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.     

Rethinking the African AIDS Epidemic

Half the AIDS victims in the world are in East and Southern Africa, where adult HIV sero‐prevalence was 11.4 percent by the end of 1997 and over 25 percent in two countries of Southern Africa. HIV/AIDS infection is not the result of ignorance, as nearly everyone has sufficient knowledge about AIDS and how it is transmitted. The high levels of AIDS arise from the failure of African political and religious leaders to recognize social and sexual reality. The means for containing and conquering the epidemic are already known, and could prove effective if the leadership could be induced to adopt them. The lack of individual behavioral change and of the implementation of effective government policy has roots in attitudes to death and a silence about the epidemic arising from beliefs about its nature and the timing of death. International responsibility may have to be taken before the needed effective policies are put in place.     

Has the HIV Epidemic Peaked?

This study reviews the highly diverse regional and country patterns of HIV epidemics and discusses possible causes of the geographic variation in epidemic sizes. Past trends and projections of the epidemics are presented and the peak years of epidemics are estimated. The potential future impact of new prevention technologies is briefly assessed. A final section summarizes the future impact of the epidemic on key demographic variables. The main finding of this analysis is that the HIV epidemic reached a major turning point over the past decade. The peak years of HIV incidence rates are past for all regions, and the peaks of prevalence rates are mostly in the past except in Eastern Europe, where they are expected to peak in 2008. But owing in part to the life‐prolonging effect of antiretroviral therapy and to sustained population growth, the absolute number of infected individuals is expected to keep growing slowly in sub‐Saharan Africa and to remain near current levels worldwide, thus posing a continuing challenge to public health programs. No country is expected to see a decline in its population size between 2005 and 2050 that is attributable to high mortality related to AIDS.     

The United Nations on the Demographic Impact of the AIDS Epidemic

A report prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released in Geneva on 27 June 2000 (just prior to the XIIIth International AIDS Conference held in Durban, South Africa) updates estimates of the demographic impact of the epidemic. It characterizes AIDS in the new millennium as presenting “a grim picture with glimmers of hope”—the latter based on the expectation that national responses aimed at preventing and fighting the disease are in some places becoming more effective. According to the report, which emphasizes the considerable statistical weaknesses of its global estimates, the number of people living with HIV/AIDS in 1999 was 34.3 million (of which 33.0 million were adults and 1.3 million were children under age 15; slightly less than half of the adults affected, 15.7 million, were women). Deaths attributed to AIDS in 1999 amounted to 2.8 million, bringing the total since the beginning of the epidemic to 18.8 million. These figures represent moderate upward revisions of earlier UN estimates shown in the Documents section of PDR 25, no. 4. The revised estimate of the number of persons newly infected with HIV in 1999 is, in contrast, slightly lower: 5.4 million, of which 4.7 million were adults and 2.3 million were women. An excerpt from the 135‐page Report on the Global HIV/AIDS Epidemic, focusing on countries in the worst‐affected area, sub‐Saharan Africa, is reproduced below. (Figures shown have been renumbered.)     

AIDS and kitchen gardens: insights from a village in Western Kenya

In rural Africa, indigenous farming and natural resource management systems exemplified by kitchen gardens are being reshaped by the HIV/AIDS epidemic and its negative impacts (illness, stigma and mortality, and economic costs) and positive opportunities (organizational responses to the epidemic). Subtle changes in crops and farm techniques can be traced to these diverse influences of HIV+ infection, illness, mortality, widowhood, foster child care, and AIDS support groups, as well as the organizations, ideas, and flow of funding from outside. These findings draw on original field data: a village census, in-depth interviews with gardeners, and group discussions in a village in Bungoma District (in 2005 and 2007). This part of western Kenya is a typical small-farm zone that has faced a moderate HIV/AIDS epidemic since the 1990s, following decades of demographic, environmental, technological, and institutional changes. Implications of this case study for further research on HIV/AIDS and on micro-level population–environment change suggest that households are useful but imperfect analytical units and are best seen as part of complex social networks, shaping connections to markets. These important “mediating institutions” link AIDS as a demographic and economic force with environmental outcomes in cultivated landscapes.     

HIV/AIDS and Cross-National Convergence in Life Expectancy

This article analyzes the effect of HIV/AIDS on the cross-national convergence in life expectancy as well as infant and child survival rates by comparing three scenarios. One is based on historical and future best-guess estimated values given the existence of the epidemic. The second scenario assumes that the effect of the epidemic is much worse than expected. The final scenario is based on hypothetical values derived from estimations where the mortality caused by the epidemic is removed. For life expectancy, convergence becomes stalled in the late 1980s (without weighting by country population size) or 1990s (with weighting). Convergence in infant and child survival rates does not become stalled, but slows down. These results are mainly attributable to the epidemic since all signs of stalled convergence or even divergence disappear in the “No AIDS scenario.” Given the existence of the epidemic, however, the reduced degree of inequality in life expectancy attained by 1985 is only expected to be achieved again by 2015 at the earliest. If the epidemic turns out much worse than expected, divergence could continue to 2050. No divergence is to be expected in infant and child survival rates in any of the scenarios.     

Sexual Behavior in China: Trends and Comparisons

Dramatic political, economic, and social changes in China over the past several decades have been accompanied by much discussion in popular media and among academics of a fundamental transformation in Chinese sexual behavior. Several studies have examined current Chinese sexual behavior but have been limited to particular provinces or cities and have been based on non‐random samples. The potential threat of a generalized HIV epidemic in China highlights the dearth of population‐based information on current patterns of sexual behavior that could help design better intervention strategies and prevent misguided ones. This article uses data from the first national probability survey of adult sexual behavior in China completed during 1999–2000, along with a historical and literature review, to address three key questions: 1) Has there been a revolution in sexual behavior in China? 2) Is China unique compared to other countries in these transformations? 3) What are the implications of these findings for China's risk of a generalized HIV epidemic?     

The worried well: maximizing coping in the face of AIDS

This paper discusses the AIDS epidemic in terms of its impact on the psychology of individuals and their relationships. Special emphasis is given to treatment strategies that therapists may find useful in working with the worried well presenting with psychological and sexual difficulties in reaction to AIDS anxiety. Issues of denial, control, and compliance will be presented as central to working with this population.     

Aids and population growth in sub-Saharan Africa: Assessing the sensitivity of projections

Despite different models to project the course of the AIDS pandemic and a scarcity of data to provide standard input parameters for those models, a limited consensus emerges from distinct sets of population projections. In sub-Saharan Africa, population growth rates are projected to remain positive in spite of the pandemic over the next few decades. To investigate this conclusion, alternative projections of an HIV/AIDS epidemic and its related mortality are first produced from different sets of input parameters and assumptions. Their incorporation into the population projections of a fast-growing country illustrates the robustness of projected population growth rates under very different scenarios of the future epidemic but with the common assumption that it will not affect the mortality of the uninfected population, fertility nor migration. This paper then shows that the projected growth rates are much less robust when interactions between the epidemic and the demographic regime are allowed and identifies several potential mechanisms for such interactions. In particular, it suggests that improving our confidence in the medium-term projections of the demographic impact of AIDS in the region requires less a refinement of the projections of the epidemic than a better understanding of its impact on the timing of the postulated fertility decline.     

Gaydar,Marriage, and Rip-Roaring Homosexuals: Discourses About Homosexuality in Dear Abby and Ann Landers Advice Columns, 1967–1982

ABSTRACT

Over the past 70 years, the history of acceptance of the lesbian, gay and bisexual (LGB) community within the United States has seen much change and fluctuation. One of the places that this dialogue has been preserved is through the syndicated advice columns of Dear Abby and Ann Landers, in which individuals in the United States were writing in for advice to deal with their anxiety over a newly emerging and highly visible new community of individuals once considered to be mentally ill and dangerous. Using discourse analysis, this article traces the evolution of public and scientific opinions about the LGBT community during the years leading up to the Stonewall riots all the way to right before the AIDs epidemic. This analysis sheds light on several moral panics that emerged regarding this newly visible population, especially in regard to disturbances within the domestic sphere and a stigmatization of bisexuality.     

The Impact of HIV/AIDS on Adult Mortality in Zimbabwe

In June 2000, an estimated 25 percent of adults in Zimbabwe were living with HIV/AIDS. Statistical data on the impact of the epidemic, though problematic in many ways, are better for Zimbabwe than for many other countries in sub‐Saharan Africa. This analysis presents estimates of adult mortality in Zimbabwe based on multiple sources, including registered deaths adjusted for incomplete reporting, estimated at approximately 50 percent. Comparison of estimates from different data sources shows that they are subject to substantial errors. At the same time, the estimates leave no doubt that adult mortality risks in Zimbabwe more than doubled between 1982 and 1997. The evidence that this rise is due to AIDS deaths is circumstantial, but very strong; there is no credible competing explanation.     

On the Socioeconomic Impact of the HIV/AIDS Epidemic

The UN General Assembly Special Session on HIV/AIDS met 25–2 7 June 2001 and adopted a Declaration of Commitment on HIV/AIDS. The Declaration, in 103 paragraphs, sets out a comprehensive response strategy for governments and UN agencies, supports establishment of a global HIV/AIDS and health fund, and calls for an annual progress report to be reviewed by the Assembly. As part of the Special Session, four “round tables” were conducted on substantive topics: prevention and care, human rights, socioeconomic impact, and international funding. Round Table 3, Socioeconomic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS, was led by the United Nations Development Programme. The background document prepared for it is reproduced in full below. It argues that the brunt of the epidemic's impact on human development has been borne by households, communities, and civil society organizations. The emphasis of national and international action has been on prevention and care rather than on counteracting that impact. “Extraordinary efforts” are now required to intensify poverty‐reduction measures, to assist caregivers and orphaned children, to prevent the collapse of public services, and to promote workplace tolerance and flexibility. “While HIV/AIDS must be seen as an emergency of the highest order, steady progress in reducing poverty is still the long‐term and sustainable solution to the health crisis in the developing world. In the long run, prevention and care will only succeed if people and nations can lift themselves out of poverty.” (The Declaration was not much influenced by such arguments. It devotes two paragraphs to socio‐economic impact, both setting diffuse goals: “By 2003, evaluate the economic and social impact of the HIV/AIDS epidemic and develop multisectoral strategies [on poverty alleviation, etc.]” and “By 2003, develop a national legal and policy framework that protects in the workplace the rights and dignity of persons living with and affected by HIV/AIDS.…”) The Millennium Summit referred to in the document was the meeting on the role of the UN in the twenty‐first century held in September 2000 as part of the 55th session of the General Assembly. The Declaration of Commitment on HIV/AIDS and the Round Table 3 document can both be found at http://www.unaids.org/ungass/index.html .     

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.     

Aids and the elderly of thailand: projecting familial impacts

We apply aggregate demographic analysis and computer microsimulation to project the number of older Thais who will lose children to AIDS during their own lifetimes and to assess their involvement with ill children through caregiving and coresidence. Parental bereavements from AIDS are predicted to peak at around 80,000 per year between 2003 and 2007. Despite an HIV prevalence of only 2%, 13% of Thais who were over age 50 as of 1995 are likely to experience the loss of at least one adult child to AIDS, and 12% of them will lose multiple children. The chance of losing an adult child during one's lifetime will be 70% higher than if there were no AIDS epidemic.     

Population issues and social indicators of well-being

Relating demographers' measures of various population characteristics (size, growth/decline, density, age/sex structures, migration, et cetera) to measures of well-being recently developed within the social indicators movement promises to provide new knowledge about the linkage of population and well-being that can enhance decision making about important population issues. A conceptual schema is presented that suggests specific relationships to examine at various levels of aggregation, that helps to classify research already done in this area, and that helps to identify "holes" in the knowledge base. Some special methodological features of research in this area suggest considerable time and care will be required to produce dependable new knowledge. These include: (a) the inherent multilevel nature of the relationships (involving properties of individuals and collectivities); (b) the slow rate at which population characteristics change; (c) the absence of much good well-being data from the past; and (d) the limited nature of the collectivities for which population data are available.     

Predicting Ambivalence: When Same-Sex Sex is Only “Sometimes Wrong”

ABSTRACT

Despite Americans’ growing acceptance of LGBTQ people and their sexual behaviors over the past 40 years, approximately 10% of the population consistently expresses conflicted feelings, reporting that same-sex sex is only sometimes wrong. This research employs a theory of socially structured ambivalence to examine how individuals with ambivalence toward the morality of same-sex sex differ from those with strong moral stances. Using multinomial regression analysis of General Social Survey data, we find that socio-structural conflicts—e.g. simultaneous membership in institutions with conflicting normative messages—are predictive of ambivalent attitudes, and the presence of these structured conflicts appears to have a cumulative effect. These findings provide evidence of the predictive power of socially structured conflicts in producing ambivalent attitudes and expand the existing literature on ambivalence and attitudes about same-sex relations. We propose that scholars conceptualize ambivalence as a distinctly socio-structural and relational construct that may help to signal fertile ground for social change.     

Drinking,Smoking, and Morality: Do ‘Drinkers and Smokers’ Constitute a Stigmatised Stereotype or a Real TB Risk Factor in the Time of HIV/AIDS?

This paper follows up an unexpected finding from a community survey that identified drinking and smoking as the most important tuberculosis (TB) risk factor, far ahead of ones commonly associated with TB such as poverty, overcrowded living conditions, and HIV-positive status. It reports perceptions of drinking and smoking from a three-phased study of the stigma associated with TB, consisting of a qualitative pilot study using focus-group discussions (2006), a larger-scale community survey (2007), and follow-up group discussions (2009). The community attitude survey was conducted with a sample of 1,020 adults living in a low-income township in the Eastern Cape Province, South Africa. The study found that the moral and the biomedical understanding of TB risk are intertwined. In the community survey, perceptions of drinking and smoking as TB risk were predicted by fear of contracting TB and being a self-reported born-again Christian. In the follow-up study, heavy drinking and smoking in shebeens (unlicensed township liquor outlets) was associated with a risky lifestyle that can spread both TB and HIV. The paper discusses the similarities and differences in the roles of church and shebeen in providing social support to township dwellers to cope with problems of daily life. It is tentatively concluded that the stereotypical shebeen ‘drinkers and smokers’, alternatively pitied and maligned by moral society, might serve as the scapegoat that deflects pollution from the ‘new’ TB linked to the AIDS epidemic.     

The San Francisco bathhouse battles of 1984: civil liberties,AIDS risk,and shifts in health policy

In the mid-1980s, controversy emerged in a number of American cities over the roles gay bathhouses and sex clubs might play in the spread of AIDS, and in raising safe-sex awareness. In 1984, San Francisco became the first city where political debates broke out over AIDS-related policies for bathhouses and sex clubs. These debates were dominated by questions of public health and gay civil liberties. A variety of proposals were put forward during 1984 to try to reconcile these two concerns, or to give one a higher priority than the other. Certain officials in San Francisco's government, and members of its gay/lesbian/bisexual community, strongly disagreed over whether the businesses should be closed, should make their own AIDS-prevention efforts, or should continue operating under new regulations. Policies implemented for the city's baths were disconnected from the known AIDS risk of different sexual behaviors, and from research findings on AIDS and the local baths. Political and judicial decisions concerning San Francisco's bathhouses and sex clubs that were made in 1984 had continuing influences on these businesses through the later 1980s and the 1990s.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

Sub‐Saharan Africa's Future: A US National Intelligence Council Conference Report

The US National Intelligence Council's 2020 Report, Mapping the Global Future, was issued in December 2004. It presented an assessment of geopolitical trends and set out some speculative scenarios for global development over the next 15 years. Excerpts were carried in the Documents section of PDR 31, no. 1. A follow‐up conference in 2005 brought together a group of US experts on Africa to explore likely trends and drivers of change in sub‐Saharan Africa over the same period, partly in the light of the Report's treatment of that region. Part of the NIC's summary of the conference discussions is reproduced below. (Omitted sections discuss globalization, terrorism, democratization, foreign influences, and religion. The full summary is available at http://www.odci.gov/nic/confreports_africa_future.html .) It is notable that the topic of population, which once would have figured heavily in such prognostications, nowhere appears in the conference deliberations. Yet the region's population growth is still rapid—and is plausibly a major driver of change. In the UN's medium projections, sub‐Saharan Africa's population, estimated at 906 million in 2005, will more than double by 2050, its share of world population rising from 12 percent to 19 percent. In the 15‐year time frame of the NIC it will likely grow by 200 million. Those numbers are of course tenuous, contingent on the expectations they embody about the timing of the region's transition to low death and birth rates (and specifically in their assessment of the future course of the AIDS epidemic)—which in turn will be influenced by many of the factors that the NIC conferees considered.