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.     

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.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

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.     

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.     

Analysis of HIV Caregivers in South Africa: A South African Depression and Anxiety Group

ABSTRACT

The severity of the HIV/AIDS epidemic in South Africa is well documented. However, little is known regarding the well-being of caregivers of persons with HIV/AIDS in South Africa. This study sought to evaluate characteristics, similarities and differences between groups of HIV caregivers in rural, semi-rural, and urban areas of South Africa. Interesting trends were noticed in the areas of suicidality, alcohol abuse, and intimate trauma. Findings indicate a substantial need for further study in the area of suicidality, denial of or lack of desire to know HIV status and the accompanying diagnostic stigma, and the need for a support network within lay caregivers.     

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.     

Constructing an alternative family unit: families living with HIV/AIDS redefine African traditional parenting patterns

This article is based on a study, conducted at Inanda, of caregivers who mainly take care of children that are infected and/or affected by HIV/AIDS. ¹ 1. The discussion of this article emanates from a three‐year‐long study that focused on the after‐effects of HIV/AIDS. Six participants from 15 in‐depth interviews are used for the focus of the article. Based on recurring similar characteristics, the other nine participants were excluded. All the participants of the study were Zulu speakers, one of the main languages of the country. I use fictitious names to conceal their identities. It explores the reality and experiences of the family members. The focus of the article is based on data analysed following interviews with the caregivers. Family parenting experience portrays HIV/AIDS caregiving as an intense, emotional and powerful experience, filled with pride and hope as well as exclusion. Findings of the study reflect a change in the definition and practice of parenting. Another finding is that HIV/AIDS is forcing a redefinition of the concept and practice of parenting beyond the traditional boundaries of age, sex and gender. One of the main findings of the study was that the respondents' parenting practices and coping strategies are largely influenced by a strong commitment to the wellbeing of the children. The study found that, in relation to some community members, the respondents have a different parenting style. Their commitment depicts their self‐sacrifice, an indication of some continuity in what is expected of African parenting practice. The thesis of this article is that the HIV/AIDS context is principally responsible for a shift in the understanding of the concept and practice of parenting within an African context.     

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.     

A Model of Heterosexual Adaptive Relationship Functioning in South Africa: Implications for HIV Prevention Interventions

Abstract

Objectives: Couple-based HIV prevention efforts are an important HIV prevention strategy in South Africa but there is a lack of understanding as to what constitutes healthy relationships in South African sociodisadvantaged communities. Methods: To address this, 8 focus group discussions were conducted with 27 men and 23 Black African women living in a large disadvantaged community in Cape Town, South Africa. Results: A model of adaptive relationship functioning is put forth, which involves four primary relationship components that emerged as central to healthy relationships: active relationship building, emotional support/display, communication, and problem-solving. Conclusions: The results of this study can inform couple-based HIV prevention efforts.     

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。     

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).     

Qualitative evaluation of HIV/AIDS IEC activities in Madagascar

UNICEF commissioned a qualitative evaluation of a program in which two partners conducted prevention activities concerning HIV/AIDS and STIs amongst youth in Madagascar. The evaluation assessed project activities and conducted a practical exercise in focus group methodology, following a workshop on evaluation techniques. Information was collected from a wide range of people, including 441 participants in 46 focus groups in nine sites. Six sites were areas of project activities and three sites were targeted for future activities. Clubs that integrated HIV/AIDS and STI information into their regular activities were most successful in their information, education and communication activities. A more participatory approach is recommended, to achieve a better match between target groups and messages delivered, and to foster trust and support. Another challenge remaining is to address fears and stigma through advocacy for the care and support of affected people.     

Approaches to caring, essential elements for a quality service and cost-effectiveness in South Africa

By 2010 there will be close to two million orphans in South Africa, mainly as a result of HIV/AIDS. This paper assesses different approaches to the care and support of children orphaned by AIDS and other vulnerable children, as well as the cost-effectiveness of each approach. Using a typology of care and essential elements of care, six approaches are evaluated: informal, non-statutory foster care; community-based support; home-based care; unregistered residential care; statutory adoption and fostering; and statutory residential care. A cost-effectiveness analysis assessed actual programs and the costs of providing a minimum standard of care for the six approaches. High costs are associated with formal models of care. Informal approaches may lack the resources to meet children's rights. Resources should be largely allocated to the more cost-effective, informal, community-based structures, but formal models will still be needed for those children who cannot be placed elsewhere.     

The Socio‐Economic Determinants of HIV/AIDS Infection Rates in Lesotho,Malawi, Swaziland and Zimbabwe

Using data from the Demographic and Health Survey, this article analyses the relationship between HIV status and the socio‐economic and demographic characteristics of adults in Lesotho, Malawi, Swaziland and Zimbabwe. It constructs the risk profile of the average adult, computes the values of age, education and wealth where the estimated probability of infection assumes its highest value, and determines the percentage of adults for whom these three factors are positively correlated with that probability. It finds that in all four countries: (i) the probability of being HIV‐positive is higher for women than for men; (ii) the likelihood of infection is higher for urban than for rural residents; and (iii) there is an inverted‐U relationship between age and HIV status. Also that, unlike gender, rural/urban residence and age, the relationship between the probability of infection and wealth, education and marital status varies by country. The results provide support for country‐specific and more targeted HIV policies and programmes.     

Children orphaned by HIV and AIDS in middle childhood in Potchefstroom,Northwest: The role of a social worker

ABSTRACT

The effects of HIV and AIDS have devastated families and communities in South Africa. The scourge has also left many children orphaned in the country. Given the vulnerability of orphaned children, social workers are in the forefront of ensuring that these children are cared for and protected from any harm. Hence, the purpose of this paper was to explore the role of a social worker in issues related to children orphaned by AIDS in their middle childhood. This study was situated within a qualitative research paradigm utilizing purposive, non-probability sampling of 10 participants recruited from Potchefstroom in the Northwest Province of South Africa. A semi-structured interview schedule was employed as a research tool, and in-depth one-on-one interviews were adopted as the method of data collection. A thematic content analysis was used to analyze the data collected during the interviews. The main findings point towards the need to educate children about HIV and AIDS and to empower their caregivers. The primary conclusion drawn from this study is that social workers play various key roles which contribute towards the well-being of orphaned children. Recommendations are posed in relation to social work service providers, government interventions, and future research.     

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.     

HIV/AIDS stigma in Chinese Internet forums: a content analysis approach

This study examines the stigmatization of HIV/AIDS and people living with HIV/AIDS (PLHA) on three popular Chinese Internet forums. A corpus of 275 entries discussing AIDS and PLHA was coded, based on a scheme of five stigmatizing behaviors. A high percentage of postings showed at least one and often several stigmatizing behaviors. These findings suggest that participants openly revealed their fears and biases about AIDS and PLHA online. In addition, when sexual behaviors were identified in the entries, a higher likelihood to stigmatize, a greater absence of empathy, and more intense negative emotions were shown. Further investigation of the five variables of stigmatization shows that labeling, negative attribution, and responsibility were the most frequent stigmatizing behaviors in these messages. Implications of this tendency to feel free to stigmatize HIV/AIDS and PLHA in online forums are discussed. The study also provides suggestions to health practitioners and policy makers for how to address online AIDS stigmatizing behavior.     

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