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.     

HIV and fertility in Africa: first evidence from population-based surveys

The historical pattern of the demographic transition suggests that fertility declines follow mortality declines, followed by a rise in human capital accumulation and economic growth. The HIV/AIDS epidemic threatens to reverse this path. We utilize recent rounds of the demographic and health surveys that link an individual woman’s fertility outcomes to her HIV status based on testing. The data allow us to distinguish the effect of own positive HIV status on fertility (which may be due to lower fecundity and other physiological reasons) from the behavioral response to higher mortality risk, as measured by the local community HIV prevalence. We show that although HIV-infected women have significantly lower fertility, local community HIV prevalence has no significant effect on noninfected women’s fertility.     

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.     

Using a gender perspective to explore forest dependence in rural HIV/AIDS-affected Malawian households

Throughout Sub-Saharan Africa, forest resources play a crucial role in enabling households to control and adapt to HIV/AIDS; however, little is known about how the disease impacts the gendered use of forest resources. This exploratory study characterizes how the dependence on forest resources changes for female and male respondents in HIV/AIDS-affected households in Malawi through three phases: before HIV was known to be present; during HIV-related morbidity; and after AIDS-related mortality. The results presented for female and male respondents in this paper are strikingly similar, and many respondents report that there are no longer any traditional gender roles for household tasks due to HIV/AIDS. Therefore, we question the thinking around gender-specific forest-related interventions for HIV-affected people. Moreover, given the gendered knowledge base that must surround resource use, what do these changes in traditional roles mean for sustainable forest resource use in the future? Further research on knowledge transmission around these resources is warranted.     

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.     

More Than Pop Culture: Depictions of HIV in the Media and the Effect on Viewer's Perception of Risk

When young adults are questioned about where they gain their knowledge of HIV, overwhelmingly popular media (including television) is reported. Thus, the goal of this article is to question how media is used to educate and influence young people's present perceptions of HIV/AIDS. Narrative analysis of popular prime time shows was used focusing on the story lines and characters used to introduce the topic, as well as the myths and facts about HIV. Results presented provide researchers a clearer insight to how popular shows discuss HIV/AIDS while also highlighting the ways Social Cognitive Theory can still be utilized.     

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.     

AIDS, “reversal” of the demographic transition and economic development: evidence from Africa

Using country- and region-level data, I investigate the effect of HIV/AIDS on fertility in Africa during 1985–2000. Results differ depending on the variation used and the estimation method. Between estimates that exploit cross-sectional variation suggest a positive significant effect of HIV/AIDS on fertility, whereas within estimates that are identified of off time-series variation show both positive and negative results depending on the HIV/AIDS variable used. These within estimates are insignificant in most of the specifications.     

Knowledge and attitudes about HIV/AIDS among community-living older women: reexamining issues of age and gender

Although older women face unique risks related to HIV/ AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT

Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.     

Tools and training strengthen African AIDS groups

Recent estimates indicate that AIDS has stricken approximately 21 million adults and children in sub-Saharan Africa. Many grassroots organizations were born during the early 1990s in response to the pandemic. Two Population Council researchers undertook four collaborative interventions to strengthen such organizations. Their efforts showed that providing simple, carefully chosen forms of technical assistance can greatly improve the ability of grassroots organizations to achieve their goals. Modest investments of time and expertise can yield considerable positive results. In Uganda, the National AIDS Control Program's Community Counseling Aides (CCA) Project sends trained volunteers to conduct AIDS education and provide basic nursing care. KIWAKKUKI, a women's group in Moshi, Tanzania, provides AIDS education and care for people affected by AIDS. In Ndola, Zambia, the INDENI Petroleum Refinery's HIV/AIDS Committee conducts educational activities, provides condoms and medical care, and addresses the needs of employees' families. In Lusaka, Zambia, the women of the KWASHA MUKWENU care for children orphaned by AIDS. Population Council interventions in each of these programs is described.     

Uncovering the impact of the HIV epidemic on fertility in Sub-Saharan Africa: the case of Malawi

We evaluate the impact of the HIV/AIDS epidemic on the reproductive behaviour for all women in Malawi, HIV-negative and HIV-positive alike, allowing for heterogeneous response depending on age and prior number of births. HIV/AIDS increases the probability that a young woman gives birth to her first child, while it decreases the probability to give birth of older women and of women who have already given birth. The resulting change in the distribution of fertility across age groups is likely to be more demographically and economically important than changes in the total number of children a woman gives birth to.     

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.     

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.     

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.     

滇西某大型筑路工地流动人口艾滋病风险分析

本研究采用定性与定量相结合的方法对滇西某大型道路建设工地流动人口的艾滋病风险进行调研与分析,该工地流动人口所面临的主要艾滋病风险是高危商业性性行为。深入调研发现,因其特殊的行业特征,工地流动人口中形成了对商业性性行为默许、容忍、合理化的氛围,对于所面临的艾滋病风险存在侥幸心理,各职业人群由于知识、社会经济处境不同,其与艾滋病相关的高危行为有明显差异。基于研究发现,本文对流动人口艾滋病预防干预实践、艾滋病预防研究的社会人文视角及未来研究方向等提出了讨论和建议。     

Probabilistic population projections for countries with generalized HIV/AIDS epidemics

In 2015, the United Nations (UN) issued probabilistic population projections for all countries up to 2100, by simulating future levels of total fertility and life expectancy and combining the results using a standard cohort component projection method. For the 40 countries with generalized HIV/AIDS epidemics, the mortality projections used the Spectrum/Estimation and Projection Package (EPP) model, a complex, multistate model designed for short-term projections of policy-relevant quantities for the epidemic. We propose a simpler approach that is more compatible with existing UN projection methods for other countries. Changes in life expectancy are projected probabilistically using a simple time series regression and then converted to age- and sex-specific mortality rates using model life tables designed for countries with HIV/AIDS epidemics. These are then input to the cohort component method, as for other countries. The method performed well in an out-of-sample cross-validation experiment. It gives similar short-run projections to Spectrum/EPP, while being simpler and avoiding multistate modelling.     

Social networks, perceptions of risk, and changing attitudes towards HIV/AIDS: new evidence from a longitudinal study using fixed-effects analysis

The study presented here is an investigation of the importance of social interactions to perceptions of the risk of AIDS, and explores spousal communication about the AIDS epidemic in rural Malawi. A fixed-effects analysis based on longitudinal data collected in 1998 and 2001 shows that social interactions on the subject of HIV/AIDS have significant and substantial effects on respondents' perceptions of the risk of HIV/AIDS, even after controlling for unobserved factors that affect the selection of social networks. These effects are more complex than previously thought. The dominant mechanisms--social learning and social influence--are found to vary by sex and by region, because of regional variations in the marriage pattern and the resulting implications for the formation of local social networks. The conclusion of the study is that rather than fostering denial and inaction, social interactions are an important vector of change in the face of the HIV/AIDS epidemic.     

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.     

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 .