Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia

This report evaluates the extent of perceived and enacted HIV/AIDS-related stigma in a rural setting in Zambia. Stigmatisation is abundant, ranging from subtle actions to the most extreme degradation, rejection and abandonment. Women with HIV and pregnant women assumed to be HIV positive are repeatedly subjected to extensive forms of stigma, particularly once they become sick or if their child dies. Despite increasing access to prevention of mother to child transmission initiatives, including anti-retroviral drugs, the perceived disincentives of HIV testing, particularly for women, largely outweigh the potential gains from available treatments. HIV/AIDS related stigma drives the epidemic underground and is one of the main reasons that people do not wish to know their HIV status. Unless efforts to reduce stigma are, as one peer educator put it, “written in large letters in any HIV/AIDS campaign rather than small”, stigma will remain a major barrier to curbing the HIV/AIDS pandemic.     

WOMEN ATHLETES AS FALSELY ACCUSED DEVIANTS: Managing the Lesbian Stigma

As the behavior of women athletes is often interpreted to violate gender norms, women athletes are frequently devalued and stigmatized. The present study examines the manner in which such devaluation and stigmatization impact on women athletes and how these athletes manage the lesbian label attached to their sport participation. In-depth telephone interviews were conducted with 24 intercollegiate athletes from three Division I universities. Processes underlying athletes' responses parallel Becker's construction of the "falsely accused deviant" and Goffman's conceptualization of "stigma management." Factors leading to false accusation of lesbianism are discussed, as well as the various mechanisms utilized by athletes to manage the lesbian label.     

THE WELFARE IMPLICATIONS OF MORAL HAZARD AND ADVERSE SELECTION IN COMPETITIVE INSURANCE MARKETS

I model a competitive insurance market with both moral hazard and adverse selection, and analyze the effect on welfare when both problems are present simultaneously. An examination of the interaction between these two problems leads to two hypotheses. First, the nature of the equilibrium contracts is such that each problem partially offsets the welfare loss associated with the other. And second, the degree to which this occurs increases as agents become more heterogeneous. Simulation results overwhelmingly support both hypotheses.     

Nonresponse weighting adjustment using estimated response probability

To reduce nonresponse bias in sample surveys, a method of nonresponse weighting adjustment is often used which consists of multiplying the sampling weight of the respondent by the inverse of the estimated response probability. The authors examine the asymptotic properties of this estimator. They prove that it is generally more efficient than an estimator which uses the true response probability, provided that the parameters which govern this probability are estimated by maximum likelihood. The authors discuss variance estimation methods that account for the effect of using the estimated response probability; they compare their performances in a small simulation study. They also discuss extensions to the regression estimator.     

Three Object Relations Models of Couple Treatment

This article describes three different approaches to the treatment of couples, all based on different versions of object relations theories. Object relations as a term has various meanings embodying different theoretical assumptions. It is used differentially to highlight certain aspects of clinical phenomena, to connote certain developmental paradigms, and to signal the importance of real, interactional aspects of human behavior. The three therapeutic approaches to work with couples illustrate some of the ways that the greater conceptual complexity of object relations theories affects how love is explained, couple conflicts defined, and what makes for change in couples treatment. Understanding the basic assumptions of a given theory will enable us to increase our informed consent to the use of theory in our practices.     

A model for short-term group therapy on a children's inpatient unit

The paper describes the group therapy model which has evolved over the past two years on the Child Psychiatry Inpatient Unit of North Carolina Memorial Hospital. It begins with a brief review of the literature concerning group therapy with latency-aged children. The setting and patient population are described. Vignettes from group sessions are used to illustrate techniques which have evolved to deal with this particular setting and population. These include a leadership style characterized by much clarification, modeling, and limit setting; extensive focus on beginning and terminating; clearly defined behavioral limits; the use of time out; and use of play materials requiring little skill or attention as anxiety binders as well as projective media; and observation and supervisory discussions open to all members of the treatment team. The paper concludes with a discussion of the potentials and limitations of group therapy in such a setting. The thesis is that this model is effective in diagnosing developmental levels, in developing interpersonal skills, in substituting verbalization for action, and in mastering separation anxieties, though the setting limits the extent to which controlled regression, transference, and group pressures can develop and be used to produce change.     

The VFW — A case study in the “iron law of oligarchy” and goal displacement

The iron law of oligarchy is applied to the VFW. Using participant observation and qualitative interviews, membership of the VFW is dichotomized into a leadership oligarchy and a drinking membership. Opinions of members of the two groups about the purposes of the organization and about each other are documented. An historical analysis traces the change in organizational goals over time from promoting nationalism, fraternalism, and special benefits for members to political advocacy of veterans' rights.     

Compliance Versus Risk in Assessing Occupational Exposures

Assessments of occupational exposures to chemicals are generally based upon the practice of compliance testing in which the probability of compliance is related to the exceedance [γ, the likelihood that any measurement would exceed an occupational exposure limit (OEL)] and the number of measurements obtained. On the other hand, workers’ chronic health risks generally depend upon cumulative lifetime exposures which are not directly related to the probability of compliance. In this paper we define the probability of “overexposure” (θ) as the likelihood that individual risk (a function of cumulative exposure) exceeds the risk inherent in the OEL (a function of the OEL and duration of exposure). We regard θ as a relevant measure of individual risk for chemicals, such as carcinogens, which produce chronic effects after long-term exposures but not necessarily for acutely-toxic substances which can produce effects relatively quickly. We apply a random-effects model to data from 179 groups of workers, exposed to a variety of chemical agents, and obtain parameter estimates for the group mean exposure and the within- and between-worker components of variance. These estimates are then combined with OELs to generate estimates of γ and θ. We show that compliance testing can significantly underestimate the health risk when sample sizes are small. That is, there can be large probabilities of compliance with typical sample sizes, despite the fact that large proportions of the working population have individual risks greater than the risk inherent in the OEL. We demonstrate further that, because the relationship between θ and γ depends upon the within- and between-worker components of variance, it cannot be assumed a priori that exceedance is a conservative surrogate for overexposure. Thus, we conclude that assessment practices which focus upon either compliance or exceedance are problematic and recommend that employers evaluate exposures relative to the probabilities of overexposure.