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.     

Internet Use Among People with HIV/AIDS

ABSTRACT

The Internet offers people with HIV/AIDS timely information about treatment advances and supportive social contacts for this stigmatized disease, yet little is known about Internet use patterns among people with HIV/AIDS. This study of 120 persons with HIV/AIDS in the U.S. found approximately 19% used the Internet for HIV/AIDS-related purposes, much lower than the rate for general Internet use among the U.S. population. Lower incomes were associated with lower rates of use, echoing the “digital divide” found in the general population. Access from home was most common and information sought was primarily on medical treatments and medications. Possible reasons for low access rates, strategies for increasing access, and implications for other client groups are discussed.     

Social support on Weibo for people living with HIV/AIDS in China: a quantitative content analysis

The Internet has recently become an important source of social support. People living with HIV/AIDS (PLWHA) in China created an online support group (the HIV/AIDS Weibo Group) on Weibo, the Chinese equivalent of Twitter, in January 2011. To investigate social support in the HIV/AIDS Weibo Group, the content of all 7215 messages posted in this Weibo group since its launch on 18 January 2011, was analyzed. The analysis demonstrates that the majority of messages fell into the category of social support. Moreover, social support provisions were far more frequent than social support requests. The results also show that informational support, compared with emotional and instrumental support, was the most frequently requested and provided type of support in this Weibo group.     

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.     

Stigma Management Among Gay/Bisexual Men with HIV/AIDS

People with HIV infection are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. To manage the stigma of their disease, they mount complex coping strategies. This paper reports results from a qualitative study that examined gay/bisexual men's experiences of living with HIV infection. Unstructured interviews from a diverse sample of 139 men were analyzed to examine how men coped with AIDS-related stigma. We discerned a variety of stigma management strategies that could be arranged along a continuum from reactive to proactive based on the extent to which they implicitly accepted or challenged the social norms and values that underlie the stigmatization of HIV/AIDS. Reactive strategies to cope with stigma involve defensive attempts to avoid or mitigate the impact of stigma, but imply acceptance of the underlying social norms and values that construct the stigma. Examples of reactive strategies include hiding one's HIV status, presenting one's illness as a less stigmatizing one (e.g., cancer), or distancing one's self from more damaging aspects of AIDS-stigma (e.g., attributing infection to blood transfusion). Proactive strategies challenge the validity of the stigma and imply disavowal and resistance of the social norms and values that underlie the stigma. Examples of proactive strategies include engaging in public educational efforts that address misperceptions about HIV transmission and social activism to change the social and political conditions that affect PWA/HIV.     

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.     

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.     

Women in India: The Context and Impact of HIV/AIDS

ABSTRACT

The response to the HIV/AIDS epidemic on the Indian subcontinent has been hampered by several factors, including societal stigma, lack of educational resources, lack of economic opportunities, and the competing priorities for a nation just growing and developing an infrastructure for education, industry, and health. In particular, Indian women are silent victims in this epidemic because they do not readily have a respected voice in decision making and priority setting for the government. The epidemic is increasingly affecting and infecting Indian women (e.g., female commercial sex workers, married women, and pregnant women). The status of Indian women has placed them at extreme disadvantage because India is a country with socially progressive laws but has been slow to change its social norms. The reported HIV prevalence is low although many researchers agree a large amount of underreporting occurs. For India to address this emerging epidemic among women appropriately, it should focus on three intervention areas: (1) short-term solutions such as treatment options for those already infected with HIV to prevent further infection to sexual partners and children; (2) intermediate solutions such as education for those who are uninfected but engaging in behaviors that may put them at risk, such as injection drug use, engaging in commercial sex work, engaging in extramarital sexual relations, and having sexual partners who are not monogamous; and 3) long-term solutions such as addressing the root causes of inequality (e.g., disparities in education and employment and unwillingness to change social norms).     

Sifting Through Trauma: Compassion Fatigue and HIV/AIDS

This article explores the compassion fatigue of the author and the graduate students he supervised while conducting psychotherapy with persons living with HIV/AIDS at a counseling center in Atlanta, Georgia. The metaphor of a sifter is suggested to represent the self-care strategies that providers employ to avoid and manage compassion fatigue. Several vignettes are presented and discussed from the perspective of the provider. The vignettes facilitate an examination of the contribution of trauma experienced by persons living with HIV/AIDS to the compassion fatigue of social service providers. The author recommends a renewal of research in the area of compassion fatigue among social service providers working with these clients.     

阿拉伯国家艾滋病问题现状综述

本文概述了阿拉伯国家艾滋病问题的现状，分析了阿拉伯国家自身的文化、社会结构特点与艾滋病传播的关系，指出艾滋病已成为当今阿拉伯各国不可忽视的重要问题，同时也对阿拉伯国家防治艾滋病的前景做出了较乐观的估计。     

HIV/AIDS: Measuring an Evolving Virus

Many social work journal articles portray HIV as a chronic illness. Although HIV medical management has evolved, it is far from chronic for most of the world. With such rapid developments in the field of HIV/AIDS, this article examines validity of knowledge measurements developed pre-HAART. Further, what place does validity hold in the maintenance of these measurement devices? The authors review several widely used measurement scales utilized in developed nations—The Beliefs About Preventing AIDS, The HIV Knowledge Questionnaire, and The International IADS Questionnaire-English Version—to answer these questions and to promote understanding for social workers in the field of HIV/AIDS regarding validity of the instruments.     

Greater involvement of people living with HIV/AIDS in South Africa

This study reports on a pilot project, the greater involvement of people living with HIV/AIDS Workplace Model, which places trained fieldworkers living openly with HIV/AIDS in selected partner organisations sectors, where they set up, review or enrich workplace policies and programmes. The project adds credibility to partners' HIV/AIDS programmes and creates a supportive environment for people living with HIV/AIDS (PLWHA) and others to speak about HIV/AIDS. Eleven men and women living with HIV, aged between 30 and 45, and with varied life experiences and education levels, shared a willingness to speak about their HIV status in their workplace. They worked in very different environments but their collective experiences showed that PLWHA can add value to workplace HIV/AIDS programmes in a way that is relevant, effective, efficient, sustainable and ethical. They made companies and communities more aware of the intense need for HIV/AIDS policies and encouraged care and support for infected and affected people.     

College Students and HIV/AIDS: A Comparison of Nontraditional and Traditional Student Perspectives

Objective and Participants The authors compared nontraditional college students' knowledge and perceptions of HIV/AIDS and sexual practices with previously reported results about traditional students. Methods Nontraditional students completed an online survey with questions based on national HIV/AIDS surveys. Traditional students completed the same survey with paper and pencil. Results Overall, the authors found more similarities than differences between the 2 groups. The findings support previous research that suggests that although college students are knowledgeable about HIV and its risks, they express little personal concern about becoming infected. The authors also discuss how apparent differences between nontraditional and traditional students regarding personal concern about becoming infected, relationship status, and information sources may influence the development of effective prevention strategies geared toward nontraditional college students. Conclusions Institutional leaders need to adapt to these differences, and researchers should undertake additional studies to clarify these differences so that college students may be more effectively educated about HIV/AIDS and encouraged to get tested.     

Participatory action research on HIV/AIDS through a popular theatre approach in Tanzania

A participatory theatre approach stimulated communities to break the silence about sexual and cultural practices leading to HIV transmission, and then to openly discuss what they could do to reduce transmission. Participants were district officials, artists, village and ward leaders, youths, and entire communities. Community theatre specialists trained young community members in participatory research and theatre. These artists then researched and encouraged people in their communities to discuss and evaluate the factors contributing to HIV transmission in their communities. Discussion results were transformed into community and district level performances. This was a very successful IEC effort that identified key risk behaviours and locally developed culturally appropriate, relevant materials, delivered in a popular way. People reflected upon their situation and behaviour, and community leaders addressed harmful practices. Feedback sessions were held with co-ordinators and artists to record lessons learned and make recommendations for improving and expanding the programme.     

Fallout from Communism: The Role of Feminism in Fighting HIV/AIDS among Women in Russia

ABSTRACT

I have no political platforms. I don't like the system of rules the word ‘feminist’ implies.

—Roza Khatskelevich, New York Times, 2003     

Who Can Help People with HIV/AIDS in Africa? Governance of HIV/AIDS and Civil Society

This paper locates NGOs dealing with HIV/AIDS problems in sub-Saharan Africa into the larger governance context within which they function. This aims at a theoretical shift to assess the aspirational characteristics for the agency of NGOs that are used to legitimate contracting out implementation of internationally designed HIV/AIDS policies to these organizations. The paper interrogates the nature and impact of the governance structure on NGOs and then looks at the implications of this for HIV/AIDS. The questioning is based on a juxtaposition of the perspective of international policy fora in relation to civil society organizations with the way NGO work is perceived by the people at the receiving end of the policies. The paper suggests that as part of the international governance structure, NGOs are limited within the policy frameworks created by this structure. Furthermore, due to their organizational characteristics, NGOs lack capacity to establish sustainable long-term interventions relevant for sociocultural change as perceived by people themselves.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Differences in health-related quality of life among persons living with HIV/AIDS

We sought to identify differences in health-related quality of life (HRQoL) among a sample of HIV positive individuals receiving case management services in northern Florida. Our study consisted of 97 individuals receiving HIV case management that included 56 males (57.7%) and 81 African Americans (83.5%) who were 47.05 years old (SD = 9.33). HRQoL was measured using the HIV/AIDS Targeted-Quality of Life scale (HAT-QOL). Results show significant group differences in HRQoL by race, income, tobacco use, alcohol use, drug use, and CD4 cell count, despite only 43% of this sample being able to recall their most recent CD4 count. Translating these findings to inform practice, HIV care providers need to provide continuing education to patients about their disease status, knowledge, and treatment as it relates to self-care. Also, HIV care providers should be especially cognizant of the impact that tobacco, alcohol, and illicit drug use has on HRQoL for persons living with HIV/AIDS (PLHA) by working to assess social support, identify readiness for change, and make appropriate referrals for treatment.     

Transferring a University-Led HIV/AIDS Prevention Initiative to a Community Agency

Summary

Given the urgent need for HIV/AIDS interventions that will reverse current infection trends among urban minority youth, identifying effective and socially relevant approaches is of primary concern. HIV/AIDS prevention initiatives that are housed in, and led by, communities may address the limits of laboratory-based inquiry for this complex and socially-situated health issue. In this article, we describe the process of moving a researcherled, HIV/AIDS prevention research program—the Collaborative HIV/AIDS Adolescent Mental Health Project (CHAMP)—from a university laboratory to a community mental health agency with the goal of strengthening program access, effectiveness, and sustainability over time. We outline the framework, timeline, and responsibilities involved in moving the program, research, and technology from its original university base to a local community agency. From the challenges faced and lessons learned during this complex transfer process, we hope to enhance understanding of ways in which we can narrow the gap between academic and community leadership of HIV/AIDS prevention research.