Global HIV and AIDS: Calling all Social Work Educators

As the HIV/AIDS global pandemic continues to grow through a third decade, the need for social work educators to prepare social workers in distinct fields of practice with skills to assist those infected with and affected by HIV is of paramount importance. HIV/AIDS holds multi-level and multi-system effects for vulnerable populations. This article features global HIV and AIDS teaching resources beginning with common global practice challenges. Next, five teaching units focus on practice needs and challenges of divergent vulnerable populations including men who have sex with men, women, injecting drug users (IDU), commercial sex workers, and children orphaned by AIDS. Discussion questions, selected readings and electronic resources accompany each unit. The authors close the article with suggested recommendations for content integration into social work courses, and next steps for the profession.     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore, Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HIV prevention study, interviewed at baseline, 324 (57%) were reinterviewed 5.2 months later. At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both interviews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports of presence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.     

Analyzing HIV/AIDS and Alcohol and Other Drug Use as a Social Problem

Most prevention and intervention activities directed toward HIV/AIDS and alcohol and other drug use separately as well as the combining of the two (e.g., those who are both HIV/AIDS and using alcohol and other drugs) comes in the form of specific, individualized therapies without consideration of social influences that may have a greater impact on this population. Approaching this social problem from the narrowed view of individualized, micro solutions disregards the larger social conditions that affect or perhaps even are at the root of the problem. This paper analyzes the social problem of HIV/AIDS and alcohol and other drug abuse using three sociological perspectives—social construction theory, ethnomethodology, and conflict theory—informing the reader of the broader influences accompanying this problem.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Neighborhood history as a factor shaping syringe distribution networks among drug users at a U.S. syringe exchange

Throughout the U.S., high visibility drug markets are concentrated in neighborhoods with few economic opportunities, while drug buyers/users are widely dispersed. A study of Pittsburgh Syringe Exchange participants provides data on travel between and network linkages across neighborhoods with different levels of drug activity. There are distinct racial patterns to syringe distribution activity within networks and across neighborhoods. Pittsburgh's history suggests that these patterns emerge from historical patterns of social and economic development. Study data demonstrate the ability of IDUs to form long-term social ties across racial and geographic boundaries and use them to reduce the risk of HIV transmission.     

Club Drug Use,Sexual Behavior,and HIV Risk Among Community and Internet Samples of Hispanic MSM: Implications for Clinicians

ABSTRACT

Hispanic men who have sex with men (MSM) are at high risk of HIV infection. This study reports on the club drug use and sexual behaviors of two distinct samples (community and Internet) of Hispanic MSM living in the AIDS epicenter of Miami-Dade County. Both samples reported high rates of unprotected anal sex and high numbers of sex partners; rates of club drug use (cocaine, ecstasy, methamphetamines, GHB, amyl nitrites, and Viagra) were also high. Recent use of club drugs was associated with both unprotected receptive and insertive anal sex in the Internet sample, but not in the community sample. Implications for social work practice are discussed.     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore,Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HW prevention study, intelViewed at baseline, 324 (57%) were reintelViewed 5.2 months late!: At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both intelViews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports ofpresence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.     

Sex differences in trust and trustworthiness: A meta-analysis of the trust game and the gift-exchange game

We present a meta-analytic review of the literature on sex differences in the trust game (174 effect sizes) and the related gift-exchange game (35 effect sizes). Based on parental investment theory and social role theory we expected men to be more trusting and women to be more trustworthy. Indeed, men were more trusting in the trust game (g = 0.22), yet we found no significant sex difference in trust in the gift-exchange game (g = 0.15). Regarding trustworthiness, we found no significant sex difference in the trust game (g = −0.04), and we found men, not women, to be more trustworthy in the gift-exchange game (g = 0.33). These results suggest that men send more money than women do when their money is going to be multiplied, thereby creating an efficiency gain. This so-called “male multiplier effect” may be explained by a stronger psychological tendency in men to acquire resources.     

The potential of online social networking data for augmenting the study of high-risk personal networks among young men who have sex with men at-risk for HIV

Capturing dynamics in high-risk personal networks is essential for preventing HIV transmission. Online social networking data offer incentive to augment traditional selfreported approaches for network enumeration. To explore what online networks reveal about dynamics among high-risk associates, we examine the relationship between egocentric confidant and sex networks and personal Facebook friendship networks of a cohort of young Black men who have sex with men. Although overlap exists between self-reported and Facebook associates, the stabilities of each were unrelated. Confidants who were also Facebook friends with a respondent were, however, more likely to be retained. Thus, Facebook networks contain stable confidants.     

Vietnamese American sexual behaviors & HIV infection

This brief report presents some preliminary findings of an on‐going ethnosexual field study of Vietnamese American sexual behaviors in Orange County, California, and indicates how they may be related to HIV infection. The primary objective of the study is to gather data on those sexual behaviors having the highest likelihood of transmitting the AIDS virus. The field research data indicate that in the ‘Vietnamese American population, highly acculturated Vietnamese homosexual men, whose partner preference is primarily for Anglo men with whom they play both sexual roles in anal intercourse, appear at present to be at highest risk for HIV infection. Transmission of the AIDS virus within the Vietnamese American population may be facilitated by Vietnamese American men who practice unsafe sex with both Anglo and Vietnamese men. The field research data also indicate that a potential exists for the spread of HIV into the heterosexual population through the sexual activity of Vietnamese men with non‐Vietnamese female prostitutes in California and Mexico, and through the sexual activity of ‘Vietnamese men with Thai and Vietnamese prostitutes in Thailand and Vietnam while on return visits to Southeast Asia.     

Risk behaviors and perceptions of AIDS among street injection drug users

Standardized survey interviews (n = 325) and guided in-depth interviews (n = 22) were conducted with injection drug users (IDUs) in Long Beach, California, to document drug usage and injection patterns, sexual practices, perceived risk of HIV infection, sources of health information, and knowledge and attitudes about AIDS. Most IDUs reported sharing needles (87.9%), and a large minority reported regular sterilization of needles/syringes (40.3%). Lower rates of needle sharing were reported among cocaine users than among heroin and speedball users. HIV seroprevalence was 5.7 percent (11/194). Sexually active female (60.7%) and male (20.5%) IDUs reported exchanging sex for money or drugs. Overall, 48.3 percent of IDUs reported having made changes in their injection practices and one-third reported modifying their sexual behavior in order to avoid HIV infection. Differences in drug use, sexual practices, and drug treatment history were found with regard to gender, ethnicity, age, and type of drug injected. Implications of findings for the development of AIDS risk-reduction programs are presented.     

Gauging the Acceptability of HIV Vaccines: An Exploratory Study Examining Knowledge,Attitudes, and Beliefs Among Injecting Drug Users in Viet Nam

ABSTRACT

In contrast to other countries in Southeast Asia, the HIV/ AIDS epidemic is in the initial stages in Viet Nam, although the rates have increased notably since 1997. This study examined attitudes towards the use of an HIV vaccine (when one becomes available) as a means for preventing the disease. Since injecting drug users are the great majority of those affected by the HIV/AIDS epidemic in Viet Nam, two focus groups (n = 18) were conducted among this population to identify potential barriers and incentives for HIV vaccination. Most were willing to be vaccinated if an HIV vaccine were available. Although there were some concerns about side effects, financial costs, and stigmatization, the benefits were seen to outweigh the risks. The findings may help governments better understand the potential demand for this type of vaccine and design social marketing campaigns for post-trial HIV vaccine dissemination in order to maximize potential uptake of an HIV vaccine.     

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.     

A social network approach to estimating seroprevalence in the United States

Results from a representative survey of respondents in Florida are given, concerning their knowledge about members of their personal network, and specifically how many people respondents know in selected subpopulations. We employ a method known as a “network scale-up method”. By using a collection of subpopulations of known size, and also asking about one subpopulation (those who are seropositive) of unknown size, we make various estimates of personal network size and the size of the seropositive subpopulation. Our best (maximum likelihood, unbiased) estimates are 108 members of the network defined by “having been in contact with during the previous two years”, and (approximately unbiased) 1.6 million for the seropositive subpopulation. Because of the proportional over-representation of AIDS (and presumably, therefore, seropositive) in Florida, by a factor of about two, this latter estimate could be an overestimate.     

Gamers’ confidants: Massively Multiplayer Online Game participation and core networks in China

Through a survey of more than 18,000 participants in a Chinese Massively Multiplayer Online Game (MMOG), this study examines how the size and diversity of Chinese gamers’ core networks vary by individuals’ sociodemographic, socioeconomic and game-related characteristics. It represents the first study focusing exclusively on the gamer population and one of the most recent examining personal networks in contemporary China, home to over 560 million Internet users. We found that Chinese gamers have notably larger and more diverse core networks than those of major studies. Coplaying patterns and attachment to the game community contributed significantly to network size and diversity.     

The Relationship Among Population Size,Requests for Bareback Sex,and HIV Serostatus in Men Who Have Sex With Men Using the Internet to Meet Sexual Partners

Recent research has indicated the use of the Internet to meet sexual partners among men who have sex with men (MSM) is increasing. This medium also serves as a major source for social and sexual networking among MSM who live in more rural areas. In addition, data suggest the use of the Internet to initiate sexual relationships among this population may increase the risk of transmission of sexually transmitted infections, including HIV. The purpose of this study was to examine differences between self-reported HIV serostatus and requests for condomless bareback (BB) sex among a sample of Florida MSM (n = 483) using a popular Internet sexual networking site to meet sexual partners. Specifically, these variables were assessed in relation to population size among the site's seven geographic regions within the state. Findings indicated an overall statistically significant relationship among requests for BB sex and self-reported HIV serostatus. However, there was not a significant relationship among these variables and geographic region. Thus, although previous data have emphasized the importance of different HIV prevention strategies among rural versus urban MSM, there may not be major differences in HIV serostatus and requests for unsafe sexual practices among these men who use the Internet to meet sexual partners in comparison to MSM in more populated areas.     

Identity and Self-Presentation in the House/Ball Culture: A Primer for Social Workers

Members of the house/ball subculture, a segment of the population of young men and transgendered people of color who have sex with men in the United States, are examined in relationship to self-identity and presentation. To enhance cultural awareness and understanding for helping professionals, historical backdrop, categories of identity, theoretical applications, and insight concerning the social network and fluidity of self within the house/ball community are described and examined. Case illustrations demonstrate the importance of cultural competence concerning this marginalized population, especially when considering HIV prevention and care, health disparities, violence, and poverty.     

Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment

Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index–Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.     

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.