Using the ESID Model to Reduce Intimate Male Violence Against Women

Described how the Experimental Social Innovation and Dissemination (ESID) model was successfully used to reduce intimate male violence against women. Following the principles of ESID, the experimental social innovation involved providing trained paraprofessional advocates to work one-on-one with women who had been assaulted by partners or ex-partners. Advocates worked with women for 10 weeks, assisting them in obtaining needed community resources such as legal assistance, housing, education, and employment. Two hundred seventy eight women who had exited a domestic violence shelter program were randomly assigned to the experimental or control condition. Participants were interviewed 6 times over a period of 2 years: pre- and postintervention (10 weeks later), and at 6, 12, 18, and 24-month follow-up. Women who received the intervention reported less violence over time as well as higher social support and perceived quality of life. The relevance of the ESID model in addressing this as well as other significant social problems is discussed.     

Bridging the HIV Divide: Stigma,Stories and Serodiscordant Sexuality in the Biomedical Age

At a time when advances in biomedicine have rendered people with HIV non-infectious under certain conditions, much public discourse on HIV remains stuck in a paradigm of ‘risk’, which does little to lessen the divide between people with and without HIV in society or challenge the way intimate relationships across this divide are typically stigmatised as undesirable and problematic. We rarely hear the stories of couples who live with mixed HIV statuses and how they themselves perceive and manage their so called ‘serodiscordance’. In this article, we examine such stories by mixed-status couples in Australia. In stark contrast to the dominant discourse, these couples invoked narratives of love, the everyday unimportance and manageability of HIV, and recent developments in HIV medicine, thereby challenging the way serodiscordant sexuality has been cast in public health research. Drawing on Ken Plummer’s work on hidden sexual stories, we consider not only the content of their stories, but the broader significance of stories to the world in which they are enacted, of storytelling as a rally for social and political recognition and legitimacy. Reflecting on our own role in the co-production of research stories, we argue that by moving marginalised sexual stories out of silence, stigmatised communities and researchers can conjointly and incrementally shape a new public discourse and new forms of ‘intimate citizenship’.     

基于未感染者与感染者双重视角的艾滋病污名

艾滋病污名由公众污名和自我污名两部分构成。前者指公众所持有的对艾滋病和艾滋病感染者的偏见、刻板印象和歧视; 后者指艾滋病感染者感知到的来自公众的偏见、刻板印象和歧视, 并由此产生的负面自我认知。测量主要从未感染者和感染者两个层面展开。艾滋病的公众污名与自我污名广泛存在于个人、家庭、医疗、媒体等诸多领域, 阻碍艾滋病的有效防治并损害社会平等。减少艾滋病污名的干预既需要消除公众的偏见、刻板印象和歧视, 改善社会环境; 也需要感染者自我的心理健康和治疗意愿, 提升生活质量。未来应该从未感染者和感染者的双重视角出发, 对其相互作用机制、测量工具、干预措施及连带污名等进行深入研究。     

ESID,Dissemination, and Community Psychology: A Case of Partial Implementation?

Dissemination, the second stage of Experimental Social Innovation and Dissemination (ESID) is a critical, if not defining, element of this social change model. This paper attempts to assess the extent to which community psychology has adopted and implemented ESID's dissemination focus in its training and publications. We identify four levels of commitment to dissemination: dissemination advocate, dissemination activist, dissemination researcher, and experimental dissemination researcher. Content analyses of textbooks, journal publications, and conference papers and a brief survey of doctoral training in the field were conducted. Findings suggest that the dissemination aspects of ESID have been modestly and partially implemented within the field. That is, although there is some evidence of a commitment to dissemination practice (advocate, activist), there is much less evidence of a commitment to dissemination research. The implications of these findings for the effectiveness of the ESID model and for training and practice in community psychology are discussed.     

A Social Problem-Solving Model of Adherence to HIV Medications.

HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS.     

Psychological Predictors of Condom Use to Prevent HIV Transmission Among Zimbabwean Students

Psychologists have much to contribute to HIV prevention. It is important to identify predictors of HIV preventive behaviour and to incorporate this information in AIDS education. The Health Belief Model is an established model of health behaviour that has recently been applied to AIDS prevention. It originally posited that perceptions of susceptibility to, severity of, and solutions to, illness predicted health behaviour. It thus emphasized “disease” dimensions of illness. It was expanded to include barriers to, cues to, and social support for, health behaviour. The enlarged model thus incorporated “social” dimensions of health behaviour. Because preventing AIDS involves a partner and considerable social risks and skills, inclusion of social components may improve the capacity of the Health Belief Model to predict HIV preventive behaviour. An inventory measuring condom use and the enlarged Health Belief Model was completed by 181 male and 171 female teacher-trainees. Data were analysed using multiple regression with hierarchical entry, first of disease dimensions (susceptibility, severity, solution), then social dimensions (barriers, cues, social support). Addition of social dimensions to the disease dimension equation yielded a significant F-change among both sexes and increased the variance explained from 16% to 30% among males, and from 4% to 14% among females. The full regression was significant only among males. The implications of these results for intervention goals, messages and strategies among both sexes are elucidated.     

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice

Abstract

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in “clusters” of others with genetically similar strains. This is called “molecular HIV surveillance” (MHS). In 2019, “cluster detection and response” (CDR) programs that re-use MHS data became the “fourth pillar” of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for “HIV data justice.” The essay contributes to a “bioethics of the oppressed.”     

Fairweather and ESID: Contemporary Impact and a Legacy for the Twenty-First Century

This paper illustrates how the articles in this special issue demonstrate the central values, research, and action principles inherent in Fairweather's ESID model. The programs described in these articles address earlier social problems in new forms (e.g., previously, institutionalized mentally ill patients and now, the homeless mentally ill) and new issues (e.g., HIV prevention). Dissemination of innovative programs is abundant, but only recently has research begun in earnest to study the critical processes of dissemination. Moreover, Fairweather has pointed us in important, but yet unrealized directions for how to pursue a theory of social change on the basis of ecological concepts, innovative research methods and data analytic techniques, and salient change agent behaviors and principles.     

The chronic illness quality of life (CIQOL) model: explaining life satisfaction in people living with HIV disease.

The chronic illness quality of life (CIQOL) model theorizes that life satisfaction in persons living with a chronic illness such as HIV disease is a function of illness-related discrimination, barriers to health care and social services, physical well-being, social support, and coping. The CIQOL model was evaluated using data from 275 persons living with HIV disease. Women reported less life satisfaction and confronted more barriers to health care and social services than men, and White participants reported higher perceptions of AIDS-related discrimination than non-White participants. The CIQOL model provided an excellent fit to study data (root-mean-square error of approximation = .03) and accounted for almost a third of the variance in life satisfaction scores. Barriers to health care and social services played a particularly prominent role in the model.     

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.     

Personal Meaning,Social Support,and Perceived Stigma in Individuals Receiving HIV Mental Health Services

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.     

Health Beliefs and Attitudes Toward People Living With HIV/AIDS

The present study was concerned with the relationship between health beliefs and attitudes toward people living with HIV/AIDS. Measures of attitudes toward people with HIV/AIDS, beliefs about the transmission of HIV, and health locus of control beliefs were completed by 128 undergraduate students. In general, subjects who believed that HIV was transmitted through normal social contact wanted to avoid contact with people with HIV/AIDS, and showed other negative attitudes, such as lack of sympathy and blame. They also believed that their health was influenced by powerful others and chance. The findings are discussed in terms of fear of contracting HIV and the tendency to blame the victim.     

Mental health correlates of HIV risk behaviour and STIs/HIV infection among university students from 22 low,middle and high income countries

The aim of this study was to determine mental health correlates of HIV risk behaviour and self-reported STIs/HIV infection among university students in 22 low, middle and high income countries. Data on mental health and HIV risk were collected from 16 567 undergraduate university students (mean age 20.9, SD = 2.9) from 23 universities in 22 countries across Asia, Africa and the Americas. Results indicate that overall 16.8% of the students had two or more sexual partners in the past 12 months, and among the sexually active, 73.7% had inconsistently used a condom in the past three months with their primary sexual partner, 3.2% had ever been diagnosed with a sexually transmitted infection (STI) and 0.6% had been diagnosed with HIV. In multivariate logistic regression poorer mental health and child abuse (physical and sexual) were associated with HIV risk behaviour, and child abuse (physical and sexual) was associated with STI and HIV positive diagnoses.     

Social Determinants of HIV Among Men Who Have Sex with Men in Cape Town

Little is known about how social factors influence vulnerability to, and consequences of, HIV infection among men who have sex with men (MSM) in South Africa. This study aimed to analyse social stratification and its links with HIV among MSM in Cape Town, South Africa. Six interviews and six focus group discussions (n = 25) were conducted. Tools were based on the World Health Organisation’s Commission on the Social Determinants of Health framework. Directed content analysis was used to analyse data. Race and education were directly linked to social position. MSM from lower social positions were more vulnerable to HIV, and had more negative consequences of HIV infection, compared to wealthier MSM. Engagement with community leaders, health workers and police to promote inclusion could reduce vulnerability of MSM to HIV. Increased access to free, non-discriminatory HIV-related services would reduce inequities in access to HIV services by MSM.     

Mapping an HIV/STD prevention curriculum for Zambian in-school settings

HIV/AIDS poses grave risk to human development in sub-Saharan Africa. Evidence-based interventions that are rooted in local culture could help efforts to prevent threats to human development from HIV/AIDS. We used concept mapping (Concept System, 2006 ) to construct the components and content of a locally developed HIV/AIDS curriculum for use by secondary schools in Lusaka, Zambia. Participants were school counsellors (n = 14), youth health program officers (n = 7), and regular education teachers (n = 3) from the education, health, and youth development agencies in Lusaka, Zambia (males = 11; females = 13; mean age 38; SD = 15 years). Concept mapping yielded six statement clusters defining preliminary components of a locally grounded in-school HIV/AIDS prevention curriculum and the content items that define these components: (1) life skills education (18 items), (2) sexuality and reproductive health (10 items), (3) treatment, care and support (13 items), (4) counselling (12 items), (5) basic facts about HIV/AIDS (11 items), and (6) dissemination of information about HIV/AIDS (11 items). Zambian locally constructed constructs for an HIV/STD prevention curriculum overlap those promoted by public health programs in the country and internationally.     

Manufacturing Mistrust: Issues in the Controversy Regarding Foster Children in the Pediatric HIV/AIDS Clinical Trials

The use of foster children as subjects in the pediatric HIV/AIDS clinical trials has been the subject of media controversy, raising a range of ethical and social dimensions. Several unsettled issues and debates in research ethics underlie the controversy and the lack of consensus among professional researchers on these issues was neither adequately appreciated nor presented in media reports. These issues include (1) the tension between protecting subjects from research risk while allowing them access to the possible benefits of research; (2) the blurring of the potentially conflicting roles of investigator and physician and the boundaries between research and therapy; (3) the adequacy of Institutional Review Board oversight; and (4) trust and the relationships among physicians, investigators and industry. The media controversy about the pediatric HIV/AIDS clinical trials can be seen as a means of “manufacturing mistrust” in health care, research and social services that have not always met the needs and expectations of the public. In an era of emerging infections, it is critical to the public’s health that people understand the role of rigorous and ethical research in the development of safe and effective care. Investigators, journalists and the public need to become knowledgeable about major ethical issues in the conduct of research in order to engage in dialogue about balancing research risks and benefits and to be able to distinguish fact from distortion in an era of multiple and rapid transmission of information.     

HIV and AIDS in Africa: social,political, and economic realities

Sub-Saharan Africa bears the brunt of the HIV epidemic, which is fueled by the many ethical, social, and political complexities that make up Africa. In turn, the pandemic has also caused many ethical, social, and political complexities that Africa now grapples with. Being infected with HIV is highly complex and challenging. Regrettably, gender inequality is still pervasive in Africa. The response by African leaders to the pandemic has been, on the whole, shamefully lethargic. For Africa to win its war against HIV/AIDS, a paradigm shift is required from the perspective of its socio-political context. What is called for is positive political will that will address all aspects of the social determinants of AIDS. What is also required is that Ubuntu is embraced meaningfully.     

Social Relations,Coping, and Psychological Distress Among Persons With HIV/AIDS1

The interrelationships among social support, coping style, and psychological distress were examined using longitudinal data from a sample of 212 persons with HIV/AIDS. Structural equation modeling analyses showed significant indirect effects on psychological distress for avoidant coping, feeling loved and understood, satisfaction with support, rejection by family members, discrimination because of HIV status, and number of AIDS symptoms. The inclusion of negative social interactions in the model is an important extension of the stress‐support literature. Feeling loved and understood mediated the relationship between social support and coping style choice. Results highlight the multidimensional nature of the processes that shape psychological outcomes in HIV disease. and suggest several potential points of intervention, including social‐support efforts that increase the sense that one matters to others, and interventions to assist patients to move from avoidant to active coping strategies.     

Professional Counseling in Kenya: History,Current Status,and Future Trends

The authors examine the history and development of the counseling profession in Kenya. This profession is deeply rooted in responses to the HIV/AIDS epidemic, the emergence of mental health needs created by the impact of political and community‐based violence, increasing student unrest in public institutions, and government efforts to provide social–emotional support for students in public schools and universities. The authors also examine the challenges for the profession and make recommendations for the future.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.