STATISTICAL CHALLENGES OF AIDS: (The 1990 Knibbs Lecture, Canberra, 27 November 1990)

Issues that are central to the understanding and management of the HIV epidemic have generated numerous statistical challenges. This paper considers questions concerning the incubation period, the effects of treatments, pre diction of AIDS cases, the choice of surrogate end points for the assessment of treatments and design of strategies for screening blood samples. These issues give rise to a broad range of intriguing problems for statisticians. We describe some of these problems, how they have been tackled so far and what remains to be done. The discussion touches on topical statistical methods such as smoothing, bootstrapping, interval censoring and the ill-posed inverse problem, as well as asking fundamental questions for frequentist statistics.     

“I Didn't Leave Y'all on Purpose”: HIV-Infected Mothers' Videotaped Legacies for Their Children

The authors analyzed twelve videotapes made by HIV-infected women for their children. Using grounded theory methods the concept of eternal mothering provides a framework to study the interactive aspects of mothering, and the significance of impending maternal death from a stigmatizing illness. In creating these videotape legacies, the mothers drew on personal experiences of gender, class, race, ethnicity, family configurations, and other social conditions. There is tension between women's self-presentation in an attempt to control the impressions they make on their children, and their decision to disclose stigmatizing secrets with the potential consequential loss of maternal authority and children's loyalty, as well as inherited shame by association.     

Promoting AIDS-preventive behaviours: The role of message fear appeal and audience's characteristics

Abstract

This study was conducted to assess the effects, in terms of cognitive elaboration and behavioural intentions, of television anti-AIDS public service announcements adopting different levels of fear appeal. At the same time, the influence of audience's characteristics, such as general orientation toward risk, perceived risk of contracting AIDS, and past sexual behaviours was analyzed. 114 Italian undergraduate non-psychology students participated in a pretest-treatment-posttest experiment on voluntary basis. Subjects were randomly allocated to the exposure of three messages adopting increasing levels of fear appeal. Results both from analyses of covariance and from structural equation modelling show that: a) extreme levels of fear appeal induce negative evaluations and reduced compliance with the message; b) future preventive intentions are much more affected by past preventive behaviours than by anti-AIDS messages; c) general orientation toward risk significantly affects both past and future preventive behaviours.     

A Microcomputer Management of Information System for Community-Based AIDS Prevention Ethnographic Team Research

Abstract

Ethnographers working on community-based intervention projects increasingly face the task of collecting and analyzing large amounts of qualitative data. In addition, these data sometimes must be simultaneously gathered across diverse populations and at multiple locations. A cost-effective approach that addresses the difficulties in conducting this type of qualitative research is the use of an ethnographic team. Yet, the team concept requires sophisticated strategies for managing large volumes of unstructured textbased data. This article documents how the Houston Nalional AlDS Demonstration Research (NADR) project configured specific basic microcomputer technologesto asslst and enhance the management of ethnographic team research. Specifically, this system was a valuable and affordable tool to increase the speed, efficiency and rigor of data collection and analysis.     

Challenges and Opportunities in HIV/AIDS Counseling: A Case of Jharkhand

The study highlights the challenges and opportunities in HIV/AIDS counseling. The major challenges are recruiting the right individuals and their capacity building and retention. The finding shows that most of the counselors are not befitting in terms of qualification and experience besides motivation, remuneration, and other issues. The study suggests that to ensure the effective counseling to reverse the epidemic, it is important to focus on such issues through appropriate policy interventions.     

“Allah will decide my life and death”: Religion and spirituality among populations at risk for HIV in Malaysia

ABSTRACT

We examined the influence of religion and spirituality on HIV risk contexts through in-depth interviews with men who have sex with men (n = 10) and female commercial sex workers (n = 10) in Malaysia. Using a grounded theory approach, five themes emerged from the interviews: (a) religion encourages caring for health, (b) health is influenced by a higher power, (c) prayer is a conduit to health assistance, (d) stigma is compounded by religion but it does not limit one’s spirituality, and (e) religion is not but should be incorporated into HIV campaigns. Incorporation of spirituality in service provision and addressing stigma is warranted.     

A three-state continuous time Markov chain model for HIV disease burden

Plasma HIV viral load (VL) is the clinical indicator used to evaluate disease burden for HIV-infected patients. We developed a covariate-adjusted, three-state, homogenous continuous time Markov chain model for HIV/AIDS disease burden among subgroups. We defined Detectable and Undetectable HIV VL levels as two transient states and Death as the third absorbing state. We implemented the exact maximum likelihood method to estimate the parameters with related asymptotic distribution to conduct hypothesis testing. We evaluated the proposed model using HIV-infected individuals from South Carolina (SC) HIV surveillance data. Using the developed model, we estimated and compared the transition hazards, transition probabilities, and the state-specific duration for HIV-infected individuals. We examined gender, race/ethnicity, age, CD4 count, place of residence, and antiretroviral treatment regimen prescribed at the beginning of the study period. We found that patients with a higher CD4 count, increased age, heterosexual orientation, white, and single tablet regimen users were associated with reduced risk of transitioning to a Detectable VL from an Undetectable VL, whereas shorter time since diagnosis, being male, and injection drug use increased the risk of the same transition.     

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p?<?.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M?=?6.39) than the common cold control condition (M?=?5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.     

Mexican and Mexican American male sexual behavior & spread of AIDS in California∗

Data generated by the authors' field research on the bisexual and homosexual behaviors of men of Mexican origin living in southern California are presented and compared with the same behaviors of Anglo men in California and Mexican men in Mexico. Preferences for playing either the anal receptive or insertive sexual role and a focus on anal intercourse by unacculturated and less acculturated men of Mexican origin who have sex with men are the sexual behaviors judged to be most significantly different from Anglo men who have sex with men in California. Sexual socialization and acculturation were found to be the most important determinants of whether an individual's adult patterns of homosexual behavior will be more or less influenced by Mexican or Anglo homosexuality in spite of the length of time they may have lived in California. Evidence is presented about the effects that acculturation, preference for a sexual role in anal intercourse, and endogamy have on the spread of the AIDS virus in the Mexican origin population in California.