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 .     

Mitigating an elephantine epidemic: gendered space for HIV/AIDS outreach through Namibian conservancies

As the reach of HIV/AIDS continues to devastate communities and create potential pressures on natural resources, conservation organizations have increasingly become involved in education and outreach to address the disease. This paper’s purpose is to investigate how increasing HIV infection rates and AIDS deaths relate to community-based conservation and livelihood strategies in the Caprivi Region of northeastern Namibia, and demonstrate that conservation organizations can play a unique role in combating the disease. As the epidemic is more widespread in the Caprivi than in any other region of the country, local organizations such as Integrated Rural Development and Nature Conservation (IRDNC) are responding to the disease by integrating it into conservation work. IRDNC’s efforts reflect a particular focus on gender, including changes in the way that HIV/AIDS is discussed in local communities, strategies to promote access to testing and care, and bringing to light the experiences of individuals and families struggling with HIV/AIDS. This approach shows that there are benefits to be gained from approaching HIV/AIDS mitigation through familiar, existing structures such as those of community conservancies in Namibia—especially the ability to circumvent heavy local stigma. Using data collected through participant observation and participatory discussions, this paper demonstrates that conservation programs can positively affect people with HIV/AIDS, highlighting the importance of mainstreaming outreach efforts that address the particular localized manifestations of the disease in the context of natural resource management.     

No One Is Immune: A Community Education Partnership Addressing HIV/AIDS and Older Adults

There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network.     

HIV/AIDS,Social Capital,and Online Social Networks

The prospects for online social networks as sites of information-gathering and affiliation for persons with AIDS and others concerned about HIV/AIDS not only represent the latest development in a trend toward circumventing traditional media and official information sources, but also may offer hope for a revitalization of HIV/AIDS discourse in the public sphere. This article provides an overview of three decades of information-seeking on the pandemic and its social and personal implications, as well as case studies of three examples of social networking surrounding HIV/AIDS. It finds preliminary evidence of the formation of strong and weak ties as described in Social Network Theory and suggests that the online accumulation of social capital by opinion leaders could facilitate dissemination of messages on HIV/AIDS awareness and testing.     

Demarcating forest, containing disease: land and HIV/AIDS in southern Zambia

The ongoing HIV/AIDS pandemic in southern Africa continues to manifest itself in unexpected ways. While the consequences of the disease appear straightforward in some aspects—e.g., medical, labor, cost—in other respects the repercussions, while large, are nonetheless highly nuanced and can be counterintuitive. This paper reports on the intersection of HIV/AIDS, migration, livelihood adaptation, land tenure, and forest conservation, to outline how adaptation to the pandemic has reworked significant aspects of land tenure to result in increased forest conservation in southern Zambia in the near to medium-term. The research uses a combination of ethnography, case studies, household survey and spatial analyses and finds that HIV/AIDS is used in customary legal settings to enhance land access. We also draw links to practical and theoretical implications of the relationship between HIV/AIDS, land tenure, and deforestation in Sub-Saharan Africa.     

Attitudes and Stereotypes Regarding Older Women and HIV Risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.     

The Impact of the AIDS Pandemic on Health Services in Africa: Evidence from Demographic and Health Surveys

We document the impact of the AIDS crisis on non-AIDS-related health services in 14 sub-Saharan African countries. Using multiple waves of Demographic and Health Surveys (DHS) for each country, we examine antenatal care, birth deliveries, and rates of immunization for children born between 1988 and 2005. We find deterioration in nearly all these dimensions of health care over this period. The most recent DHS survey for each country collected data on HIV prevalence, which allows us to examine the association between HIV burden and health care. We find that erosion of health services is the largest in regions that have developed the highest rates of HIV. Regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions shouldering the heaviest burdens have seen the largest erosion in non-HIV-related health services for pregnant women and children. Using semiparametric techniques, we can date the beginning of the divergence in the use of antenatal care and in children’s immunizations between high- and low-HIV regions to the mid-1990s.     

Stigma and Salvation: Advertising HIV Awareness in New York City: A Case Study

Popular culture representations and negotiations of HIV/AIDS have fluctuated over the last several decades, and awareness of the illness and its causes has grown due to better education and extensive cultural dialogue. The following examines two contemporary HIV/AIDS public health campaigns in the New York City area. Although there have been limited improvements in the portrayals of HIV-positive individuals, advertising focused on HIV awareness still does not directly address prevention. These two campaigns encourage two distinct messages; one that reinforces the stigma attached to HIV/AIDS and one that promises salvation.     

Using innovation to address HIV, AIDS, and environment links: intervention case studies from Zimbabwe, Uganda, and Malawi

This article presents three cross-cutting intervention case studies that address HIV, AIDS, and natural resources management in an integrated manner through innovative programming in Zimbabwe, Uganda, and Malawi. In Zimbabwe, a religious-based non-governmental group and two community organizations work together to build skills of HIV- and AIDS-vulnerable children in rural areas to meet dietary and income needs, while using natural resources sustainably. In Uganda, various government agencies and NGO actors work together to improve the food security of HIV-affected households at the national, district, sub-district, and village levels. Finally, in Malawi, a conservation organization incorporates HIV and AIDS awareness and programming into its operations and projects. Each case study presents pioneering approaches to simultaneously addressing the pressures on conservation initiatives, food security/agricultural production, income generation/livelihoods, and social and health care systems. They also provide lessons for expanding interventions and partnerships.     

Accessibility of health and human services for the HIV-infected

Most research on services for the HIV/AIDS population has focused on primary medical care or on service brokering by advocacy groups. Little research data exist on the extent to which services of programs that do not specialize in HIV/AIDS clients are available to these individuals who often have multiple and multi-dimensional problems. The reported research examines selected data from a sample of 236 medical, behavioral health and social service programs in Miami-Dade County, Florida. A constructed measure of involvement in services for HIV/AIDS clients, pertinent provider program and client characteristics are examined in the context of geo-distributed data on reported AIDS cases and census data. In logistic regression analyses, two aspects of race/– the population in the zip code area served by the program, and the clients or patients seen in the program – were significant in predicting program under-response, defined as level of response relative to cumulative reported AIDS cases from the program's zip code area. The analysis is briefly discussed regarding its relevance and methodological generalizability for HIV/AIDS and related public health policy and applied purposes.     

Sexuality and HIV/AIDS: An Exploration of Older Heterosexual Women's Knowledge Levels

Sexuality research tends to ignore older populations, and little is known about older women's sexual health knowledge. To fill this research gap, 186 Canadian heterosexual women 50 years and older were surveyed about their knowledge regarding sexuality and HIV/AIDS. Respondents had moderate levels of overall knowledge of sexual health and aging, correctly answering, on average, 60% of the 35 questions. They had lower levels of HIV/AIDS knowledge, correctly answering just over 50% of the 25 questions. Results indicate the need for social awareness and education in this group regarding both general sexual health later in life and HIV/AIDS.     

The integration of support for HIV and AIDS and livelihood security: district level institutional analysis in southern Africa

Livelihood insecurity, HIV and AIDS, and environmental change, including high climate variability, have negatively impacted the southern African region for the last decade. It is increasingly evident that there is a complex interplay of factors shaping rural livelihoods at various scales. Recognition of the varied impacts of HIV and AIDS has led to development of a conceptual framework that utilises the ‘AIDS Timeline’ or ‘Programming Matrix’, which enables differential intervention strategies to be adopted depending on the dominant impacts and trends on livelihoods. This paper presents this approach and links it to case study material from two districts in Malawi and South Africa. The evidence suggests that although there are some areas where HIV and AIDS are mainstreamed into livelihood security interventions, this is not sufficient, as holistic environmental and social approaches are not adopted. This paper reflects on the fieldwork findings to link to the AIDS Timeline in support of appropriate interventions. At the same time, we highlight the urgency in addressing the meso-scale and adopting a holistic framework that addresses livelihood security from a range of angles, including the implications for the chronically ill, interactions with environment and the capacity to implement change.     

The United States and Japan pursue a common agenda

In July 1993, the US and Japan formed the "Common Agenda for Cooperation in Global Perspective," an economic alliance to promote health and human development, respond to challenges to global stability, protect the global environment, advance science and technology, and foster exchanges for mutual understanding. A Global Issues Initiative (GII) has been created within this framework to support family planning, HIV and sexually transmitted disease prevention and control efforts, maternal and child health, primary health care, and women's empowerment. Participation in the GII has led Japan to more than double the technical assistance it provides and to broaden its geographic focus from Asia to the entire developing world. The US continues to fund population and health programs in more than 50 countries. The Common Agenda grew out of a US-Japan development assistance policy consultation dialogue known as the "Honolulu process," which sought ways to promote mutual understanding among US and Japanese development assistance personnel (through international internships) and nongovernmental organizations and to identify specific areas for joint or parallel development projects. Cooperative activities are underway in the Philippines, Indonesia, Bangladesh, India, Ghana, Peru, Guatemala, Mexico, and Jamaica. Joint project evaluations have also taken place in Zambia and Ghana. The Common Agenda's Children's Health Initiative has supported such initiatives as achieving child immunization in the Newly Independent States and joint efforts to eradicate polio and micronutrient disorders. The Women in Development initiative enhances girls' education and assists women engaged in small-scale enterprises. After initial difficulties in agreeing on joint strategies, the Common Agenda has been an "overwhelmingly positive" experience with the potential to meet critical challenges, because Japan and the US account for 40% of all development assistance worldwide.     

中国老年艾滋病的流行状况分析

艾滋病在中国的迅速流行已是不争的事实,但是人们普遍认为“艾滋病是年轻人的病”。调查资料显示,50岁及以上的老年艾滋病病毒感染者报告人数已达到全国感染者的1/10,并呈快速增长趋势。老年感染人群的主要感染渠道以既往有偿献血感染为主。老年艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人增多无论对家庭还是对社会均产生严重的后果,在艾滋病预防和控制战役中,老年是一个不可忽略的人群,应引起高度重视。     

Drought and disproportionate disease: an investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations

Environmental change and climate-related disasters are an under-examined factor impacting women’s health, globally. Drawing on ecofeminist theory, we conduct analyses examining if the HIV burden among women is higher in nations that experience suffering from droughts. Specifically, we posit that droughts, which typically impact more people and for greater lengths of time than other climate-related disasters, have a unique impact on women’s vulnerability to HIV/AIDS. We use a cross-national dataset of less-developed countries and ordinary least squares (OLS) regression to explore and compare relationships between suffering from drought and total HIV prevalence and suffering from drought and women’s proportion of HIV cases. Overall, the results demonstrate that while droughts have an inconsistent impact on total HIV prevalence, suffering from drought significantly increases the proportion of HIV cases among women in comparison to men, net of the impact of common economic, social, cultural, and political predictors. The findings suggest that suffering from drought differentially impacts women’s health in less-developed countries, where a number of mechanisms, such as transactional sex or displacement, likely underlie the associations identified.

     

Disease risk and fertility: evidence from the HIV/AIDS pandemic

A fundamental question about human behavior is whether fertility responds to disease risk. The standard economic theory of household fertility decision-making generates ambiguous predictions, and the response has large implications for human welfare. We examine the fertility response to the HIV/AIDS pandemic using national household survey data from 14 sub-Saharan African countries. Instrumental variable (IV) estimates using distance to the origin of the pandemic suggest that HIV/AIDS has increased the total fertility rate (TFR) and the number of surviving children. These results rekindle the debate about the fertility response to disease risk, particularly the HIV/AIDS pandemic, and highlight the question of whether the HIV/AIDS pandemic has reduced GDP per capita.     

社会性别化的风险、经历与反应——对美国妇女与艾滋病的探讨

艾滋病目前已成为美国一个严重的社会问题和大众健康问题。妇女从 2 0世纪 80年代在边缘徘徊 ,到 90年代已陷入了该危机的“震中”。本文将从女权主义的视野来审视这场社会性别化的传染病 ,即把社会性别当作主要变量来考察它同种族、族裔、阶级、性取向以及文化等诸因素的交叉互动 ,并从纷繁复杂的艾滋病现象和文献中梳理出妇女与艾滋病关系上的社会性别差异。文章最后将提出若干可资借鉴并值得我们警觉的建议     

Environmental Change,Risky Sexual Behavior,and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti

Local natural resources are central to rural livelihoods across much of the developing world. Such “natural capital” represents one of several types of assets available to households as they craft livelihood strategies. In order to explore the potential for environmental scarcity and change to contribute to perpetuation of the HIV/AIDS pandemic, we examine the association between declining natural capital and engaging in risky sexual behaviors, as potentially another livelihood strategy. Such an association has been demonstrated in Kenya and Tanzania, through the fish-for-sex trade. To explore the possibility of this connection within rural Haitian livelihoods we use Demographic and Health Survey data, with a focus on rural women, combined with vegetation measures generated from satellite imagery. We find that lack of condom use in recent sexual encounters is associated with local environmental scarcity—controlling for respondent age, education, religion and knowledge of AIDS preventive measures. The results suggest that explicit consideration of the environmental dimensions of HIV/AIDS may be of relevance in scholarship examining factors shaping the pandemic.     

流动人口行为特征及其空间过程与HIV/AIDS扩散

流动人口的行为特征及其空间过程是HIV/AIDS扩散的重要因素之一,其行为特征的高危性和流动性使流动人口成为HIV/AIDS的易感人群,在其流动的空间过程中与不同类型人口的相互接触,当发生与HIV/AIDS人群的高危行为时,一方面容易使自己感染HIV;另一方面,流动人口成为HIV携带者后与其他人发生高危行为则会成为HIV的传染源之一,其结果是导致了HIV/AIDS在感染者数量和感染空间上的扩散。因而,针对流动人口高危行为特征及其空间过程提出防控HIV/AIDS扩散的对策是可行的。     

Internalized Homophobia,HIV Knowledge,and HIV/AIDS Personal Responsibility Beliefs: Correlates of HIV/AIDS Discrimination among MSM in the Context of Institutionalized Stigma

ABSTRACT

There exists a paucity of research on the psychosocial risk factors of HIV/AIDS among men who have sex with men (MSM) in settings where they are stigmatized or face prosecution. The present study investigates discrimination against people living with HIV (PLHIV), internalized homophobia, HIV/AIDS personal responsibility beliefs and HIV knowledge in a purposive sample of 106 self-identified MSM obtained through a web-based survey disseminated by two voluntary welfare organizations. Results indicate that internalized homophobia is positively associated with discrimination against PLHIV. Internalized homophobia also substantially mediates the effect of HIV/AIDS personal responsibility beliefs on discrimination against PLHIV, highlighting the confounded nature of HIV/AIDS and homosexual stigma in a setting where stigma is deep-rooted and institutionalized. Internalized homophobia may thus serve as a barrier to the effectiveness of HIV prevention efforts among MSM in Singapore.