to effect positive community health changes.     

When Injustice Gets Old: A Systematic Review of Trans Aging

A lack of knowledge regarding the needs and experiences of trans and gender-nonconforming older adults contributes to and perpetuates the experiences of marginalization associated with being trans. Mitigating the conditions of marginalization—including those that are compounded by age—requires the production of trans aging knowledge. It was with the intent to produce such knowledge that this systematic review was undertaken. In so doing, five medical databases, eight social science databases, and two gray literature databases were searched. These included the following: CINAHL (1942–), Medline (1942–), Health Services/Technology Assessment Texts, Web of Science, EMBASE (1947–), Sociological Abstracts (1952), Social Services Abstracts (1806–), Gender Studies Database (1972–), LGBT Life with Full Text, Ageline (1978–), PsycINFO (1806–), Scopus, ERIC, The New York Academy of Medicine Grey Literature Report, and Dissertations & Theses: Full Text. A total of 436 titles and abstracts were independently reviewed. Of these, 106 full-text articles were retrieved; 34 met the inclusion criteria and were reviewed. The following themes were identified: 1. the methodological challenges associated with conducting research with trans and gender nonconforming older adults;

2. violence and abuse among trans and gender nonconforming older adults;

3. discriminatory policies and practices in health and mental health care;

4. the lack of appropriate HIV/AIDS education, prevention, and treatment strategies for trans and gender nonconforming older adults;

5. obstacles in education, employment, government systems, and housing; and

6. the lack of adequate social support networks.

Gaps in the literature, recommendations for future research, and implications for policy and practice were also identified.     

Girl-trafficking,HIV / AIDS,and the position of women in Nepal

This article focuses on trafficking of young Nepalese girls and women. Trafficking is an integral part of the social and economic fabric of Nepal, as in other parts of the world. The practice causes intolerable degradation and suffering for the girls and young women involved, who are treated as a commodity. It presents a risk to their physical and mental health, and in particular to their sexual health. The article examines the connections between coercive sex work and HIV infection, and community and government responses to HIV infection among trafficked sex workers. In particular, it considers the current AIDS prevention and control program in Nepal, and criticizes it from the feminist perspective of the authors, who are a Nepalese nurse who has undertaken academic work in New Zealand related to women's health, and a New Zealand feminist academic, who is also a nurse.     

Eastern and Southern Africa

This article reviews the literature on migration and the spread of HIV/AIDS in Eastern and Southern Africa. It includes Angola, Botswana, Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The literature focuses separately on AIDS or migration. HIV/AIDS is widespread and prevalent in these regions. The major concern is that migrants are at risk due to their migration and HIV infection is spread after a return to their home countries. Populations at risk include rural-to-urban migrants, displaced persons in the Sudan and in the Horn of Africa, refugees crossing borders, and pastoralists moving within rural areas. In 1997, there were an estimated 1.3 million refugees in east African countries and 5 million internally displaced due to conflicts in Angola, Mozambique, and South Africa. Risk factors among migrant groups include high rates of partner change, unprotected sexual intercourse, nonuse of condoms, prior sexually transmitted diseases, IV drug use, and residence in a high HIV-prevalence community. Confounding factors may be age, gender, occupation, and mobility. Health services for migrants vary between countries. There are successful models for prevention of HIV. 13 targeted interventions are identified.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

Reducing HIV risk among people with serious mental illness

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.     

How Does a “Risk Group” Perceive Risk?

Abstract

Throughout the HIV/AIDS epidemic, female sex workers have been identified as a “risk group” and interventions developed to reduce their behavioral risk-taking. Both individual and structural level programs continue to target “risks” such as multiple partners and lack of condom use. Sex workers themselves, however, are likely to view their experiences more holistically, perceiving a range of risks within their work. This paper presents qualitative data from a participatory study conducted with brothel-based migrant Vietnamese sex workers in Cambodia, illuminating one community's perceptions of the sex industry. It argues that design and implementation of effective HIV prevention activities must be based on sex workers' own interpretations and responses to risk, using them as a realistic entry point for effecting change. Actively engaging with sex workers through participatory research and projects offers the first step in shifting the current epidemiological focus toward identifying feasible, context-specific risk-reduction strategies.     

Evaluation of HIV/AIDS prevention through peer education, counselling, health care, training and urban refuges in Ghana

Since 1996, Ireland Aid has supported UNICEF Ghana in the implementation of five activities that promote behaviour change to limit the spread of HIV/AIDS and STIs. The interventions are run by different local organisations, and have provided over 75,000 in and out-of-school youth and commercial sex workers with preventive education. People retained the information given, are knowledgeable about how HIV is transmitted, and can name key preventive methods. They pass on the information to their friends. Commercial sex workers were empowered to support one another in negotiating for safer sex. The programme was supported by community members, leading to demand for condoms and for education on HIV/AIDS/STIs. One project gave support to pregnant girls, including health care and vocational training. A drawback in the programme has been the occasional delays in the supply of the educational materials to the peer educators.     

'All red in the face': students' views on school-based HIV/AIDS and sexuality education

School-based HIV/AIDS and sexuality education is a fraught area, the site of struggles around moral values, knowledge, the nature of childhood and adolescence and pedagogy. The dominant discourses on HIV/AIDS and sexuality education in Australian secondary schools, as evident in policy documents, are currently predominantly libertarian and therapeutic, championing the need for 'openness' in the interests of the students' emotional maturity and social responsibility and their good health. However, Policy does not always translate readily into practice. This article draws upon a study involving focus group discussions with Australian senior high school students concerning their responses to the school-based HIV/AIDS and sexuality education programmes in which they have taken part and other sources of knowledge about HIV/AIDS. The article focuses in detail upon the students' valorizing of openness, trust and expertise in the face of the embarrassment, their perception of surveillance and their fears of lack of confidentiality that characterize their experience of HIV/AIDS and sexuality education. It is concluded that the nature of the teacher-adolescent relationship tends to work against the achievement of the objectives of such education.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

An impact evaluation of student teacher training in HIV/AIDS education in Zimbabwe

Zimbabwe introduced a nation-wide program to teach AIDS education in 1994. This paper evaluates changes in student teachers' level of knowledge about transmission, symptoms and prevention of STDs and HIV/AIDS; their attitude towards persons living with AIDS; and their sensitivity to the impact of the epidemic and to discussing and teaching about these issues. There was an increase in knowledge of HIV prevention and in teachers' ability to discuss reproductive health and sexual issues. However, as students were exposed to other HIV material outside the programme, not all of this change is due to the programme. Course attendance needed to be enforced and the curriculum needed to be updated with student participation. Peer educators and participatory techniques are needed to get students to internalise positive attitudes and behaviour. The education materials need to address the lack of female empowerment in making decisions and negotiating for safer sex.     

Peer-led interventions to reduce HIV risk of youth: A review

One approach in HIV prevention programming targeting youth is to use peer leaders in what is referred to as peer education programming. This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and are delivered in low- and middle-income countries. Interventions were identified through a comprehensive search of the peer reviewed AIDS-related literature as well as publication lists of major organizations in the UN family that address HIV and AIDS. Our synthesis of study results finds that these programs have demonstrated success in effecting positive change in knowledge and condom use and have demonstrated some success in changing community attitudes and norms. Effects on other sexual behaviors and STI rates were equivocal. We include an overview of characteristics of successful programs, a review of program limitations, and recommendations for the development and implementation of successful community-based peer-led programs in low-income countries.     

Midlife and Older Gay Men Living with HIV/AIDS: The Influence of Resiliency and Psychosocial Stress Factors on Health Needs

HIV/AIDS research has mostly focused on younger gay men. This cross-sectional study originated from a larger study of 316 respondents to include a subsample of 38 midlife and older gay men living with HIV/AIDS. The study explores physical and mental health utilization rates, including physical and mental health status. Resiliency, internal health locus of control beliefs, and psychosocial stressors of age and sexual orientation discrimination, stigma, and internalized homophobia were also examined. A total of 65.8% of the HIV/AIDS participants received no mental health services the past year, despite reporting higher mental health distress. Of those reporting an HIV status, 10.5% indicated having no health visits in the preceding year and more delays in seeking care when needed and unmet health needs for which services were not sought. Participants reporting higher resiliency indicated less mental health distress and better health access indicators. Stigma and internalized homophobia negatively affected resiliency. Implications for practitioners working with midlife and older gay men are provided.     

HIV/AIDS-Core competencies for practice: A framework for the education and training of social workers

This article identifies the increasing relevance of HIV and AIDS for social work practice in the 1990s and argues that the topic should be included as a core component of all DipSW qualifying programmes. It identifies direct work with people affected by the virus, health education and the politics of AIDS in relation to anti-discriminatory practice as key features of this training. The new educational-agency partnerships developing around DipSW are welcomed as having the potential to ensure a continuum of training for social workers. Local authorities, for instance, should have sufficient influence upon basic training to ensure that workers enter employment with a basic awareness of HIV and AIDS and the complex issues which it raises for practice generally. Agencies can then focus on planning effective training strategies which meet the specific and specialist needs of workers arising out of particular areas of practice.

The importance of maximising upon the symbiotic relationship between agencies and educational institutions is stressed, in order to ensure that the rhetoric of partnership is translated into action.     

HIV/AIDS among youth: A community needs assessment study

Adolescents remain at great risk for HIV transmission and contracting AIDS. Health education, preventive methods, and direct clinical intervention represent major strategies in combating this disease. In order to help increase the effectiveness of these activities, University faculty and a county health agency collaborated to conducted an extensive HIV/AIDS needs assessment of adolescents. The survey included high school, middle school, and community youth (N=1567). Results showed a relatively high level of knowledge about HIV/AIDS, yet participation in risk behavior which did not correlate with knowledge. Data suggested that parents and school were important sources of information about HIV/AIDS. Implications for social work practice and policy are discussed.The research was funded by the U.S. Conference of Mayors and done in collaboration with the Lucas County Health Department, Toledo, Ohio.     

Evaluation of community-based AIDS education and risk reduction projects in ethnic and racial minority communities: A survey of projects funded by the U.S. public health service

The purpose of this study was to describe proposed program evaluation methods used to determine effectiveness of selected federally funded AIDS education and risk reduction interventions focused on ethnic and racial minority populations. Funding for AIDS prevention programs has grown significantly since 1985, when the first allocation of $11 million was earmarked for general AIDS prevention and education. In 1987, funds specifically targeting minority populations were set aside from AIDS prevention and education programs. Nine agencies/divisions within the Department of Health and Human Services (DHHS) were identified as having funded AIDS prevention and education projects targeted toward ethnic and racial minority populations. The grants and contracts reviewed for this study were limited to those programs receiving Federal funding through DHHS. Few programs provided information within the broader context of sex education and drug education. The modification of needle-sharing behavior among IV drug users and unprotected sex with an IV drug user were the two most frequent risk factors targeted. All 63 programs used at least one formative evaluation method. The most frequently used formative techniques were monitoring achievement of project objectives and counting the number of people participating in program activities. Forty programs counted the amount of AIDS literature distributed. Thirty-three programs conducted a baseline assessment of AIDS knowledge, and 33 programs conducted a baseline assessment of risk behaviors for HIV infection. Results from this study support the National Academy of Sciences recommendation that while summative evaluation will ultimately be valuable, it would be premature to begin developing outcome evaluation strategies at the present time. It is incumbent upon program planners and evaluators to ensure that premature program evaluations are not made in an effort to eliminate direct federal funding of minority community-based strategies to stop the spread of HIV infection.