Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.     

Social Networks and Unobserved Heterogeneity in Risk for AIDS

As a sexually transmitted disease, AIDS spreads along social networks; consequently,it is reasonable to propose to utilize these networks in teaching people to avoid practices that put them at increased risk of contracting AIDS. Most obviously, homosexual men are both at relatively high risk of contracting AIDS, and in many urban areas have well crystallized community structures and high social connectivity. We present evidence suggesting that using such social networks can have the unanticipated consequence of reaching a set of men who are at relatively low risk. Evidently, there is great unobserved heterogeneity among the population in terms of risk, and while this heterogeneity is not captured by conventional measures of risk behavior, it is closely linked to network processes.     

A gender comparison of HIV and drug use across the rural-urban continuum

Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in researchers' understanding of how and to what extent women may differ in their drug-using and HIV risk behaviors compared to their better-studied male counterparts. This study, derived from a sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural communities, attempts to compare the drug usage and needle and sexual risk behaviors of male and female drug users that put them at risk for HIV infection. The overall seropositivity rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results of multivariate analyses indicate that females compared to males were 1.4 times more likely to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs. Furthermore, there was a strong linear relationship between drug use type and HIV seroprevalence among women drug users. Compared to those who were neither crack smokers nor injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be HIV seropositive, while those who were both crack smokers and injectors were 5 times more likely to be HIV seropositive, and those who were injectors only were 6 times more likely to be HIV seropositive. These findings indicate that among women, drug abuse and its associated risk behaviors, increase the vulnerability of this population for HIV and thus render them an extremely important priority population on which to focus HIV prevention and public health efforts and programs.     

AIDS in China

Most recent official statistics indicate that there was a cumulative total of 133 AIDS cases in mainland China through the end of October 1996 and 5157 people infected with HIV. Official statistics also indicate continuing increases in recent years in the number of people with AIDS and people infected with HIV, and that the incidence of infection is growing in China. HIV has been found to have been transmitted in China through IV drug use, sexual activities, from mother to child, and through transfusions and the use of blood products. Important risk factors for the spread of HIV in China include high population density, a considerable transient population, drug use, prostitution, blood transfusion, the improper sterilization of medical instruments in rural areas, changes in people's sexual attitudes and behaviors, and lack of information on safe sex. The Chinese government reports having taken considerable steps to check the spread of HIV/AIDS and supports communication and education as an essential tool in the fight against the epidemic. Life expectancies in China's provinces and municipalities are listed.     

India's National Family Health Survey provides new information on maternal and child health and AIDS awareness

Teams surveyed a sample of 88,562 households, drawn from 99% of the population of India in 24 states plus the National Capital Territory of Delhi, between April 1992 and September 1993 to collect a basic set of information on all 500,492 household members, with more details on the 89,777 women in the households who had ever been married and were aged 13-49 years. This National Family Health Survey (NFHS) collected information from the women on a range of health topics including child immunization, women's knowledge of AIDS, services and facilities use during pregnancy and childbirth, infant feeding and treatment for diarrhea, and infant, child, and maternal mortality. Levels of infant and child mortality declined in India, but 8% of all children still die before their first birthday and 11% die before reaching age 5. As for maternal mortality, there are an estimated 420 maternal deaths per 100,000 live births annually. That rate implies that at least 100,000 Indian women die each year due to causes related to pregnancy and childbirth. Survey results indicate the need to strengthen vaccination programs and teach women about proper infant feeding practices. They also highlight the need to increase antenatal care and other medical services. In all of these areas, the NFHS results indicate wide variation among India's regions and states. Furthermore, a general lack of AIDS awareness suggests that the government's AIDS awareness campaign, relying primarily upon electronic media, has not yet reached the majority of India's population.     

Dividing women: the framing of trafficking for sexual exploitation in magazines

Each year thousands of women are trafficked for sexual exploitation. To understand how the mass media represent trafficking, a qualitative framing analysis of magazines, published from 2000 through to 2010, was conducted. Results showed magazines presented complementary frames of victimization and benevolence. Magazine articles shed light on trafficking, which operates in society’s shadows and is far removed from many people’s lives, but articles reinforce hierarchies and divisions: between women and men; among women; and among “good” prostitutes who deserve help and “bad” prostitutes who do not. Articles imply that the problem of trafficking is one of individual vulnerability, which can be remedied by charitable efforts, and ignore the larger cultural, political, economic, and educational systems of sex discrimination. Traffickers and men who buy sex were largely absent from magazine stories, and focus on the sale of sexual services, rather than the purchase, emphasized women’s role in the trafficking process while making men’s roles invisible. Because the mass media can shape public opinion and public policy, such incomplete reports may lead to ineffective policies.     

HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

Gender differences in substance use and initiation of sexual activity

Even though widespread efforts have focused on educating young adults about HIV and AIDS, many individuals continue to engage in behaviors that place them at risk. These behaviors include frequent experimentation with alcohol and other drugs prior to sex, engaging in sexual activity with different partners, and inconsistent safe sex practices (Butcher et al. 1991). The combination of these risky behaviors causes increased concern about the spread of HIV among those of college age. This study focused on two behaviors by examining the relationship between substance use during adolescence and early initiation of sexual activity in a sample of 950 subjects aged 19–21 in a mid-sized southern city. Results indicate that early use of alcohol and marijuana relates to earlier initiation of sexual activity and subsequent risky sexual behavior among young adults. Also, gender differences were observed for frequent users of marijuana and alcohol with males engaging in riskier sexual practices. Recommendations for interventions are made.     

Mortality Differentials by Marital Status: An International Comparison

Although the greater longevity of married people as compared with unmarried persons has been demonstrated repeatedly, there have been very few studies of a comparative nature. We use log-linear rate models to analyze marital-status-specific death rates for a large number of developed countries. The results indicate that divorced persons, especially divorced men, have the highest death rates among the unmarried groups of the respective genders; the excess mortality of unmarried persons relative to the married has been generally increasing over the past two to three decades; and divorced and widowed persons in their twenties and thirties have particularly high risks of dying, relative to married persons of the same age. In addition, the analysis suggests that a selection process is operating with regard to single and divorced persons: the smaller the proportion of persons who never marry or who are divorced, the higher the resulting death rates.     

Nondrinker Mortality Risk in the United States

The literature has shown that people who do not drink alcohol are at greater risk for death than light to moderate drinkers, yet the reasons for this remain largely unexplained. We examine whether variation in people’s reasons for nondrinking explains the increased mortality. Our data come from the 1988–2006 National Health Interview Survey Linked Mortality File (N = 41,076 individuals age 21 and above, of whom 10,421 died over the follow-up period). The results indicate that nondrinkers include several different groups that have unique mortality risks. Among abstainers and light drinkers the risk of mortality is the same as light drinkers for a subgroup who report that they do not drink because of their family upbringing, and moral/religious reasons. In contrast, the risk of mortality is higher than light drinkers for former drinkers who cite health problems or who report problematic drinking behaviors. Our findings address a notable gap in the literature and may inform social policies to reduce or prevent alcohol abuse, increase health, and lengthen life.     

Moderate Alcohol Consumption and the Risk of Mortality

There has been a growing consensus that moderate consumption of alcohol is associated with a lower risk of mortality and that this association is probably causal. However, a recent review article has raised a serious challenge to this consensus. In short, it determined that most prior research in this area committed serious misclassification errors; furthermore, among those studies that were free of these misclassification errors, no support for a protective role of alcohol consumption was found. This article reexamines the issue using prospective data for more than 124,000 persons interviewed in the U.S. National Health Interview Surveys of 1997 through 2000 with mortality follow-up through 2002 using the Linked Mortality File. The study involves about 488,000 person-years. Controlling for a variety of covariates, this study finds that compared with nondrinkers, those who consume a moderate amount of alcohol have lower all-cause and CHD mortality. The fact that the current study has taken care to avoid the pitfalls of some earlier studies and still finds that those who consume a moderate amount of alcohol have lower all-cause mortality and CHD mortality lends credence to the argument that the relationship is causal.     

Ultrasonometric profiling of incidence and risk of osteoporosis in rural women

BACKGROUND: It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly aging population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation profiled the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. METHODS: Between 2001 and 2005, adult female subjects (n = 323) in the age range of 40-87 were drawn from an independent, community dwelling, convenience sample. Bone mineral density T-scores were evaluated using heel ultrasonometry. Demographic and risk factor data, Merck Osteoporosis Evaluation SCORE questionnaire data, and the Osteoporosis Risk Assessment questionnaire data were analyzed. RESULTS: Results of these scans indicate that 25% of the total population had a T-score < or = -1.0, implying a 1.5- to 2.0-fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause and weight had a positive correlation with T-scores. While the overall scores on the Merck SCORE questionnaire were inversely correlated to T-scores, no significant correlation was found between the Osteoporosis Risk Assessment questionnaire and T-score data. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. CONCLUSION: That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop preventative awareness and provide education on bone health management. This finding has particularly important ramifications, since the sample was rural women, who typically have limited access to diagnostic bone density procedures.     

Sexual activity among never-married men in northern Thailand

We use data collected in 1991 to investigate sexual activity among never-married men in Thailand, with a focus on age at first intercourse, characteristics of sexual partners, and conditions under which men visit prostitutes. We sampled men from a broad spectrum of northern Thai society, including university undergraduates, soldiers, and semiskilled/unskilled workers. We found that except for the students, the majority of each subsample is sexually experienced; prostitutes are the most common type of sexual partner for all groups. Alcohol consumption is associated with several measures of sexual activity. Condom use with prostitutes varies among the subsamples. Among men who have both prostitute and nonprostitute partners, the majority of those who do not use condoms with prostitutes also do not use condoms with their nonprostitute partners. We consider the implications of these results for the AIDS epidemic in Thailand.     

Validity of centenarian data in the 1960 Census

This paper examines the question of how many genuine centenarians there actually are in the United States as compared with those reported in the census. It is concluded that the numbers of centenarians shown in various United States censuses are definite overstatements of the number of true centenarians. It seems likely that instead of the 10,326 centenarians reported in the 1960 census there were at most only about 3,700. Overstatement of ages seems to be particularly the case among those who claim to be aged 110 or over, and it is believed that there probably are no persons who are actually this old.The analysis has been made by projecting, through the me of population life table survival factors, the populations reported cit carious advanced age groups in one census to the next census and then comparing the results with the corresponding number reported in the latter census for the same age cohort. In general, the enumerated populations at ages below 95 are reasonably close to the projected populations, especially for white persons. On the other hand, at ages 95 and over-especially for centenarians-the enumerated populations significantly exceed the projected ones.As a subsidiary part of the analysis, the paper points out the significant differences at the older ages between the "full count" age distribution in the 1960 census and the corresponding "inflated 25 per cent sample" one. This is a subject that bears further investigation and explanation.The paper also discusses centenarians on the social security benefit rolls and concludes that the present data cannot be considered of substantial accuracy with regard to genuine centenarians, particularly the oldest ones. In a number of years, however, this program will provide excellent data, became the individuals involved will have been on the benefit rolls for many years and will have had their ages proved with reasonable accuracy.     

Superimpose Material Deprivation Study on Poverty Old Age People in Hong Kong Study

Due to a range of shortcomings of income-based measures of poverty in older people, an alternative approach is proposed to counteract those shortcomings. Hong Kong index of material deprivation aims to identify a consensus-based list of goods and services that are necessities in society and to establish that these goods and services are not available due to their lack of affordability. This paper reports on the validation of Hong Kong index of material deprivation based on an approach proposed by Townsend (Poverty in the United Kingdom, Penguin Books, London, 1979) in Hong Kong. Through a survey of 2339 older Chinese people aged 65 and older, we found that a broad consensus regarding the necessities in their daily lives exists and Hong Kong index of material deprivation is a reliable and valid measure of poverty because its reliability and validity is good and acceptable. Finally, we have shown that the overlap between the poor in terms of income and the deprived is moderate and the profiles of those who are core poor (both poor in terms of income and the deprived) are more similar to those who are deprived than those who are poor in terms of income. Hong Kong index of material deprivation index has been developed, which offers a supplementary measure of poverty other than income poor and provides future avenues for improved understandings of poverty in old age.     

滇西某大型筑路工地流动人口艾滋病风险分析

本研究采用定性与定量相结合的方法对滇西某大型道路建设工地流动人口的艾滋病风险进行调研与分析,该工地流动人口所面临的主要艾滋病风险是高危商业性性行为。深入调研发现,因其特殊的行业特征,工地流动人口中形成了对商业性性行为默许、容忍、合理化的氛围,对于所面临的艾滋病风险存在侥幸心理,各职业人群由于知识、社会经济处境不同,其与艾滋病相关的高危行为有明显差异。基于研究发现,本文对流动人口艾滋病预防干预实践、艾滋病预防研究的社会人文视角及未来研究方向等提出了讨论和建议。     

Attitudes and Stereotypes Regarding Older Women and HIV Risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.     

The Effect on Elderly Parents in Cambodia of Losing an Adult Child to AIDS

Little systematic quantitative research is available on the parents of adults who become ill and die of AIDS despite their large number and the wide range of adverse consequences. This study, based on survey data from Cambodia, explores economic and social effects on parents in a country characterized by extreme poverty and a substantial AIDS epidemic. Results indicate that parents play a major role during the illness of an adult son or daughter, often sharing living quarters, providing care, and paying for illness‐related expenses. These contributions to the societal response to AIDS come at considerable cost to parents at advanced ages. Multivariate analysis suggests lasting negative consequences for parents’economic well‐being, and the consequences are more substantial if the adult child's death was from AIDS rather than from other causes. The study found little evidence of stigma associated with losing a grown child to AIDS: reactions from local community members are more likely to be sympathetic and supportive than negative. These results underscore the need for organizations dealing with AIDS to recognize the contributions older persons make in coping with the epidemic and to address the burden it imposes on them.     

Part 3: A community divided

The task of those who seek to encourage and offer social support has become more difficult as the majority of social institutions, and the state have established, over time, stronger and more pervasive modes of communication. The intricacies of gay identity have been articulated largely by forces outside of the gay movement, with the inevitable result that GSOs and ASOs have occupied less space in the consciousness of gay men. Additionally, I hypothesize that men who are HIV-positive are engaging in fewer sexual contacts than men who are HIV-negative, and consequently lessening their attendance at venues where cruising is the main event. Financially and structurally, I shall demonstrate the disparity between GSOs and ASOs, and suggest that there is a natural intersection wherein the two SMOs could, and ought to cooperate, especially in the areas of fund-raising, joint program development, recruitment and political lobbying. However, their ideological bases appear to be sufficiently different to preclude such affiliations. These disparate ideologies are amplified by the mass media, and are consequently internalized by the members of the gay community. In the longer term, the divisiveness that manifests itself in the proliferation of numerous collectivities within the gay movement will contribute to the further isolation of gays from each other, and thwart any future attempts at coalition building, which could obviate the continued existence of a gay movement. Some writers suggest that the gay movement is going through a phase in an inevitable process of paradigm shifting, and in the end, the community will come back together-stronger and more unified than it was previously. However, if this is a phase it is clear that the gay movement is in the 'dark before the dawn' initial phase of this paradigmatic shift, and subsequent phases are by no means guaranteed. As AIDS spreads beyond marginalized groups, and infiltrates the social majority, it is possible that much of the discrimination that has positioned gay men as 'other' will be abandoned in favour of a more enlightened, pluralistic conviction of the humanity of gays as full-fledged members of a mosaic-type community structure. On the other hand, it is also possible that as AIDS spreads into mainstream Western communities, gays will be further vilified and scapegoated as the perpetrators of this deadly disease. Preventative action is required to offset this possibility-preventative action can be affected by building a strong and unified gay community ready to withstand the onslaught of the mainstream enmity. This action would frame AIDS and gayness such that this type of situation would not come about. What is required is a new mode of co-operation among ASOs and GSOs, a model which firstly puts the gay house in order, and is then suitably structured to be more inclusive of all gay men's needs, and positioned to assist in the second wave of HIV infection-the general public.     

Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies

Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys, which include results from HIV tests, allow the study of HIV infection at the level of the cohabiting couple. This article exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two findings about the dynamics of the HIV/AIDS epidemic that have important implications for policy. First, at least two‐thirds of the infected couples are sero‐discordant, that is, only one of the two partners is infected. This implies scope for prevention efforts among infected couples. Second, among 30–40 percent of the infected couples only the woman is infected. This is at odds with levels of self‐reported extramarital sex by women and with the common perception that unfaithful men are the main link between high‐risk groups and the general population. These findings are confirmed by tests of robustness. These results indicate that extramarital sexual activity among women in union is a substantial source of vulnerability to HIV that should be, as much as male extramarital activity, targeted by prevention efforts.