Ethical aspects of HIV/AIDS prevention strategies and control in Malawi

HIV/AIDS prevention campaigns have been overshadowed by conflicting, competing, and contradictory views between those who support condom use as a last resort and those who are against it for fear of promoting sexual immorality. We argue that abstinence and faithfulness to one partner are the best available moral solutions to the HIV/AIDS pandemic. Of course, deontologists may argue that condom use might appear useful and effective in controlling HIV/AIDS; however, not everything that is useful is always good. In principle, all schools of thought and faith seem to agree on the question of faithfulness for married couples and abstinence for those who are not married. But they differ on condom use. On the ground, the situation is far more complex. We simply lack a single, entirely reliable way to resolve all disagreements regarding HIV/AIDS prevention strategies.

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

The Catholic Church,moral doctrine,and HIV prevention in Recife,Brazil: Negotiating the contradictions between religious belief and the realities of everyday life

Religious beliefs have had a key role in shaping local responses to HIV and AIDS. As the world's largest Catholic country, Brazil is no exception. Yet little research has been conducted to document how religious doctrine is enacted in practice among its lay leaders and followers. In this article, we present ethnographic research from Recife, Brazil, conducted to understand the way in which religious doctrines are interpreted at a local level. Contextualised within the sociology of contemporary Brazilian Catholicism, we draw on interviews with clergy members, lay leaders, and parishioners to discuss how the Catholic Church's vision of sexuality translates into everyday lives of its followers. We explore the disjuncture between the Catholic ideals of fidelity and delaying sex until marriage with the everyday reality of the Church's followers, highlighting the role that gender plays in defining sexual roles and expectations. We conclude by posing questions for future research and HIV prevention strategies considering the formal institutional response of the Brazilian Catholic Church to AIDS on the one hand, and the social and cultural contexts in which Catholics live their daily lives on the other.     

Risk perception and victim perception: The judgment of HIV cases

There is a vast literature confirming that reactions to different risks are strongly affected by characteristics other than scientific risk estimates; most of this research has concentrated on mapping people's representations of sets of widely varying dangers (e.g. diseases, natural disasters, accidents). This study explored a potentially vital component of risk that cannot be studied by eliciting general reactions to many hazards: the extent to which who is at risk contributes to perceptions and judgments of a risk. While it may be preferable to assume that misfortunes affect the population uniformly, of course the truth is not so egalitarian. Thus, for both theoretical and policy reasons, it is worth exploring psychometrically representations of a particular risk as it affects different people. Using multidimensional scaling and hierarchical cluster analysis, we constructed models of respondents' representations of a disease assumed to be particularly affected by victim perception: Human Immunodeficiency Virus (HIV). Subjects rated the similarity of all possible pairs among 16 scenarios involving HIV infection; the scenarios contained information about both the victim and the method of contraction. A set of attribute scales as well as political/demographic information allowed us both to interpret the structures and to predict individual differences. The results confirmed that reactions to HIV infection are greatly affected by reactions to the victim. In particular, the perceived distastefulness and riskiness of the method of infection loomed larger than did either the overall likability of the victim or the general riskiness of the victim's behavior. Further, the salience of the most statistically influential dimension, ‘deservedness’, depended significantly on demographic and political characteristics of the respondents, suggesting that the relationship between personal values and risk perception is in part mediated by victim perception. Implications for risk perception work and public policy are discussed.     

An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.     

The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.     

Developmental issues in indigenous psychologies: Sustainability and local knowledge

The present paper endeavours to discuss some of the potential issues inherent in the developmental work for indigenous psychologies, especially in the Western context. The discussion is made around two topical issues, sustainability and local knowledge. The developmental processes in indigenous psychologies are influenced by the inter- and intracommunity environment. It is important to trace the development of local knowledge in a sustained community environment. The cross-fertilization of ecological perspectives with indigenous psychological knowledge can enlighten our understandings of global issues in psychology as well as the applications of psychological knowledge to a local context. A theoretical model is proposed to highlight major social psychological processes in a participatory community environment − the model is expected to address essential contentious issues to the future of a globalized psychology, especially the way integrated local knowledge can lay the foundations of a globalized indigenous psychology.     

The Body of Christ has AIDS: The Catholic Church Responding Faithfully to HIV and AIDS in Papua New Guinea

Using the example of the Catholic Church in Papua New Guinea (PNG), I detail how, through praxis, it has brought to life a living theology of HIV and AIDS. In this way, the Catholic Church in PNG is responding faithfully to the epidemic. As a Christian country with a generalised HIV epidemic, where the body of an individual is reconstituted through the liturgical practices of baptism and Eucharist, theologically, in PNG the body of Christ has AIDS. In order to examine the ways in which the Catholic Church in PNG has responded faithfully to the Christian body with AIDS, I do so in relation to the three theological virtues of faith, hope and love.

Innovation in HIV prevention: organizational and intervention characteristics affecting program adoption

A multiple case study design was used to explore the organizational characteristics of community-based organizations that provide HIV prevention programs and the criteria these organizations employ when judging the merits of externally-developed HIV prevention programs. In-depth interviews were conducted with organizational representatives of 38 randomly-selected HIV prevention providers throughout Illinois. Results indicated that there were three main types of adopting organizations: adopters of entire programs, adopters of program components and practices, and adopters of common ideas. These three types of organizations were distinguished by their level of organizational commitment to HIV prevention, organizational resources, and level of organizational maturity. Narrative data from the interviews are used to describe the dimensions that underlie the organizations' program adoption criteria. The criteria of merit used by these organizations to evaluate prevention programs provide partial empirical support for existing theories of technology transfer. Implications for designing and disseminating HIV prevention programs are discussed.     

Counseling to End an Epidemic: Revisiting the Ethics of HIV/AIDS

In the decades since HIV/AIDS was first identified, medical discoveries have advanced prevention and treatment, and shifting demographics have changed the face of the illness. Despite these changes, the counseling literature on HIV/AIDS and its ethical implications for counselors have remained limited and stagnant. Whereas past discussions have focused primarily on issues of confidentiality, this article addresses multiple ethical implications of HIV/AIDS to reflect current knowledge about the illness and its effects on clients.     

HIV/AIDS prevention support resourcing with family and peers: University student perspectives

This study explored how students construct family and peers as resources for their HIV prevention. The participants were 20 education students from a South African technology education university (female = 60%, black = 85%; age range = 18 to 24). They completed a semi-structured interview on their access to family and peers talking about HIV/AIDS prevention in the context of perceived cultural influences. The data was thematically analysed using open-coding. Findings suggest that students shared information about HIV/AIDS prevention with peers, and less so with family. They perceived cultural taboos around sex talk to be a barrier to open discussion of HIV/ADS. Students may need to acquire strategies to negotiate HIV/AIDS prevention approaches with family in the context of culture.     

Structural and Community Change Outcomes of the Connect‐to‐Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention,Testing, and Medical Care

Connect to Protect (C2P), a 10‐year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV‐related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions’ context and operation that facilitated and undermined their ability to achieve structural change and build communities’ capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS‐competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV‐risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions’ ability to successfully implement HIV‐related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS‐competent community.     

The Role of the Black Church in HIV Prevention: Exploring Barriers and Best Practices

Black people have the highest rate of HIV/AIDS infection in the USA, and they are less likely to access quality physical and mental healthcare. To address these disparities as outlined in the National HIV/AIDS Strategy, there is a need for culturally congruent, innovative approaches to HIV/AIDS prevention. The first multi‐denominational national study of Black faith leaders was conducted utilizing focus groups that were held in 11 US cities. The 265 participants were faith leaders who reported involvement in such prevention practices as sponsoring HIV/AIDS workshops, integrating HIV/AIDS messaging in the worship service, hosting HIV/AIDS screenings, distributing written materials about HIV/AIDS through the bulletin or flyers, pastoral counselling, advocating for policies that provide quality healthcare to the community and disseminating HIV/AIDS prevention messages through new media such as the Church website. These findings, including attention to barriers to engagement, provide insight into innovative practices that can be integrated into faith‐based HIV/AIDS prevention programming. Copyright © 2016 John Wiley & Sons, Ltd.     

Relations of Power in Different Spaces: An Exploration of the Schooling Experiences of Children in an HIV/AIDS Context

In this article we explore how the concept of relations of power in different spaces plays out in the lives of school children living in an HIV/AIDS context, and how processes of inclusion and exclusion are associated with particular spaces. The article uses Foucault's (2000) identification of four distinct relations of power to argue that within different school spaces we find economic, political, judicial and epistemological relations of power that are embedded in the way children experience reality. The study was conducted in five primary schools, three secondary schools, one early Childhood Education (ECD) centre, a special school and their communities in the province of KwaZulu Natal. Participants were teachers, learners, out of school youth, and members of community organisations working in the district. Data collection methods included individual and focus group interviews. Within the focus group interviews various participatory research techniques were used, including ranking exercises, projective activities, transect walk, body mapping, photo voice. The findings in the study revealed three complex and contradictory schooling spaces: policy space, curriculum space, and safe spaces in which learners' schooling lives are played out. The study showed that space is fundamental in the exercise of power as revealed in the exclusionary and inclusionary ways in which children experienced their schooling lives.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

The Role of Male Sexual Partners in HIV Infection Among Male-to-Female Transgendered Individuals

SUMMARY

Male-to-female transgendered persons (MtF) in San Francisco have very high HIV prevalence and incidence. To explore possible sources for these high rates of HIV infection, a rapid needs assessment was conducted using two methods: (1) an interviewer-administered, mostly closed-ended survey with the male partners of MtF persons, and (2) focus groups with MtF persons. Five main themes were evident from the findings: (1) male partners of MtF persons are of all ages, races, sexual orientations, and socioeconomic backgrounds; (2) high-risk sex occurs between MtF persons and their male sexual partners, despite a high level of concern about HIV among both the male and MtF study participants; (3) drug use appears to play a role in unsafe sex between MtF and their male partners; (4) male partners of MtF persons may represent a possible bridge for HIV transmission among different populations, given that they reported sex with male and female partners, as well as transgendered partners; and (5) men engaging in receptive anal sex with MtF partners probably occurs more frequently than reported by the male participants, given the comments of MtF study participants. The results indicate a need for creative, community-based HIV prevention strategies that target the male partners of MtF transgendered persons.     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。