Effects of sociodemographic factors,stage of illness,and perceived stigma on the identification of a support person among women with HIV infection

Addressing the lack of research on the social distribution of social support and research on the social experience of women with HIV infection, this article examines how sociodemographic factors, stage of illness, and perceived stigma affected the identification of a supportive social relationship among HIV‐infected women. Data were collected from women with HIV disease living in the state of Georgia. Logistic regression analysis indicates that after taking account of other factors, marital status, rural‐urban residency, stage of illness, and stigmatization were significant predictors of whether the women identified a support person. Single status and rural residency had negative effects on the outcome. Those who were at the advanced stage of illness were less likely than those at the asymptomatic stage to identify a supportive relationship. Contrary to our expectation, stigmatization had positive effects on the outcome. Implications and limitations of the analysis are discussed, followed by directions for future research.     

How Does a “Risk Group” Perceive Risk?

Abstract

Throughout the HIV/AIDS epidemic, female sex workers have been identified as a “risk group” and interventions developed to reduce their behavioral risk-taking. Both individual and structural level programs continue to target “risks” such as multiple partners and lack of condom use. Sex workers themselves, however, are likely to view their experiences more holistically, perceiving a range of risks within their work. This paper presents qualitative data from a participatory study conducted with brothel-based migrant Vietnamese sex workers in Cambodia, illuminating one community's perceptions of the sex industry. It argues that design and implementation of effective HIV prevention activities must be based on sex workers' own interpretations and responses to risk, using them as a realistic entry point for effecting change. Actively engaging with sex workers through participatory research and projects offers the first step in shifting the current epidemiological focus toward identifying feasible, context-specific risk-reduction strategies.     

Meeting the needs of adolescents living with HIV through home based care: Lessons learned from Tanzania

PurposeHome based care is central to HIV care and support throughout Africa. Most programs have not addressed the unique needs of adolescents living with HIV, who display lower retention in HIV care and treatment adherence. This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs.MethodsWe conducted a qualitative study in Dar es Salaam and Tanga Region consisting of in-depth interviews with 14 adolescents living with HIV, 10 primary caregivers, and 12 providers assigned to their households. Interviews examined adolescents' experiences of growing up with HIV, perceptions of current home based care, and challenges in increasing acceptability of services.ResultsWe found the program did not align well with adolescents' expectations. Adolescents felt home based care to be more relevant to their caregivers and did not form independent relationships with providers. They expressed anxiety that participation might lead to inadvertent disclosure of their status and consequent discrimination. Both adolescents and their caregivers felt disappointment that no material or financial support was available despite widespread poverty, although they appreciated receiving psychosocial support and practical referrals. Providers demonstrated motivation to work with adolescents but acknowledged lacking requisite skills such as ways to communicate with young people and key messages to deliver.ConclusionsDespite challenges, we identified feasible adaptations to make home based care more adolescent-centered. These include actively engaging adolescents in program design, improving provider training in communication with adolescents, and proactively addressing unrealistic expectations. Finally, increasing referral links to a wider range of services could improve program effectiveness by integrating it into a broader development approach.     

Perspectives on disclosure among children living with HIV in India

BackgroundFollowing the widespread uptake of anti-retroviral therapy (ART), young children living with HIV are entering adolescence and beyond, necessitating disclosure of HIV status. However, few studies have described children's experiences following disclosure.MethodsWe assessed disclosure status among children attending HIV clinics at two tertiary-care centers in southern India. Children who had disclosure were administered a pre-tested questionnaire assessing their knowledge about HIV, ART, experiences following disclosure, perceived stigma and ideas about their future. The association of the children's responses with social desirability bias was examined using a modified social desirability scale.ResultsTwenty-four caregiver-child dyads participated in this study. They constituted a subset of children who had been told of their HIV diagnosis from a larger study of 247 dyads. Mean age at disclosure was 10.9 ± 2.5 years. Medical personnel were responsible for disclosure to 14 children, parents/caregivers to 3 children, both medical and care personnel together to 4 children and other relatives to remaining 3 children. Disclosure was met with acceptance by one-third of the children. Despite disclosure, five children did not know how HIV spreads, and three were unaware about how infection could be prevented. Notwithstanding their positive status, 20 children felt that they were treated well at school and by their immediate relatives, although 11 children mentioned that they needed to hide while taking ART. Social desirability bias did not play a role in the responses given by these children.ConclusionsThe rate of disclosure of HIV status among children living with HIV in India was low, even among older children. Most children accepted their status, but knowledge about HIV and ART was inadequate. Disclosure was predominantly performed by medical personnel, rather than the primary caregiver. Incorporating disclosure into the care process for older children is likely to be beneficial, and should be recognized as an iterative process with a need for incorporating cultural sensitivities and a comprehensive approach to health education.     

Determinants Influencing Male Condom use Among University Students in Portugal

ABSTRACT. A self-administered questionnaire was carried out among university students in Portugal, with the aim to examine determinants influencing male condom use, according to the information–motivation–behavioral skills model (J. Fisher & Fisher, 1992). Students’ levels of information, motivation, and behavioral skills regarding preventive sexual behavior (male condom use) were ascertained and were used to determine their association with condom use among 880 male and 1,807 female students aged 18 to 35 years old. Although 86.9% of respondents indicated that they used a condom during their first sexual intercourse, only 32.8% used a condom always during sexual intercourse in the last 12 months. Most young people, especially women, had a good level of information regarding HIV/AIDS transmission/prevention. They also showed reasonable positive attitudes and had positive subjective norms and intentions toward HIV/AIDS preventive behaviors. Men presented a higher perceived difficulty and a lower perceived effectiveness of HIV/AIDS preventive behavior, therefore reporting higher risk acceptance. A path analysis revealed that preventive sexual behavior did not depend directly on information level but on motivation and behavioral skills (especially among men). Information about HIV prevention/transmission was not significantly associated with condom use. The finding that motivation and behavioral skills were the strongest determinants of condom use suggested that these may be important factors in effective sexually transmitted infection-prevention programs.     

“To be HIV positive is not the end of the world”: Resilience among perinatally infected HIV positive adolescents in Johannesburg

BackgroundResilience, or positive adaptation to challenging situations, has potential to improve health outcomes for high risk populations. Resilience may be particularly important for perinatally infected HIV positive adolescents, who are exposed to significant stigma, risks and stressors. Despite recognition that HIV positive adolescents show remarkable resilience in the face of adversity, little is known about how resilience occurs within this population.MethodsThe aim of this study was to identify elements of resilience in a group of perinatally infected HIV positive adolescents attending HIV clinics. In-depth interviews were conducted with 25 purposively selected HIV positive adolescents (15 female, 10 male) between the ages of 13–19 years in Johannesburg. Data were analysed in NVIVO 10 using a thematic approach to coding.ResultsDespite marked stressors in the lives of these adolescents, a high degree of resilience was described. Characteristics of resilience in this group included a pertinent set of beliefs, including a belief in fate and recognition of personal strength as a consequence of managing adversity. Character traits such as a pragmatic acceptance about one's life, actively taking responsibility, and a robust self-esteem were evident. Social behaviours included the ability to pursue and access adults and healthcare to meet developmental needs, having a desire to support and help others and challenging HIV related stigma. These characteristics were underscored by the capacity for self-reflection.ConclusionPerinatally infected adolescents, who face high levels of hardship and change, nevertheless exhibit strong resiliency beliefs, traits, and behaviours. Healthcare environments have the potential to be utilized as powerful resources in fostering resilience in HIV positive adolescents, if characteristics of adolescent resilience were integrated into current prevention and intervention programming. Resilience promotion could lead to improved health outcomes for HIV positive adolescents.     

The Friends Thou Hast

Abstract

Most studies of male commercial sex workers (CSWs) in Thailand have been framed within a context of HIV risk and have investigated sexual behaviours and HIV knowledge. However, Mann et al. (1992) have identified health and social services and a supportive social environment as equally essential partners in an HIV-preventive triumvirate. This paper is based on extended observation and a series of in-depth interviews with forty-three male CSWs who are both organised (bar workers) and freelance as well as a number of clients (farang and Thai) and bar management. This paper examines the social environment in which male CSWs operate. It considers workplace conditions and support, the personal relationships workers have with parents, friends, clients, other bar workers and management, and how these are influenced by workers' cultural norms. A number of recommendations designed to reduce HIV-infection rates are made.     

Influence of Social Support on Gay Men Living with HIV

This article examines the social support networks of gay men living with HIV. Many people do not realize that HIV is still a significant health concern. The rate of HIV infection has not decreased substantially in over 15 years, and in the United States alone health care practitioners see approximately 40,000 cases per year. Some of the literature on this topic suggests that gay men with HIV receive more social support from friends than from family members. Research also suggests that these men sometimes experience losses of social support after they are diagnosed as HIV positive. Five gay men with HIV participated in in-depth interviews for this study. During these interviews 14 open-ended questions were posed with several of these questions having follow-up probes/questions. The questions focused on specific aspects of the participant's support network. Participants' responses to the interview questions were transcribed and content analyzed for relevant themes. Results indicated that whereas many of the men maintained their supportive contacts with family members and friends, others experienced changes in their support networks after they were diagnosed as HIV positive. Further results revealed that all men interviewed were satisfied with the level of support they received from the people in their support networks.     

Sexual orientation differences in HIV testing motivation among college men

Objective: To investigate sexual orientation differences in college men's motivations for HIV testing. Participants: 665 male college students in the Southeastern United States from 2006 to 2014. Methods: Students completed a survey on HIV risk factors and testing motivations. Logistic regressions were conducted to determine the differences between heterosexual men (HM) and sexual minority men (SMM). Results: SMM were more motivated to get tested by concern over past condomless sex, while HM were more often cited supporting the testing program “on principle” and wanting a free t-shirt. SMM and HM differed in behaviors that impact HIV risk and other demographics. However, differences in testing motivation by concern over past condomless sex or wanting a free t-shirt persisted when controlling for these demographic and behavioral differences. Conclusions: Appropriately designed HIV prevention interventions on college campuses should target SMM's distinct concern over past condomless sex as a testing motivation.     

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

College Students and HIV/AIDS: A Comparison of Nontraditional and Traditional Student Perspectives

Objective and Participants The authors compared nontraditional college students' knowledge and perceptions of HIV/AIDS and sexual practices with previously reported results about traditional students. Methods Nontraditional students completed an online survey with questions based on national HIV/AIDS surveys. Traditional students completed the same survey with paper and pencil. Results Overall, the authors found more similarities than differences between the 2 groups. The findings support previous research that suggests that although college students are knowledgeable about HIV and its risks, they express little personal concern about becoming infected. The authors also discuss how apparent differences between nontraditional and traditional students regarding personal concern about becoming infected, relationship status, and information sources may influence the development of effective prevention strategies geared toward nontraditional college students. Conclusions Institutional leaders need to adapt to these differences, and researchers should undertake additional studies to clarify these differences so that college students may be more effectively educated about HIV/AIDS and encouraged to get tested.     

Correlates of Participation in a Family-Based HIV Prevention Program

Abstract

This study examines the relationship between contextual factors and attendance in a family-based HIV prevention program for low-income, urban, African-American women and their children. Participants' motivations to become involved, their concerns about discussing sex-related issues with their children, recruiters' perceptions of respondents' understanding of the program, and environmental stressors were examined. Participants' level of motivation and recruiters' success in improving respondents' understanding of the program were significant correlates of attendance. Stressors experienced by the family and concerns around talking with children about sex were not significantly associated with participation. Recommendations to enhance involvement in family-based HIV prevention programs are made.     

‘Pain on Top of Pain,Hurtness on Top of Hurtness’: Social Discrimination,Psychological Well-Being,and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT

This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than $10,000 per year (80%), and acquired HIV through heterosexual sex (58%). Analyses demonstrated that social discrimination manifested in the women's lives as poverty, HIV/AIDS-related stigma, and gender inequality. These experiences caused intense psychological distress and limited WLH/A's ability to implement the safer-sex skills that they learned during the intervention. We discuss the applied and theoretical implications of our findings, advocating for HIV and sexual risk-reduction interventions that are based on an ecological framework that addresses holistically the individual, relational, and sociostructural factors that affect women's sexual risk behaviors.     

Support for basic psychological needs in the context of HIV disclosure for older youth

Purpose

This study utilized Self-Determination Theory's sub-theory Basic Needs Theory (Deci & Ryan, 2000) to understand older youths' perceptions of support for their basic needs of autonomy, relatedness, and competence in the context of disclosing their HIV status.

Methods

Semi-structured interviews lasting 10–60 min each were conducted with nine youth aged 17–19 (4 women and 5 men) and two adult staff at a one-week residential program in a large southern city. Participant observations of disclosure-related conversations and experiences were conducted and recorded throughout the program. Reliability and validity assurances were met in multiple ways. Analysis of the content of interviews and observations indicated consistent themes that converged on the research questions.

Results

When participants perceived more support for their basic psychological needs for autonomy, relatedness, and competence, they reported more self-determined motivation to disclose their status and better satisfaction with their decisions. The results of this study indicate that Basic Needs Theory is useful for understanding how the basic psychological needs of autonomy, relatedness, and competence are satisfied or thwarted in the context of HIV disclosure for older youth.

Conclusions

Programs and people working with older youth with HIV/AIDS can use BNT to help youth identify, create, and adapt contexts to be supportive of their basic needs for autonomy, relatedness, and competence, and provide guidance and support accordingly. Providers can utilize this information to support youth in strategizing about their disclosure decisions and goals for their well-being.     

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.     

Exploring the needs of parents for achieving reunification: The views of foster children,birth family and social workers in Spain

BackgroundFamily reunification refers to the process through which children and adolescents under a measure of temporary separation (foster care or residential) return to live with their biological families. The research has begun to reflect a paradigm change in intervention and support for these families that affects the consolidation of reunification and the prevention of new processes of separation and reentry into the protection system.ObjectivesThis article examines the needs of parents who are susceptible to an educational intervention from a positive focus that contributes to the consolidation of family reunification.MethodEighteen semi-structured interviews were conducted and 22 discussion groups were convened with 135 participants (63 protection-system professionals, 42 parents and 30 children and adolescents). The data were analyzed through content analysis and were subject to peer revision.ResultsA series of parents' specific educational needs when their children return home was recognized. These needs can be the objects of family intervention based on a positive focus directed toward highlighting parents' strengths and are related to awareness of family progress, emotional management, giving and receiving help from other families and social support. The participants' comments show that feelings of self-sufficiency and positive reinforcement are fundamental for consolidation of the process.ConclusionsSocial support through formal and informal networks may be a path to explore for providing more and better support after returning home. Empowering families so that they can be agents of support for other families can be a way to consolidate reunification, allowing families to be active agents in the reunification process. In addition, listening to children's voices can be a good strategy for family consolidation.     

EDITORIAL

Abstract

This exploratory, qualitative research was conducted to obtain the perspectives of people with significant physical disabilities regarding factors that have facilitated and hindered the development of a positive self-concept, participation in the broader society, and the formation of interpersonal relationships. The sample was high achieving in terms of education and/or career and attributed positive self-perceptions and their success in the broader society and interpersonal relationships to the attitudes and perceptions regarding their abilities, talents, and potential modeled in supportive family relationships. Females reported the influence of significant others most often, and males the effectiveness of their personality characteristics. Societal barriers, both practical and attitudinal, were reported along with the process for developing a positive self-perception despite these.     

Lights,camera, condoms! Assessing college men's attitudes toward condom use in pornography

ABSTRACT

Objective: Investigate male college students' attitudes toward actors' use of condoms in pornography. Participants: Two hundred thirteen undergraduate males attending a large, state-supported midwestern university in the fall semester, 2012. Methods: Using a Web-based procedure, participants completed questionnaires assessing their pornography use, sexual history characteristics, and their attitudes toward condom use by adult performers. Results: Factor analysis of the 11-item condom use attitudes questionnaire supported 2 distinct subscales: Condom Supportive Attitudes and Condom Critical Attitudes. Although participants typically agreed with statements supportive of condom use and generally disagreed with statements critical of condom use in pornography, gay men had significantly higher condom supportive subscale scores than did heterosexual men. Neither subscale was correlated with weekly viewing of pornography. Conclusions: Although some producers of adult films argue that actors wearing condoms will displease many viewers, current findings suggest that young men express support for use of condoms by pornographic film actors.     

The Community College Nurse as an Occupational Health Nurse

Abstract

Objective: This multisite study assessed college student's perceptions and practices regarding carrying concealed handguns on campus. Participants: Undergraduate students from 15 public midwestern universities were surveyed (N = 1,800). Methods: Faculty members distributed the questionnaire to students in general education classes or classes broadly representative of undergraduate students. Results: Useable questionnaires were returned by 1,649 students (92%). The majority (78%) of students was not supportive of concealed handguns on campuses, and 78% claimed that they would not obtain a permit to carry a handgun on campus, if it were legal. Those who perceived more disadvantages to carrying handguns on campus were females, who did not own firearms, did not have a firearm in the home growing up, and were not concerned with becoming a victim of crime. Conclusions: The majority of students was not supportive of concealed handguns on campus and claimed that they would not feel safer if students and faculty carried concealed handguns.     

EDITOR's NOTES

Abstract

In order to uncover personal attributes and systemic influences involved in being accepting and supportive of their sons' gay identities, 14 members of a chapter of Parents and Friends of Lesbians and Gays were invited to describe their coming out processes as parents of gay sons. A qualitative approach examined parental definitions of acceptance, the parents' relationships with their sons, the parents' renditions of their coming out processes, and ecosystemic influences on the parents' coming out processes. Ethnographic content analysis suggested that the relevant attributes of parental personalities and their proximal environments were similar in this sample including emotional investment in the people involved, openness to new realities, and the capacity to find and use resources.