Qualitative research on homosexual and bisexual behavior relevant to HIV/AIDS

The spread of the international AIDS pandemic has drawn attention to the urgent need for data on human sexual behavior; yet the lack of an established tradition of theory and method in sex research has limited the development of research initiatives in this area. This has been particularly true in the study of homosexual and bisexual behavior, which has relied heavily on the use of quantitative survey methods that largely fail to address cross‐cultural differences in the structure and meaning of same‐sex sexual experience. More qualitative approaches offer the possibility of investigating homosexual and bisexual behavior within a broader social and cultural context and can therefore play an important role in developing a framework for the comparative analysis of behavioral data. This article seeks to contribute to the development of theory and method in sex research by outlining key research issues and possible methodologies for the qualitative investigation of homosexual and bisexual behavior in relation to HIV/AIDS.     

A rejoinder to the comments of Hartman & fithian and pomeroy & brown on the female sexological examination

The spread of the international AIDS pandemic has drawn attention to the urgent need for data on human sexual behavior; yet the absence of an established tradition of theory and method in sex research has limited the development of initiatives in this area. This has been particularly evident in the lack of attention given to the ways in which cross‐cultural differences structure the meaning of sexual experience. While survey research can play an important role in documenting sexual behavior, qualitative research on sexual culture is equally important in order to develop a framework for the comparative analysis of behavioral data. This article seeks to contribute to the development of theory and method in sex research by outlining key research issues and possible methodologies for the qualitative investigation of sexual culture in relation to HIV/AIDS.     

An ethnography of HIV/AIDS and sexuality in the People's Republic of China

China's HIV epidemic is now a growing reality, yet there is virtually no evidence of it in the HIV/AIDS literature. This report documents ethnographic and epidemiologic findings from field visits conducted in Beijing, Chengdu, and Kunming; the latter in Yunnan province, site of China's most severe nidus of HIV infection. This report also elaborates those cultural, social, and political factors involved in China's attempt to manage its growing HIV epidemic. Contemporary attitudes toward sexuality in China which impinge upon such management, as revealed through ethnographic interviews, are reviewed. Data from the First Sino‐American Management of HIV Disease Symposium (to which the author was a delegate) are also blended with the ethnographic material to further clarify the cultural and epidemiologic status of HIV/AIDS in China. It is the conclusion of this report that HIV/AIDS and its management pose a transforming, ineluctable challenge to China's traditional attitudes toward sexuality.     

Sexual behavior and AIDS knowledge of young male prostitutes in Manhattan

Despite their presumed high risk for AIDS, there are almost no sexual behavior data available which are sufficient for the development and assessment of intervention programs for male prostitutes. This study was designed to obtain such data. Fifty 14–27‐year‐old male prostitutes in Manhattan were interviewed using structured instruments to assess sexual orientation, sexual behavior, knowledge of AIDS, and substance abuse. The sample was 50% homosexual, 26% bisexual, and 24% heterosexual. High rates of condom use were found for anal intercourse (average 85%). Subjects were safest in sex with male customers, less safe with male partners for pleasure, and least safe with female partners. Differential use of condoms plus other unsafe sexual activities continue to place the male prostitute at risk for HIV infection. AIDS knowledge was high and positively correlated with safety of sex. Drug and alcohol abuse and dependence were frequent, although there was little intravenous drug use. These and other variables were not significantly associated with degree of safety in sex. The methods employed in this study can be used to assess other populations of male prostitutes as well as intervention programs.     

Will It Be Silence and Violence or Safety and Prevention for the Next Generation of Gay Youth?

Rates of unprotected anal intercourse and HIV infection are alarmingly high among young gay males. This second wave of infection indicates that traditional models for AIDS education are not working. AIDS educators need to rethink HIV-prevention efforts. Studies consistently find a high level of knowledge about HIV transmission and high levels of commitment to safer sex among gay males, but what accounts for the breakdown between safer sex intentions and practices among them? This article employs social constructionist and queer theoretical assertions that sexuality is socially and culturally produced in complicated and pluralist ways. The analysis examines how risky sexual situations shape young gay males' sexualities by exploring two examples selected to represent, alternatively, models of safer sexual and unsafe sexual trajectories. Implications for HIV prevention practices and policies are discussed.     

Implications of increased infectivity in early-stage HIV infection. Application of a Bernoulli-process model of HIV transmission

Recent reports suggest that the infectivity of sexually transmitted HIV (i.e., the probability of transmission on a single sexual contact) may be up to 1,000 times greater during the first few months of infection than during the long asymptomatic period that precedes the development of AIDS. Assuming the validity of this estimate, a simple Bernoulli-process model of HIV transmission indicates that, in some cases, the expected number of secondary infections is greater for the brief period of primary infection than for the much longer asymptomatic phase. The implications of these findings for current HIV/AIDS prevention practices are analyzed with particular attention to the role of condom use in preventing HIV transmission.     

A support group for individuals recently testing HIV positive: A psycho‐educational group model

The present paper describes an eight‐week psycho‐educational group model that is easily adaptable to any agency that is concerned with a comprehensive package of services for counseling HIV + persons, as well as for others involved in the long‐term management of issues related to the health threat presented by HIV infection.     

Marital Aspirations,Sexual Behaviors,and HIV/AIDS in Rural Malawi

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in‐depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long‐overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.     

Between skepticism and empowerment: the experiences of peer research assistants in HIV/AIDS,housing and homelessness community‐based research

People living with HIV/AIDS (PHAs) in Canada are a highly researched population, yet their inclusion in the research process is minimal. Community‐based research (CBR) has become a recognized tool for addressing issues of power and exclusion within researcher/community relationships by inviting the community's equitable involvement as research partners. Within the context of HIV/AIDS research, this includes a commitment to the Greater Involvement of People Living with HIV/AIDS (GIPA) at all stages of the research process. One way of adopting GIPA principles within CBR is through providing employment, research training, and capacity building opportunities for PHAs as peer research assistants (PRAs). Drawing on data from two in‐depth focus groups with seven PRAs from the Positive Spaces, Healthy Places: Community‐based Research Study, this paper will highlight important methodological practices for academic and community‐based researchers who are working with and supporting PRAs.     

Research with Gay Drug Users and the Interface with HIV

Abstract

Studying the co-occurrence of drug use and sexual risk behaviors among gay men poses special challenges for research. The importance of conducting such research, however, is underscored by current trends in the gay community, including increases in methamphetamine and club drug use. This increase has been associated with high-risk behavior for the transmission of HIV and other diseases (e.g., hepatitis B and hepatitis C). The author describes methodological issues related to initiating and conducting research among gay male drug users, and discusses how such research can guide more effective prevention, treatment, and policy initiatives related to drug abuse and HIV/AIDS.     

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.     

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.     

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.     

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.     

The Economics of HIV/AIDS: A Survey

This article surveys the main economic issues associated with the HIV/AIDS epidemic, paying special attention to sub–Saharan Africa. It explores the economic and behavioural determinants of HIV transmission, the microeconomics of market failures associated with high HIV prevalence, the prospects for regional development from a macroeconomic perspective and the efficient design of policies for coping with the epidemic. In line with the recent appeal by the UN Secretary General, the article argues that, without a decisive effort to halt HIV/AIDS, people living in the region are bound to experience a further fall in their standard of living in both relative and absolute terms. However, to be effective, anti–AIDS programmes must be rooted in sound economic principles.     

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.     

Chapter 12. Families Caring for Persons with HIV/AIDS

SUMMARY

The extent to which family members are willing and able to assist with daily activities and provide emotional support can greatly affect the quality of life for persons with chronic illness. In the case of HIV/AIDS, the burdens of symptom management and medication are amplified by social stigma. This chapter provides a summary of the physical, psychological, social, and spiritual issues associated with HIV/AIDS along with approaches to assessment and treatment.     

Sex,drugs and matrices: Mathematical prediction of HIV infection

The purpose of this paper is to consider a very simple model of the AIDS epidemic. This model illustrates how the spread of AIDS can be affected by parameters whose values, at the present time, are very imprecise or unknown. Of particular interest are the data related to sexual encounters and practices, data which are often unreliable or ambiguous. In this regard, the present model also suggests that the epidemiology of AIDS is particularly sensitive to the limitations in the assessment of sexuality/drug‐related behavior. Using a system of elementary differential equations, the present paper illustrates (using 3 examples) that depending upon the value of critical parameters, one could predict either very rapid increases of seropositivity or a decreasing rate of seropositivi‐ty. Thus, in order to diminish the ambiguity, it becomes crucial to make careful estimates of the sexual “interaction” coefficients, along with all other parameters, to insure that reasonable predictions can be made.     

HIV/AIDS and work: The implications for occupational therapy

Improvements in preventive and rehabilitative care have transformed many cases of Human Immunodeficiency Virus (HIV) from being an absolute fatal disease to a chronic, expensive illness. As survival rates and life expectancy increase for people with HIV/AIDS, work plays a more central role in improving their quality of life [5]. Persons with HIV/AIDS face numerous physical challenges in maintaining employment. Signs and symptoms of HIV infection and related opportunistic infections include fatigue, muscle weakness, neuropathy and decreased sensation, bowel and bladder incontinence, persistent cough, weight loss, decreased range of motion and coordination, limited endurance, cardiac problems and vision loss. Occupational therapy practitioners must identify the unique impact they can make on a client's quality of life by addressing work-related issues faced by the HIV/AIDS population.     

Sinic conundrum: A history of HIV/AIDS in the people's republic of china

China's HIV/AIDS case rate continues to grow despite national and World Health Organization efforts. Reports in Western journals are nearly nonexistent, and what is in print does not provide evidence of the infection's historical progress. I traced progress of the infection since my last report (1991) and based current findings on unobtrusive data [HIV blood screening (assays)] provided by State epidemiology‐prevention stations and on ethnographic interviews conducted with public health officials from the Center for AIDS Surveillance, Chinese Academy of Preventive Medicine, and epidemiology personnel in Beijing, Chengdu, Chongqing, and Shanghai during fieldwork in China in 1992 and 1993. Cultural, social, economic, and political factors involved in China's historical attempts to manage a growing HIV case rate are discussed. Together, data reveal a widening geographic and social distribution of the virus over time, which, in conclusion, should now qualify China's HIV status as epidemic.