Employer‐sponsored programmes for the prevention and treatment of HIV/AIDS: Recent experience from sub‐Saharan Africa

This article examines a sample of employer programmes in sub‐Saharan Africa that supplement government efforts to prevent and treat human immunodeficiency virus (HIV). Some of these programmes provide workers with in‐house education, voluntary HIV testing and antiretroviral treatment. Others rely on new forms of employment‐based group health insurance that include an HIV treatment package. In addition, some enterprises use the workplace as a platform for launching efforts into neighbouring communities to reach spouses, children, sex workers, secondary school students and others. Early evidence suggests that employer programmes maintain the health of large fractions of workers living with HIV who are served by them. They further enable enterprises to avoid productivity losses and turnover costs associated with HIV. At the same time, they take pressure off government agencies that face demands for treatment far exceeding their capacity. The article identifies features of successful employer programmes including “elite appeal”, which mobilizes community leaders and role models to deconstruct stigma, change perceptions and call for behavioural change; and “collateral linkage”, which extends the reach of HIV workplace programmes by linking them to related community concerns: e.g. alcohol abuse, malaria and domestic violence. Looking forward, the potential for expanding employer programmes as well as the restrictions associated with the limited scale of formal‐sector employment within sub‐Saharan African economies is assessed. Actions by which governments, employer associations, trade unions and international organizations can encourage further development of such programmes and extend their reach are suggested.     

FEMALE SEX WORK,NON-WORK SEX AND HIV IN PERTH

This study is based on repeated interviews with twelve heterosexual female commercial sex workers (SWs) in Perth. These informants deploy, with various degrees of success, strategies to demarcate ‘work-sex’, with its socially ascribed stigma, from ‘non-work sex’. Such strategies inhibit the spread of HIV at work but, ironically, increase the risk of HIV transmission during non-work sex. SWs recognise this risk and construct a variety of rationales to reduce their fear of contracting HIV and justify their strategies of demarcating work-sex from non-work sex. Efforts to reduce the risk of HIV infection among Perth SWs would seem to depend upon addressing not only these strategies of demarcation but these rationales in a supportive environment that recognises the creative complexities of their lives.     

A life of fear: Sex workers and the threat of HIV in Uganda

Schoemaker J, Twikirize J. A life of fear: sex workers and the threat of HIV in Uganda The way individuals perceive their risk to certain threats influences their adoption of preventive behaviour. This study explored sex workers' perception of risk of HIV infection within the context of other serious threats. The study was carried out in Kampala, Uganda, using peer ethnography. Sex workers were well aware of their risk of HIV infection but this risk was eclipsed by other more immediate and frightening threats. Sex workers' willingness to gamble with HIV is explained by the fact that their existence is already very dangerous, and taking risks is an inherent part of their trade. Decriminalising sex work could make their lives somewhat safer, motivating them to better protect themselves, but this is unlikely to happen in Uganda. Attempting to enforce some coercive control mechanisms would not work, given the pervasive corruption in law enforcement and the judiciary, the institutions that would be responsible for implementing such control.     

Applying the Theory of Reasoned Action to condom use among sex workers

This study assessed the relationship between constructs from the Theory of Reasoned Action (TRA) on condom use in a sample of 1394 Filipino female sex workers. Path analysis for observed variables was used to examine the relationship between attitudes, norms and behavioral intentions on behaviors within the context of condom use during vaginal sex. Results indicate that the direct paths between attitudes toward the behavior and subjective norms were small in comparison to the direct paths between these two constructs and behavioral intentions. This supports the findings of the TRA, which states that behaviors are influenced by attitudes toward the behavior and subjective norms as mediated through intentions to perform the behavior. In addition, it was illustrated that the participation of the managers in the intervention will more than likely influence the success of the intervention. These findings exemplify the need to develop HIV preventative interventions that are sample specific. In conclusion, condom attitudes and policies of managers who employ commercial sex workers are very important for reducing risky sexual practice among their workers.     

The impact of HIV/AIDS on social security contributions: The case of Zimbabwe

Significant early retirement from work due to HIV/AIDS-related illness is reducing the gainfully employed population and threatening the viability of the statutory social security schemes run by the National Social Security Authority in Zimbabwe. The economy has been in recession for a decade, with high inflation and significant job losses also impacting negatively on contributions to the National Pension and Other Benefits Scheme (NPOBS), and government imposes ceilings on insurable earnings from which contributions are drawn. There are currently no consistent strategies to mitigate attritional effects of these factors on the social security schemes. The aim of this study was to prospectively project the potential impact of HIV/AIDS and imposed ceilings on NPOBS revenue in the presence of high inflation. It was found that HIV/AIDS will reduce projected contributions to the scheme by more than 30 per cent by 2030. Policy strategies to adjust and frequently review levels of growth of imposed ceilings on insurable earnings in line with inflation growth and to invest in HIV/AIDS prevention could be adopted to ameliorate the negative impact of HIV/AIDS and/or ceiling caps on social security contributions in Zimbabwe.     

Supervisor ideology and organizational response: HIV/AIDS prevention in outpatient substance abuse treatment units

Distinct practice ideologies or ideologies of care are deemed to influence greatly the selection of intervention methods and the mix of services adopted by the providers. Examined here is the relation between clinical supervisor ideology and variation among human service organizations in their provision of HIV/AIDS prevention services. Data were drawn from a 1990 national, representative sample of outpatient substance abuse treatment (OSAT) units. The study affirms that ideology is central to both means and ends in HSOs, helping to define the organization's mission and goals, and establishing guidelines for practice and procedures. Future research on the relationship between ideology and HIV/AIDS education can benefit from efforts to develop alternative strategies for measuring ideologies of care among both managers and staff in substance abuse settings.     

AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research

The current analysis considers the  human immunodeficiency virus (HIV)  prevention research record in the social sciences. We do so with special reference to what has been termed "AIDS Exceptionalism"—departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for "Prevention for Positives," supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to address effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior.     

Sexual Communication and Seroadaptation Practices in HIV-Negative Midlife and Older Men Who Have Sex With Men

Advances in treatments have increased the longevity of people with HIV. The high prevalence of HIV among men who have sex with men (MSM) creates a greater risk for exposure that increases with age. Seroadaptation, which includes serosorting (sexual behavior and condom use based on knowing the serostatus of self and partners) and strategic sexual positioning (choosing receptive versus insertive anal sex), is sometimes used as an HIV risk-reduction strategy. This study examined seroadaptation, sexual communication, and HIV-risk behaviors in 420 sexually active HIV-negative MSM aged 40–81 years in South Florida via anonymous pen-and-paper questionnaire. Recreational drug use and serosorting (i.e., not using condoms if the partner said he was HIV-negative) were associated with higher risk for unprotected receptive anal intercourse. Younger age, greater number of partners, and serosorting were associated with higher risk for unprotected insertive anal intercourse. Understanding these behaviors in this group might help guide HIV-prevention efforts. Future research may examine the role of HIV-prevention medication (PrEP) in influencing sexual behavior in midlife and older MSM.     

‘You Get More Respect,’ Reasons for Sex Among African American High School Youth: A Qualitative Study

ABSTRACT

African American adolescents continue to be disproportionately impacted by HIV, sexually transmitted infections (STIs), and unanticipated pregnancies. In-depth, face-to-face interviews among a convenience sample of 32 African American adolescents (16 male and 16 female) were used to explore the reasons why some adolescents decided to engage in sex while others chose to delay sexual debut. Data were analyzed using a thematic analysis. Among the overall sample, psychological motivations, external pressure, physical pleasure seeking, and relationship-related motivations were the major themes cited for engaging in sex by participants and their friends. External support, motivation to avoid negative consequences, not feeling ready or lacking interest in sex, and having negative views about sex were among the major reasons for delaying sex. Several of the emergent themes showed gender differences. Suggestions for future research include the need for sexual education, and STI/HIV prevention programs that are gender sensitive and flexible enough to accommodate multiple factors related to sexual debut.     

The Differential Wage Impact of the Immigration Reform and Control Act on Latino Ethnic Subgroups*

Objective. This article tests whether employer sanctions for hiring undocumented workers, a provision of the 1986 Immigration Reform and Control Act (IRCA), adversely affected the hourly earnings of Latino workers. Methods. Using the Current Population Survey Outgoing Rotation Group Files from 1983–1990, a natural experiment framework is developed to assess the differential wage impact of employer sanctions on Latino ethnic subgroups. Results. Estimates of wage changes indicate that workers of Mexican descent saw a sizeable pre‐post IRCA decline in their hourly earnings relative to Cuban or Puerto Rican workers. Moreover, this change in wages is not observed among non‐Latino white workers. Controlling for the level of enforcement explains part of this decline immediately following the passage of IRCA, and enforcement efforts continue to be a significant factor several years later. Conclusions. The majority of evidence is consistent with the contention that employer sanctions adversely affected the earnings of Mexican workers.     

Impacts of HIV/AIDS on poor and socially marginalised former commercial plasma donors in rural central China: social work implications

Little is known about the impact of HIV/AIDS on people who acquired the virus through former commercial plasma donations in the mid-1990s in rural Central China. The objective of this study was to examine socioeconomic impacts associated with HIV/AIDS on poor farm workers and their families, with a particular focus on economic hardships and social exclusion. The findings from 30 interviews reveal the profound effects of deteriorating health on labour power loss. The well-being of people living with HIV/AIDS was immensely affected by the loss of income, debts due to health-related expenses and a lack of alternate sources of income. Social exclusion and HIV/AIDS-related stigma remain significant issues in a workplace, funerals, and weddings. This article highlights the economic impacts of HIV/AIDS on China’s rural population and provides recommendations for social workers to mitigate the impacts of social exclusion on vulnerable rural households in China.     

Experiences of Stigma and Spirituality of Older Black Men Living with HIV

Abstract

Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men is scant. This study aimed to investigate experiences of HIV stigma and the use of spirituality among older HIV positive Black men who sleep with men. In-depth interviews were conducted with a sample of ten men. Data were analyzed utilizing to the modified van Kaam data analysis method. Three major themes were identified that explores the participants lived experiences with HIV stigma and use of spirituality: experiences of stigma reinforcing the use of spirituality; defining spirituality as a functional concept; and self-empowerment through the use of spirituality. The findings could guide social workers and other helping professionals in developing informed assessments and interventions regarding HIV stigma and the use of spirituality. Future qualitative and quantitative research is needed to achieve generalizable knowledge about the relationship between stigma on the use of spirituality.     

Gay Men's Knowledge of HIV Transmission and ‘Safe’ Sex: A Question of Accuracy

The study described in this paper is part of a project assessing the impact of the HIV epidemic on 535 men who have sex with men. These men were surveyed about their knowledge of HIV, their sexual practices, other issues concerning the transmission of HIV, and AIDS. This paper focuses on these men's beliefs about HIV transmission, their perceptions of the safety of a number of sexual and social practices, and the factors influencing these perceptions. The findings indicate, in general, that the men surveyed were moderately well informed about HIV transmission. Some twenty percent of the men were well-informed about both ‘safe’ and ‘unsafe’ sexual practices, a small number were ill-informed and the remainder, the majority, were well-informed about some aspects and ill-informed about others. The data suggest that information from the mainstream and gay press is not only differentially available but that information is processed and interpreted by the men in different ways. Variables which influence the manner in which information is interpreted are place of residence (locale), awareness of gay community posters and pamphlets, and the men's sexual practice; these are associated with cautiousness or rashness in the men's judgments of safety and risk.     

不同代别农民工生育意愿及其影响因素——基于厦门市912位农村流动人口的实证研究

笔者利用在福建省厦门市举行的两次关于流动人口的抽样调查数据1 ,对不同代别2 农民工的生育意愿进行描述,结果表明：在最佳生育年龄方面,旧生代、过渡代和新生代农民工的看法没有太大的差异,在意愿生育数量、意愿生育质量、意愿生育性别和生育动机方面,三个代别的农民工存在显著性差异。对三个代别的意愿生育数量、意愿生育质量和生育动机的影响因素进行回归分析的结果表明：影响旧生代和过渡代农民工生育意愿三个方面的因素较复杂,其中,受教育程度和生育经历的影响较集中。对于新生代农民工而言,只有受教育程度这一变量始终在影响着其意愿生育数量、意愿生育质量和传统型生育动机;从事何种职业影响着其关于情感性生育动机的看法。笔者认为已婚农民工的生育经历对生育意愿所起的作用将为新生代的生育行为提供前车之鉴,通过进一步加强教育和提升职业层次,将为新生代农民工具备良好的生育意愿和生育行为创造条件。     

The Relationship Between Length and Number of Homeless Episodes and Engagement in Survival Sex

Survival sex is associated with many health problems, including increased substance use and HIV risk. Current research on survival sex among homeless individuals has given little attention to the unique effects of how length and number of homeless episodes influence engagement in survival sex. Using secondary data analysis from the Washington, DC, Metropolitan Area Drug Study (DC*MADS) (N = 783), the authors examined the relationship of days and number of times homeless to engagement in survival sex, while controlling for other sociodemographic and clinical characteristics. Results showed that length of homelessness and number of homeless episodes, as well as current age, previous drug use, depression, and institutionalization, increased the odds of engaging in survival sex. Results support current efforts on interventions to transition homeless individuals into housing as rapidly as possible. Service providers assisting the homeless can affect engagement in survival sex and its associated risks through creating referral networks for integrated treatment programs for co-occurring substance use and mental health problems while advocating for early housing interventions and increased housing retention. Further research is needed regarding the ways in which length of homeless episodes affects risky behaviors such as survival sex, with a particular focus on all age groups.     

The HOPE Family Project: A Family-Based Group Intervention to Reduce the Impact of Homelessness on HIV/STI and Drug Risk Behaviors

The HOPE Family Project (HIV Prevention for Parents and Early Adolescents) is an eight- session, family-based group intervention modeled on three evidence-based curricula targeting HIV/AIDS and alcohol and drug abuse prevention. The design and implementation of the HOPE Family Project was carried out by an established community collaborative board. The project aims to educate and provide tailored support to families and their youth (ages 11–14), residing in homeless shelters, regarding HIV and alcohol abuse prevention. The group model proved successful in offering an informal social support network for families living in homeless shelters and improving family functioning and youth mental health outcomes.     

Conspiracy beliefs about HIV/AIDS and birth control among African Americans: implications for the prevention of HIV, other STIs, and unintended pregnancy

In this article, we examine the potential role that conspiracy beliefs regarding HIV/AIDS (e.g., "HIV is a manmade virus") and birth control (e.g., "The government is trying to limit the Black population by encouraging the use of condoms") play in the prevention of HIV, other STIs, and unintended pregnancies among African Americans in the United States. First, we review prior research indicating that substantial percentages of African Americans endorse conspiracy beliefs about HIV/AIDS and birth control. Next, we present a theoretical framework that suggests how conspiracy beliefs influence sexual behavior and attitudes. We then offer several recommendations for future research. Finally, we discuss the policy and programmatic implications of conspiracy beliefs for the prevention of HIV, other STIs, and unintended pregnancy .     

HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.     

Geriatric Enrichment in Social Work Education: Lessons Learned from the GeroRich Projects

The Geriatric Enrichment in Social Work Education (GeroRich) initiative was a critical step in addressing the national shortage of social workers interested in gerontological practice. Sixty-seven social work programs participated in the 3-year GeroRich project designed to infuse gerontological content into the BSW and MSW curriculum. This study analyzed the lessons learned by participating institutions about the curriculum enrichment effort. Five themes emerged from the qualitative analysis of GeroRich final reports: (a) obtaining faculty buy-in and faculty development, (b) increasing student interest and engagement, (c) developing community partners, (d) developing interdisciplinary linkages, and (e) facilitating institutional commitment and sustainability. The findings from this study provide valuable information on the implementation of curricular enrichment efforts in gerontology that can benefit social work and other health care disciplines.     

COVID‐19 and social work practice for older adults in China

After the spread of COVID‐19, the Chinese central government has issued a series of policies and regulations to guide the prevention and control of the epidemic in the elderly care industry. Social workers provided a series of services for older adults in nursing homes and in the community. All efforts made by government agencies and social workers have helped older adults go through the difficult time.