AIDS Prevention via Computer-Based Intervention

The dangers posed by AIDS and the human immunodeficiency virus (HIV) are well known. Government, media, and medical organizations have provided extensive information on AIDS and on how to protect oneself against infection. Nevertheless, this fatal and irreversible disease continues to claim new victims. Clearly, there is an urgent need to develop new methods of educating the public about AIDS prevention. This paper reviews a new, interactive microcomputer approach to educating at-risk adolescents about AIDS. Emphasizing culturally sensitive and interactive approaches to prevention, the authors describe, illustrate, and assess interactive strategies and computer-based content for reducing the risks of AIDS and HIV among Black and Hispanic youth.     

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.     

HIV/AIDS and other household shocks as catalysts of local commercialization of non‐timber forest products in Southern Africa

Local trade in non‐timber forest products (NTFPs) is increasing globally, yet the causes have been little studied. We examine household shock as a driver of NTFP trade in five southern African countries, with an emphasis on HIV/AIDS‐related illness and death. Over the past two years, 95% of trader households experienced at least one shock, with family illness and death recorded for 68% and 42% of households, respectively. Almost 40% had entered the trade because of HIV/AIDS‐related shocks. Additional shocks included natural disasters, crop pests or failure and livestock loss. The sale of NTFPs was the third most common coping strategy, after kinship and agricultural adjustments. Coping strategies differed between sites and type of shock.     

Older people as resources in South Africa: Mpumalanga households

The extended family used to be relied upon to provide subsistence and care for older people in sub-Saharan Africa. However, recently South Africa has seen a reversal of roles, where older people now provide subsistence and care to younger generations; this role reversal is being accelerated by HIV/AIDS deaths among young adults. In most rural households, the non-contributory old age pension (OAP) that is means-tested is an important factor in making older people breadwinners. Using data from the 2004 Mpumalanga Older People's Survey, we examined the changing role of older people, which has been influenced mainly by changes in household structure and old age pension. Findings show that in 63% of matrifocal, multigenerational households, 76% of older people are the sole providers of household necessities, caring for the sick and grandchildren in increasingly skip-generation households.     

HIV/AIDS Prevention in the African American Community:

The high rate of AIDS cases among African Americans, especially women, suggests that HIV risk reduction behavior change programs and messages have not been highly successful in preventing HIV transmission among this population. This paper recommends that the situational and environmental context of African Americans' lives, and their responses to HIV/AIDS be addressed and incorporated into HIV prevention programs in an effort to make these programs more relevant to high risk African Americans. A multilevel system intervention approach grounded in an ecosystem perspective which focuses on the community as the primary target level of intervention is proposed to increase the effectiveness of HIV prevention efforts among African Americans.     

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.     

Sexuality,Morality and Lifestyle: The ABC of HIV Prevention Strategies in Rural Papua New Guinea

This article explores the national program for the prevention of the spread of HIV/AIDS in Papua New Guinea and its intersection with the experiences of a rural community in Western Province. The social marketing of HIV/AIDS awareness and prevention has seen an influx of categories and definitions of people, sexual behaviour and HIV/AIDS that have the potential to create confusion, but also spaces in which rural populations can understand and conceptualise AIDS. In the present paper, the preventative program is examined from the perspective of the Gogodala, whose understandings of sickness and prevention are based on an intimate and interactive relationship with the local environment. In this context, ‘lifestyle’ (ela gi) and the maintenance of certain ‘laws’ is the primary method of sickness prevention. I argue that an exploration of the local dynamic between sexuality, morality and lifestyle is vital to the evaluation of the impact of these awareness and prevention programs and the possibilities for future prevention strategies.     

Risk, sexuality and economy

From the mid 1980s onwards HIV/AIDS became a new subject of work reform, with a range of experts producing new knowledges on work and the worker in regard to HIV/AIDS and workplace organizations putting in place workplace HIV/AIDS policies and programmes. To date, much of the discussion in sociology in regard to such policies and programmes has focused on the issue of effectiveness and has been concerned with making such policy 'better'. In this article however, and with particular reference to sexuality, I suggest that such approaches fail to register that workplace HIV/AIDS policies concern new conceptualizations of worker identities. Specifically, I suggest that such policies may be viewed as part of an assemblage of work reforms which are reworking worker identities as risk identities. Thus I argue that workplace HIV/AIDS policies and programmes are best understood as risk rationalities. Further, I consider the alignment between such rationalities and neo-liberal modes of rule, and in particular consider the ways in which workplace HIV/AIDS policies render both HIV/AIDS and sexuality calculable and governable in terms of notions of risk, self-responsibility and self-management.     

Work status, benefits, and financial resources among people with HIV/AIDS

With the advent of more advanced treatments and therapies, people with HIV/AIDS are experiencing significant improvements in their health, making many of their ongoing employment and career goals more realistic. However, people with HIV/AIDS continue to have major concerns regarding the impact of working on their benefits and entitlements, including apprehensions about potential economic hardships related to loss of financial supports and health insurance coverage. This article focuses on factors related to employment status, sources of health benefits, and entitlements among people with HIV/AIDS. In addition, results of the study demonstrate differences in employment status, benefit types, and the amount of financial support individuals receive based on gender.     

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.     

Improving ascertainment of risk factors for HIV infection: results of a group-randomized evaluation

To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched prior to randomization to intervention or control, and generalized linear mixed models were used to test for an intervention effect. Twenty-one percent of cases from intervention facilities and 33.4% from control facilities (p = .09) were reported without any risk factor information. The pre-post difference (20.7% for intervention and 36.0% for control) was not significant among HIV cases (p = .11) nor among AIDS cases (p = .12; 21.3% for intervention and 31.1% for control). The methods the authors' evaluated may need to be combined with other approaches and/or alternative classification schemes to significantly reduce the percentage of cases reported to surveillance without risk factor information.     

USE OF EXPERT RATINGS AS SAMPLING STRATA FOR A MORE COST-EFFECTIVE PROBABILITY SAMPLE OF A RARE POPULATION

We consider situations in which externally observable characteristics allow experts to quickly categorize individual households as likely or unlikely to contain a member of a rare target population. This classification can form the basis of disproportionate stratified sampling such that households classified as "unlikely" are sampled at a lower rate than those classified as "likely," thereby reducing screening costs. Design weights account for this approach and allow unbiased estimates for the target population.We demonstrate that with sensitivity and specificity of expert classification at least 70%, and ideally at least 80%, our approach can economically increase effective sample size for a rare population. We develop heuristics for implementing this approach and demonstrate that sensitivity drives design effects and screening costs whereas specificity only drives the latter. We demonstrate that the potential gains from this approach increase as the target population becomes rarer. We further show that for most applications, unlikely strata should be sampled at 1/6 to ? the rate of likely strata.This approach was applied to a survey of Cambodian immigrants in which the 82% of households rated "unlikely" were sampled at ? the rate as "likely" households, reducing screening from 9.4 to 4.0 approaches per complete. Sensitivity and specificity were 86% and 91% respectively. Weighted estimation had a design effect of 1.26 so screening costs per effective sample size were reduced 47%. We also note that in this instance, expert classification appeared to be uncorrelated with survey outcomes of interest among eligibles.     

Beyond the Gender Differential: Very Young Children Coping with HIV/AIDS

This article reports on a recent study of HIV/AIDS which investigated the role of gender in the experiences of young children in one region of Namibia. The findings reveal that while gender is reported to shape school‐age girls and boys’ experiences of being infected or affected by HIV/AIDS in many African nations, gender was not an influential variable in the experiences of very young children coping with HIV/AIDS. Conditions of poor health, deprivation and stigma were equally distributed amongst young girl and boy participants. Connectivity with families and communities was shown to be influenced by living conditions but not differentiated by gender. No gender differences were identified regarding young childrens’ sense of hope and vision for the future. The article implies that there may be a particular juncture when gender begins to make a difference in the life of girls and boys—and that this could be an important focus for research. Copyright © 2006 The Author(s).     

Kin and Youths in the Social Networks of Youth‐Headed Households in Namibia

In settings highly affected by HIV/AIDS, households headed by children may result from strained family relations, poverty, and stigma associated with the disease. Understanding local systems and dynamics of support is essential to planning comprehensive models of care. This study measured size and composition of the support and conflict networks of 27 children and youth heads of household in northern Namibia and documented their perceptions of adequacy. Results showed a strong presence of and satisfaction with kin and peers as supporters, which challenges the assumptions that these households have few functional ties to family and that adults are the sole providers of support. Assistance to children without parental supervision should build on existing local strategies and children's resources.     

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.     

Chapter 4: Lesbians and HIV Disease

Lesbian women, both as individuals and as a community, are affected by the AIDS crisis. They are found among the carriers of HIV and among personal caretakers. They are among the activists, the professionals, and the volunteers whose energy and commitment drives AIDS political and service organizations. This article explores some of the problems and issues that have emerged in the relationship of lesbian women to HIV disease and to the AIDS movement. The author examines: (1) problems related to the identification and treatment of lesbians infected with HIV; (2) problems related to the absence of research and education about woman-to-woman sexual transmissions of HIV; (3) the involvement and motivation of lesbians in the development of AIDS activist and service organizations; and (4) the transformational quality of the AIDS crisis and the questions and reevaluations it has stimulated among lesbians, especially with regard to homophobia, classism, and sexism.     

Women and HIV:

Women constitute one of the fastest growing groups of people infected with HIV. Women have always been affected by HIV as informal or formal caregivers. Despite this, HIV services and education have been directed almost exclusively towards men. Given that women comprise half of the workforce, the change in the face of the epidemic requires a reexamination of the EAP professional's approach to AIDS education and services. This article delineates HTV-related issues specific to women and their impact on the functions of the EAP. Suggestions are made for targeting AIDS workplace education and prevention to women. The implications of women's issues on early identification, counseling, and referral by EAP professionals are also explored. Consideration is given to the cultural and socioeconomic diversity of women affected by HIV.     

Marketing the Damaged Self: The Construction of Identity in Advertisements Directed Towards People with HIV/AIDS

This paper explores the identities projected in advertisements directed towards HIV positive individuals and people with AIDS. Fifty such advertisements were collected from three popular American magazines for gay men over a period of seven months. Analysis of the ads reveals a paradoxical presentation of people with HIV/AIDS, which offers simultaneous conflicting images of hope and fear, power and weakness, innocence and guilt. An interactive sociolinguistic model through which this contradictory discourse might be understood is presented, drawing on Goffman's insights on stigma management and the presentation of the self in social interaction. Advertisements directed towards people with HIV/AIDS, it is suggested, present a contradictory discourse in which the advertisers are positioned as 'the wise', offering to mediate the conflicting identities of the stigmatized. The identity values enacted in this contradictory discourse are further measured against American conceptions of communication and the self as observed by Carbaugh and others. The possible consequences of these positionings on the roles made available to people with HIV/AIDS in the wider social context are discussed.     

The assessment of sexual practices relevant to the transmission of AIDS: A global perspective

Despite global similarities between the immunologic and pathogenic properties of HIV infection, there are substantial cultural and geographical variations in the transmission dynamics of HIV infection/AIDS. In the United States and Europe, for example, HIV infection/AIDS is predominantly evident among homosexual men and intravenous drug abusers. However, in Central Africa, the data indicate that HIV infections/AIDS is heterosexually acquired. Thus, the purpose of the present paper is to suggest some basic strategies and raise some critical issues for collecting data on sexual practices relevant to the transmission of HIV infection/AIDS throughout the world. Topics include assessment strategies, language and meta‐language, cross‐cultural and intra‐cultural comparability, general methodological issues, and constraints for the assessment of anal intercourse.     

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.