Social networks and HIV/AIDS risk perceptions

Understanding the determinants of individuals' perceptions of their risk of becoming infected with HIV and their perceptions of acceptable strategies of prevention is an essential step toward curtailing the spread of this disease. We focus in this article on learning and decision-making about AIDS in the context of high uncertainty about the disease and appropriate behavioral responses. We argue that social interactions are important for both. Using longitudinal survey data from rural Kenya and Malawi, we test this hypothesis. We investigate whether social interactions--and especially the extent to which social network partners perceive themselves to be at risk--exert causal influences on respondents' risk perceptions and on one approach to prevention, spousal communication about the threat of AIDS to the couple and their children. The study explicitly allows for the possibility that important characteristics, such as unobserved preferences or community characteristics, determine not only the outcomes of interest but also the size and composition of networks. The most important empirical result is that social networks have significant and substantial effects on risk perceptions and the adoption of new behaviors even after we control for unobserved factors.     

HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

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.     

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.     

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.     

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 .     

Is education a risk factor or social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across public health periods

Early in the 30-year HIV/AIDS pandemic in Sub-Saharan Africa, epidemiological studies identified formal education attainment as a risk factor: educated Sub-Saharan Africans had a higher risk of contracting HIV/AIDS than their less educated peers. Later demographic research reported that by the mid-1990s the education effect had reversed, and education began to function as a social vaccine. Recent counter-evidence finds a curvilinear pattern, with the association between educational attainment and HIV/AIDS infection changing from positive to negative across the education gradient. To reconcile these inconsistent conclusions, a hypothesis is developed and tested that education at early stages functioned as a risk factor and later functioned (and continues to function) as a social vaccine. We reason that this shift in the direction of the education effect was concurrent with changes in the public health environment in SSA that early on heightened material benefits from educational attainment but later heightened cognitive benefits from schooling. Using the 2003/2004 Demographic Health Surveys from four Sub-Saharan African countries (Cameroon, Ghana, Kenya and Tanzania), we tested this hypothesis (differential effects of schooling) using non-linear regression analysis (probit), identifying the different public health periods and controlling for confounding factors. The results support the hypothesis that the education effect shifted historically in the HIV/AIDS pandemic in SSA as we hypothesized.     

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.     

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     

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.     

Factors associated with 'feeling suicidal': the role of sexual identity

This paper examines factors associated with feeling suicidal in a large sample of urban men in Sydney and Melbourne, aged 18-50, including heterosexual, gay and bisexual men, HIV antibody positive and HIV antibody negative. As in previous research, sexuality (being homosexual or bisexual) was found to be a major predictor of suicidality. The research went some way towards explaining the close relationship between feeling suicidal and sexual orientation. Sexuality interacts with feeling bad in that, once men feel moderately bad/depressed, they are more likely to feel suicidal if they are homosexual or bisexual than if they are heterosexual. In addition, the research found that experience of verbal abuse and physical assault (harassment) increased feeling suicidal for both heterosexual and gay/bisexual men, not just for homosexual men as suggested by previous research, and that social isolation in the form of living alone is a further risk factor. Seeking counseling help and taking sexual risks were also independently associated with feeling suicidal. These actions may result from feeling suicidal rather than the reverse, and their association with feeling suicidal warrants further research. Many of the 46 independent variables examined in the research, including HIV antibody status and closeness to the HIV/ AIDS epidemic, were related to feeling suicidal only through their association with being gay/bisexual. Celibacy and general risk taking were not related to feeling suicidal in this study.     

Marital strategies for regulating exposure to HIV

In a setting where the transmission of HIV occurs primarily through heterosexual contact and where no cure or vaccine is available, behavioral change is imperative for containing the epidemic. Abstinence, faithfulness, and condom use most often receive attention in this regard. In contrast, this article treats marriage as a resource for HIV risk management via mechanisms of positive selection (partner choice) and negative selection (divorce of an adulterous spouse). Retrospective marriage histories and panel data provide the evidence for this study and results indicate that men and women in Malawi increasingly turned to union-based risk-avoidance strategies during the period that the threat of HIV/AIDS materialized. Although both sexes strategize in a similar fashion, men are better equipped than women to deploy these strategies to their advantage. The article concludes with reflections on the long-term and population-level implications of these coping mechanisms.     

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.     

Theory-Based Policy Development for HIV Prevention in Racial/Ethnic Minority Midlife and Older Women

ABSTRACT

In 2008, there were more than a million persons with HIV/AIDS in the United States. The CDC (2007) estimates that 15% of persons with HIV/AIDS are over age 50. At greater risk are women of color. Most intervention efforts have focused on intrapersonal aspects of an individual and his or her sexual-risk behaviors, with little or no attention directed toward interpersonal and socioenvironmental considerations of risk and prevention. This paper considers the limitations of current national policies relating to HIV prevention in minority populations, especially among midlife and older women of color. In particular, this paper examines risk and prevention policies in light of ecological perspectives, social capital, and dialogical theories.     

Modelling the spread of HIV/AIDS in China: the role of sexual transmission

The study presented here is an exploration of the implications of patterns of sexual behaviour for the spread of HIV in China, using a bio-behavioural macrosimulation model. To reflect the uncertainty surrounding key parameters, analyses of varied scenarios are used to show a range of possible outcomes consistent with variations in selected biological and behavioural inputs. The latter are estimated from a nationwide survey of sexual behaviour recently conducted in China, a country with an emerging HIV/AIDS epidemic, where it is feared that HIV/AIDS will spread to the general population via heterosexual transmission. The results highlight the primacy of the levels and distribution of sexual activity in the population. They offer some guidelines for understanding and interpreting the potential implications of current and prospective changes in sexual behaviour for the spread of HIV/AIDS in the world's largest population, and also highlight the need to collect better data on sexual behaviour for the estimation of key model inputs.     

Child labour in the Era of HIV/AIDS in sub-Saharan Africa: A case study of Tanzania

Exploitation of child labour is an endemic problem in sub-Saharan Africa. The situation is increasingly worsening due to increasing poverty and HIV/AIDS. We carried out a study to understand how the AIDS epidemic facilitates the presence of child labour in Iringa Rural District in Tanzania. The findings revealed that children opt for early participation in the labour force due to the ever-increasing poverty existing at their household level. There is a correlation between poverty and HIV/AIDS in general, and particularly between HIV/AIDS and the poor socio-economic condition of orphans. Current interventions to stop child labour do not yield good results because of low level of awareness on child labour issues at village levels. The government and its partners, such as ILO, should improve the coordination between the district and the communities (villages) in order to make sure that communities at the village level are reached and assisted. Furthermore, reducing rural poverty is imperative if child labour is to be eliminated.     

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.     

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.     

AIDS in China

Most recent official statistics indicate that there was a cumulative total of 133 AIDS cases in mainland China through the end of October 1996 and 5157 people infected with HIV. Official statistics also indicate continuing increases in recent years in the number of people with AIDS and people infected with HIV, and that the incidence of infection is growing in China. HIV has been found to have been transmitted in China through IV drug use, sexual activities, from mother to child, and through transfusions and the use of blood products. Important risk factors for the spread of HIV in China include high population density, a considerable transient population, drug use, prostitution, blood transfusion, the improper sterilization of medical instruments in rural areas, changes in people's sexual attitudes and behaviors, and lack of information on safe sex. The Chinese government reports having taken considerable steps to check the spread of HIV/AIDS and supports communication and education as an essential tool in the fight against the epidemic. Life expectancies in China's provinces and municipalities are listed.     

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.