Greater involvement of people living with HIV/AIDS in South Africa

This study reports on a pilot project, the greater involvement of people living with HIV/AIDS Workplace Model, which places trained fieldworkers living openly with HIV/AIDS in selected partner organisations sectors, where they set up, review or enrich workplace policies and programmes. The project adds credibility to partners' HIV/AIDS programmes and creates a supportive environment for people living with HIV/AIDS (PLWHA) and others to speak about HIV/AIDS. Eleven men and women living with HIV, aged between 30 and 45, and with varied life experiences and education levels, shared a willingness to speak about their HIV status in their workplace. They worked in very different environments but their collective experiences showed that PLWHA can add value to workplace HIV/AIDS programmes in a way that is relevant, effective, efficient, sustainable and ethical. They made companies and communities more aware of the intense need for HIV/AIDS policies and encouraged care and support for infected and affected people.     

Risk, sexuality and economy

From the mid 1980s onwards HIV/AIDS became a new subject of work reform, with a range of experts producing new knowledges on work and the worker in regard to HIV/AIDS and workplace organizations putting in place workplace HIV/AIDS policies and programmes. To date, much of the discussion in sociology in regard to such policies and programmes has focused on the issue of effectiveness and has been concerned with making such policy 'better'. In this article however, and with particular reference to sexuality, I suggest that such approaches fail to register that workplace HIV/AIDS policies concern new conceptualizations of worker identities. Specifically, I suggest that such policies may be viewed as part of an assemblage of work reforms which are reworking worker identities as risk identities. Thus I argue that workplace HIV/AIDS policies and programmes are best understood as risk rationalities. Further, I consider the alignment between such rationalities and neo-liberal modes of rule, and in particular consider the ways in which workplace HIV/AIDS policies render both HIV/AIDS and sexuality calculable and governable in terms of notions of risk, self-responsibility and self-management.     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

Child development in HIV-positive and HIV-affected children in South Africa and Malawi—What role for community organisations?

There is evidence that children who are HIV positive (HIV +) are at risk for poor developmental outcomes. The aims of this study were to use developmental screening tools to measure outcomes of children affected by HIV/AIDS attending community-based organisations (CBO) and to determine what types of CBO provision these children were receiving. In a cross-sectional study, we interviewed 979 children and their carers (4 to 13 years) at 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Developmental outcomes were assessed using the Ten Questions childhood disability screening tool and the Strengths and Difficulties Questionnaire. Health-related quality of life was measured using the Paediatric Quality of Life Scale. Overall, 13.8% (n = 135) were HIV +. HIV + children were more likely to have developmental difficulties and lower health and educational quality of life, controlling for a range of factors. Developmental difficulties and poorer quality of life were predicted by being HIV +, living in South Africa, not attending school regularly, poor housing conditions and living with a sick family member. HIV + children tended to have been enrolled in CBO programmes for a longer period compared to other children but reported lower rates of contact. A greater proportion of HIV + children received medical services, psychosocial interventions and emotional support, compared to HIV − children. However, fewer HIV + children were enrolled in play groups, early childhood intervention programmes and educational programmes. Screening for developmental problems using short tools is possible in community settings in order to identify children with developmental difficulties and plan services for children infected with and affected by HIV. This study highlights the important role of CBOs to intervene to improve child development outcomes. The delivery of evidence-based services that target child development outcomes will enable HIV-infected children to meet their developmental potential and promote their participation in their communities.     

Compelling Evidence: Research Methods,HIV/AIDS,and Politics in Papua,Indonesia

Increasing calls for an evidence-based public health (EBPH) rely on forms of quantitative evidence to decide HIV/AIDS interventions. A major criticism of this method is it downplays the significance of experiential, cultural or political facets of HIV/AIDS. We apply the concept of ‘rendering technical’ to explore the relationship between methods used in HIV/AIDS research in Papua, Indonesia and current socioeconomic conditions. We analysed research methods used in sixty-two HIV/AIDS studies, assessed presentations at an international AIDS conference, and conducted ethnographic research in Papua. Nation-wide EBPH initiatives are implemented in Papua, yet there remains a critical mass of qualitative ethnographic studies carried out by indigenous scholars emphasising experiences of persons and culture, often within a colonial or post-colonial framework. We argue these studies partially counter approaches which render technical complex realities. In political conditions where indigenous minorities suffer inequities, qualitative ethnographic research may yield critical kinds of evidence, potentially contributing to more nuanced decision-making around HIV.     

The Economics of HIV/AIDS: A Survey

This article surveys the main economic issues associated with the HIV/AIDS epidemic, paying special attention to sub–Saharan Africa. It explores the economic and behavioural determinants of HIV transmission, the microeconomics of market failures associated with high HIV prevalence, the prospects for regional development from a macroeconomic perspective and the efficient design of policies for coping with the epidemic. In line with the recent appeal by the UN Secretary General, the article argues that, without a decisive effort to halt HIV/AIDS, people living in the region are bound to experience a further fall in their standard of living in both relative and absolute terms. However, to be effective, anti–AIDS programmes must be rooted in sound economic principles.     

HIV Prevention Programs in the Black Church: A Viable Health Promotion Resource for African American Women?

ABSTRACT

Nearly 40 million people worldwide are living with the human immunodeficiency virus (HIV). The Centers for Disease Control report that women account for more than 50% of the existing 40 million HIV/AIDS cases to date. Moreover, African-American women are infected with HIV/AIDS 25 times more often than white women and four times more often than Hispanic women, making HIV/AIDS the leading cause of death for black women ages 25–34. Given the increasing rate of transmission with this population, the purpose of this article was to review the existing literature to investigate the risk factors associated with African-American women with HIV/AIDS and identify an effective method of HIV prevention for them. A discussion of religion and African-Americans in terms of the Black church and its health promotion efforts was also included. The article concludes with a discussion of program elements of HIV prevention programs in the Black church and possible challenges faced for the programs.     

Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa

Given current donor attention to orphans and children made vulnerable by HIV/AIDS, and the need for a new framework that recognizes the complementary roles of nations and non-governmental organizations (NGOs), this analysis reviews NGO-operated community-based orphans and vulnerable children (OVC) projects in Botswana, Lesotho, Namibia, South Africa, and Swaziland. There has been a lack of attention within the field of evaluation to inter-organizational relationships, specifically those with government agencies, as a factor in sustainability. We analyzed evaluations of nine OVC projects funded by the Bristol-Myers Squibb Foundation for the influence of government-NGO collaboration on project sustainability. For eight of the nine projects, evaluations provided evidence of the importance of the government partnership for sustainability. Government collaboration was important in projects designed to help families access government grants, initiate community-based solutions, and advocate for OVC rights through legislation. Government partnerships were also critical to the sustainability of two projects involved in placing children in foster care, but these showed signs of tension with government partners. In addition to the more common factors associated with sustainability, such as organizational characteristics, donors and NGOs should concentrate on developing strong partnerships with local and national government agencies for the sustainability of their projects.     

Impairments and perceived competence in persons living with HIV/AIDS

Medical advances have transformed HIV/AIDS from a short-term terminal illness to a long-term chronic condition. Consequently, the disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities and wider community participation. These changes have necessitated rehabilitation interventions for persons with HIV/AIDS to focus on issues related to enabling participation in all spheres of everyday activities. However, limited information is available on the impairments prevalent in the emergent population of people living with HIV/AIDS and on the impact of these impairments on the person's functional performance and participation in various occupations of daily living. The present study attempted to explore these issues as they are experienced by the emergent population of people living with HIV/AIDS. The purpose of the study was: (1) to explore occupational functioning across various activities, (2) to describe the various impairments prevalent in this population, and (3) to examine the impact of these impairments on the person's perceived occupational competence. Two instruments, the Sign and symptom checklist for persons with HIV disease and the Occupational Self-Assessment were administered to a sample of 35 individuals (Mean age=42.8 yrs.) living in supportive living facilities. Impairments most commonly identified by the participants included: fatigue; fear/worries; difficulty concentrating; muscle aches; and depression. The two primary areas of occupational functioning where participants reported experiencing moderate to severe difficulty included: managing finances and physically engaging in activities which were reported by 67.7% and 35.5% of the participants respectively. No statistically significant correlation was observed between various measures of impairments and the overall measure of perceived occupational competence for the sample of individuals living with HIV/AIDS included in this study.     

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.     

'All red in the face': students' views on school-based HIV/AIDS and sexuality education

School-based HIV/AIDS and sexuality education is a fraught area, the site of struggles around moral values, knowledge, the nature of childhood and adolescence and pedagogy. The dominant discourses on HIV/AIDS and sexuality education in Australian secondary schools, as evident in policy documents, are currently predominantly libertarian and therapeutic, championing the need for 'openness' in the interests of the students' emotional maturity and social responsibility and their good health. However, Policy does not always translate readily into practice. This article draws upon a study involving focus group discussions with Australian senior high school students concerning their responses to the school-based HIV/AIDS and sexuality education programmes in which they have taken part and other sources of knowledge about HIV/AIDS. The article focuses in detail upon the students' valorizing of openness, trust and expertise in the face of the embarrassment, their perception of surveillance and their fears of lack of confidentiality that characterize their experience of HIV/AIDS and sexuality education. It is concluded that the nature of the teacher-adolescent relationship tends to work against the achievement of the objectives of such education.     

Potential Roles of Black Churches in HIV/AIDS Prevention

Abstract

This study examines the role of Black churches in AIDS/HIV prevention. This is a pilot survey study design administered to 11 churches represented by 11 ministers and one church member. The analysis is both qualitative and quantitative. The results showed that most of the ministers had spoken with their congregation on HIV/AIDS. A few ministers had previously sponsored or taken part in HIV/AIDS workshops and disseminated HIV/AIDS educational material in the African American community. None of the churches had an established HIV/AIDS prevention program. Most of the ministers were receptive to implementing an HIV/AIDS prevention program, provided that it did not violate the church doctrines. The findings in this study suggest that Black churches represent an important potential resource for HIV/AIDS prevention. For success, the initial strategy should involve the minister in the early planning stage. Future research should focus on expanding the scope of this study and improving communication between the church, community-based organizations, and health professionals.     

Multi-media campaign exposure effects on knowledge and use of condoms for STI and HIV/AIDS prevention in Uganda

This study examined the influences of behavior change communication (BCC) campaigns on knowledge and use of condoms for prevention of HIV/AIDS and other sexually transmitted infections in target areas of Uganda. Data were drawn from the 1997 and 1999 Delivery of Improved Services for Health (DISH) evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Logistic regressions were used to assess the associations between BCC exposure and condom knowledge and use, controlling for individuals' background characteristics. Results indicated that BCC exposure was strongly associated with higher condom knowledge: women and men who reported being exposed to messages in the mass media were at least twice as likely as those with no exposure to know of condoms as a mean to avoid HIV/AIDS. A dose–response effect was observed, suggesting that campaigns using multiple media channels may be most effective in improving sexual health knowledge. At the same time, certain gender differences of the influences on condom use were found, with the channel and content of messages seemingly more important in terms of instilling safer sex practices. While there was some evidence of bias of self-report, exploratory analysis of the indirect effects of communications campaigns suggested that impacts may be compounded as overall awareness is increased at the community level eventually leading to behavior change among individuals.     

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.     

Economic Dependency and HIV/AIDS Prevalence in the Developing World: A Comparative,Longitudinal Analysis

The HIV/AIDS pandemic has plagued global society for over three decades. While breakthroughs in antiretroviral treatments (ART) have proven effective in suppressing the virus and HIV/AIDS intervention outreach have widened, epidemic control remains unevenly achieved among countries. At least 95 percent of HIV/AIDS sufferers originate from developing countries. Dependency theory suggests that developing countries' reliance on debt, trade, and foreign investments pose negative effects on their populations' health. Guided by dependency theory's propositions, this cross‐national study assesses whether increasing dependence on trade, debt, and foreign direct investment potentially increases adult HIV prevalence in developing countries from 1989 to 2012. Using a sample of over 80 nations, we perform a two‐way fixed‐effects OLS regression to evaluate the impact of increasing debt, trade, and foreign investment on adult HIV prevalence. Total debt, short‐term debt, external debt, and GDP were found to increase HIV prevalence. The findings for debt support dependency theory's predictions concerning the ramifications of global economic inequality on HIV/AIDS prevalence.     

ECONOMIC AND OTHER SOCIETAL DETERMINANTS OF THE PREVALENCE OF HIV: A Test of Competing Hypotheses

The spread of human immunodeficiency virus (HIV) is believed to result from HIV-infected individuals who are unaware of their infection and, thus, the possible consequences of their sexual behavior for others. However, differential rates of HIV infection between countries may reflect a different set of circumstances. We obtained data from the World Bank and several other sources to test eight alternative explanations for the global differences in prevalence of HIV infection: (1) economic underdevelopment, (2) inadequate public health care, (3) insufficient media, (4) political instability, (5) overurbanization, (6) social inequity, (7) religion, and (8) region. Our regression findings showed that income inequality and political instability had statistically significant positive effects on HIV/AIDS prevalence and that gender equality had a negative effect on HIV/AIDS prevalence. Religion and region were also important predictors, as countries that were predominately Muslim and Christian Orthodox generally had lower prevalence of HIV/AIDS, whereas West Africa, Central Africa, and Southern Africa had a higher prevalence of HIV/AIDS. None of the public health and media indicators were statistically relevant.     

Aids prevention,Stigma and migrant status

This article discusses how stigma has been applied to disease and also to foreigners, especially during epidemics. Foreigners, or migrants, fit particularly well into AIDS stigma, being both objects and originators of the generalised reaction: ‘it's somebody else's problem’. Material is presented from a European Community Concerted Action assessing AIDS/HIV prevention which surveyed programmes for short‐ and long‐term guest populations and ethnic minorities in twelve European countries. It is shown how the potential for stigmatisation seriously hindered the establishment of AIDS prevention efforts directed towards migrants. Basic shifts of programme focus which help overcome stigmatisation problems concerning migrants are defined, including: 1) making fine differentiations amongst migrant groups rather than considering ‘migrants’ as a generalised ‘other’, 2) basing programmes on a universal right to know rather than on the notion of risk group, and 3) working in real and effective collaboration with minority communities rather than imposing top down programmes.     

Calendars on the Wall

This study explores the evidence of social and personal forces in discussions concerning sexuality in client/provider interactions about HIV/AIDS. It unravels the complex ways that such forces influence the interactions, each other, and, in turn, how interactions can influence the forces themselves. The interactions were observed using participant observation techniques, and were analyzed using a framework suggested by Giddens (1979) and augmented by the author. Analysis suggested that such forces as societal norms about sexuality, promiscuity, and monogamy and the guilt associated with their violation influence client/provider interactions about HIV/AIDS. Unraveling the mutual influences of the forces may provide an opportunity to identify possibilities for altering the reproduction of the system.     

Women at Risk for Human Immunodeficiency Virus

This article reports results from a survey among women at risk for contracting human immunodeficiency virus (HIV) as well as transmitting it in a vertical (to offspring) and horizontal (sexual partner or intravenous [IV] drug usage) mode. Little is known about the extent of HIV knowledge, sexual behaviors and IV drug usage for women at risk for HIV infection. The sample (N = 620) consisted of Black (50.6%), Caucasian (28.7%), Hispanic (13.4%) and Haitian (5.0%) adult non-pregnant women from South Florida. Data concerning their drug usage, sexual behaviors and other risk factors for HIV infection are presented alone with their knowledge about HIV infection and acquired immunodeficiency syndrome (AIDS). The women had an adequate knowledge base about HIV and AIDS; however the results indicated that our sample was at risk due to the following risk factors: (1) unprotected sexual intercourse, both vaginal and anal, with men who were at high risk for HIV infection (i.e., men who were bisexual and/or used IV drugs); (2) IV drug usage by the woman themselves including needle sharing in "shooting galleries"; (3) the practice of prostitution by the women and; (4) the use of various non-IV drugs that have been shown to impair judgement and lower inhibitions regarding sexual practices. Results indicate differences in risk behaviors and knowledge about AIDS by race/ethnicity.     

Social Protection in a Context of HIV/AIDS: A Closer Look at South Africa

Abstract

South Africa is unusual in that it is experiencing high levels of AIDS morbidity and mortality, but is also able to afford a relatively developed system of social assistance. However, HIV/AIDS is affecting poverty in some unique ways and compounding other challenges such as unemployment. Its nature is such that it demands immediate action, balanced with a focus on long-term development. This is requiring a conceptual shift from ‘social security’ to ‘social protection’, since social assistance is not managing to address all dimensions of poverty and is also creating perverse incentives for people not to maximise their health. In South Africa, household studies comprise the most useful evidence to explore the particular challenges posed by HIV/AIDS. They indicate a need to review policies in all the social sectors and to focus on the issue of human capital.