"The Plague Of Blood": HIV/AIDS and Ethics of the Global Health–Care Challenge

In this essay I explore the heuristic value of the concept of ethics of complexity, chaos, and contingency by applying its framework to the analysis of the HIV/AIDS pandemic. Everyday human moral choices are outcomes of a moral impulse, and such an impulse is grounded in moral competence shaped by moral literacy. This literacy is constructed on the basis of a body of knowledge of culture, social context, environment, and the universe. It also includes the knowledge of religions and religious and secular ethical codes. I also distinguish between the social and cultural aspects of ethical systems. Both societies and cultures provide resources and constraints for the development of literacy and competence. An intentionally developed multifaith and multidisciplinary coalition may help us move away from various forms of social speciation and toward sociological mindfulness. This could help us remake the world into one that has more courage to care.     

Counseling Caregivers of Families Affected by HIV/AIDS: The Use of Narrative Therapy

This article proposes the use of Narrative Therapy with family caregivers of family members diagnosed with HIV/AIDS. The authors identify the reasons for using Narrative Therapy with African family caregivers who have relocated to the United States of America. The tenets of Narrative Therapy are outlined, and a case illustration is provided to show how Narrative Therapy can be implemented. In this case study, the client moves from a state of helplessness and hopelessness to being able to regain control of her life and improve the care of her sister. She was able to re-write her story: from feeling incompetent to a position of strength. Although Narrative Therapy was used successfully with an African family caregiver within the USA, the authors assert that the interventions have the potential to be used as effectively with those clients living in Africa, provided counselors are sensitive to cultural differences that will affect their practice.     

Building contexts that support effective community responses to HIV/AIDS: a South African case study

In this paper we discuss our conceptualisation of a 'health-enabling social environment', and some of the strategies we are currently using to build social contexts most likely to support effective HIV/AIDS management in southern Africa. In developing these ideas, we draw on our on-going collaboration with residents of Entabeni, a remote rural community in South Africa where 43% of pregnant women are HIV positive. The aim of this collaboration is to facilitate contextual changes that will enable more effective community-led HIV/AIDS management in an isolated area where people have little or no access to formal health or welfare support, and where HIV/AIDS is heavily stigmatised. We give an account of the three phases of collaboration to date. These include research; the dissemination of findings and community consultation about the way forward; preliminary project activities (skills training for volunteer health workers; partnership building and a youth rally) as a way of illustrating what we believe are six key strategies for facilitating the development of 'AIDS-competent' communities: building knowledge and basic skills; creating social spaces for dialogue and critical thinking; promoting a sense of local ownership of the problem and incentives for action; emphasising community strengths and resources; mobilising existing formal and informal local networks; and building partnerships between marginalized communities and more powerful outside actors and agencies, locally, nationally and internationally. We discuss some of the triumphs and trials of this work, concluding with a discussion of the need to set realistic goals when working at the community level in highly conservative patriarchal communities to tackle problems which may be shaped by economic and political processes over which local people have little control.     

HIV: How Science Shaped the Ethics

AIDS is a debilitating and fatal disease that was first identified as an infectious disease syndrome in the 1970s. The discovery of a nearly universally fatal infectious and rapidly spreading disease in the post–antibiotics era created apprehension in the medical community and alarm in the general population. Questions about how patients should be handled in medical and nonmedical settings resulted in the ostracizing of many AIDS patients and inappropriate patient management. Scientific investigation into modes of disease transmission and control helped to shape the management of AIDS patient care in such a way that ethical and protective practices could be developed. In this article I discuss some of the ethical questions that were addressed by appropriate scientific inquiry.     

特殊人群艾滋病行为干预的思考

艾滋病直接危害人类的健康,也对社会、政治、经济及人文伦理道德产生重大的负面影响。对艾滋病病人犯罪的监管问题,公安干警的职业暴露问题,都是目前司法实践中遇到的新课题。加强艾滋病患者违法监管,对特殊群体进行行为干预,是司法结构急待解决问题。     

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.     

大学生对艾滋病的乐观偏差

研究采用问卷法,以北京6所高校的278名被试为样本,考察了大学生对艾滋病的乐观偏差。结果表明,被试对艾滋病的感染和治愈存在着双重乐观偏差;艾滋病知识掌握程度既与感染艾滋病的乐观偏差无显著相关,也与治愈艾滋病的乐观偏差无显著相关。     

Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders

SUMMARY

Social discourses regarding gender are responsible for molding people's cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender socialization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people.

This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area.

Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis confirmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies.

Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities.     

Other- versus self-focus and risky health behavior: the case of HIV/AIDS

We examined the relationships of other-focus and self-focus with risky health behaviors among HIV+ individuals. Participants who were recruited by an AIDS advocacy organization completed anonymous questionnaires that included measures of other-focus (i.e. empathic concern and perspective-taking) and self-focus (i.e. personal distress and exaggerated internal control); direct measures of concern about the consequences of HIV/AIDS for the self, close others, and society; and a measure of willingness to engage in HIV/AIDS risk behaviors. As predicted, other-focus measures were generally associated with less, and self-focus measures with greater, willingness to engage in risky behavior. However, concern about the consequences of HIV/AIDS for close others was similar to self-focus and was associated with greater willingness to engage in risky behavior. These results are consistent with the notion that prevention efforts focusing on the consequences of HIV/AIDS – and perhaps other communicable diseases – might be more effective if they highlighted the consequences of the disease for society.     

艾滋病揭示的性别不公正

贫困妇女人群中HIV新发感染不成比例上升的现象揭示了社会中的性别不公正,通过美国和肯尼亚的案例说明,预防艾滋病需要认可和促进妇女的人权,减少针对妇女的暴力,并保障妇女的教育,普及艾滋病相关知识.对女性主义进行了重新阐释,并以南非"和平与和解"运动为例指明了新的前进方向.     

护理扩展培训在艾滋病干预模式中的探讨

新疆艾滋病形势严峻,艾滋病重点疫区的护理人员普遍存在着对艾滋病知识的缺乏,对艾滋病患者持有歧视、恐惧的心理及缺乏基本的防护知识等现状,艾滋病护理扩展培训项目的实施,通过对护理人员进行的艾滋病知识培训,对艾滋病干预模式进行了有益的探索和实践。     

Researching HIV/AIDS,Education & Childhood in the African Context

This article offers a reflective review of 12 articles and 4 brief reports included in this special issue of the International Journal of Psychology in Africa with the theme, ‘HIV/AIDS, education and childhood in the African context’. Muthukrishna and Ramsuran (2007) have emphasised that the consequences of HIV/AIDS can be far-reaching for children and young people resulting in unequal life chances. It is thus fitting that this special issue should be edited by them in KwaZulu-Natal, South Africa, in the country (and province) with the highest levels of incidence of HIV/AIDS in Africa. In this article I offer a commentary on how the interpretive lenses of the authors who are located in various disciplines provide a theorised understanding of what shapes knowledge constructions in situated African contexts.     

The Passion to Heal: A Theological Pastoral Approach to HIV/AIDS

Abstract. The global pandemic of HIV/AIDS is the most significant challenge of our time. The ongoing conversation between religion and science comes to a critical juncture in this pandemic. The global community has not yet found a vaccine or cure for this virulent virus, which will likely claim five million more lives in the coming year. The global statistics challenge even the most sophisticated imagination, with projections in the tens of millions of people dead, orphaned children, and many more living in various stages of incapacitation or diminished lives. There is a common prophetic religious imperative among Western faith communities that urgently requires both science and religion to respond. Both disciplines define their scope and purpose as universal, and the global pandemic provides a significant challenge to that universal claim. Regardless of the many differences among the nations and peoples challenged by this pandemic, there is a common moral foundation to which the Western religious and scientific traditions must respond. Religion and science cannot deny their respective social responsibilities by claiming the role of neutral bystander. There are several critical ethical choices to be made in response to the pandemic, and the disciplines of religion and science are critical in formulating those choices.     

艾滋病感染信息配偶告知中的伦理问题探析

艾滋病感染者和病人有将感染信息及时告知配偶的义务,但部分感染者和病人会以隐私保护或告知后可能面临困难为由拒绝履行,这是对避免将疾病传播给他人责任的回避,也会造成维护伦理关系名义下对关系的破坏。因而需要允许保密原则的合理例外,赋予医疗卫生机构告知权限。这一赋权带来的受益大于风险,同时也作为感染者和病人自律的制约与补充,以及信息弱势群体权益的保障。在告知举措上,需要注重伦理管理,完善相关政策措施;回应感染者和病人的生活逻辑,采取人性化告知方式;同时告知与宣传并重,减少歧视感染者和病人的舆论环境。

     

Subverting Culture: Promoting HIV/AIDS Prevention Among Puerto Rican and Dominican Women

This article discusses the challenges faced by researchers and interventionists when attempting to promote change in social norms and normative beliefs that promote HIV/AIDS risk-related behaviors among Puerto Rican and Dominican women. The article focuses on the role of culture in HIV/AIDS prevention with women by analyzing the sociohistorical context of some cultural beliefs and by illustrating the tension between risk-related and protective cultural beliefs in research conducted by the authors with women in both New York and Puerto Rico. The authors propose that promoting changes in sex-related social norms and normative beliefs might be constructed as a subversive act and present the challenge this analysis poses for community psychology. They conclude that this conceptualization might be construed as subversive because rather than idealizing culture, it promotes changes that respect diversity within the culture and foster participation in the development of new cultural values, beliefs and norms.     

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).     

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.     

A Pandemic of Terror and Terror of a Pandemic: American Cultural Responses to HIV/AIDS and Bioterrorism

Abstract. The cultural construction of American societal responses to the HIV/AIDS pandemic and terrorism is addressed. The use of metaphors of war, survival, extinction, and of those related to God in public narratives is analyzed. Issues of gender, sexuality, money, and power are also discussed within the context of the religion‐science dialogue. Suggestions are made about a possibility for a global ethic of survival based on an ethic of care.     

Sex and the Right to HIV/AIDS Education in Early Childhood

This study explored how early childhood teachers (n=5) and young children (n=174) (age range 7 to 8 years; males = 81; females = 93) in two primary schools constructed and interpreted the right to HIV/AIDS education. Data were captured using individual interviews with teachers and group interviews with young children. Analysis of the data showed that teachers viewed young children's right to health information positively but did not consider the right to sexual information. Teachers operated within discourses which upheld the image of the child as innocent requiring protection from sexual knowledge. Children's perceptions of their rights to knowledge of sex in HIV/AIDS education showed ambiguity. Some accepted the right to know whilst others felt that knowledge about HIV/AIDS was inconsistent with childhood innocence.     

The New Biology and its Impact in Biomedical Strategies Against HIV/AIDS

Abstract. The sequencing of the human genome and the initiation of the structural genomics projects have ushered in a new age of biology that involves multi‐lab, high‐cost projects with broad task‐oriented goals rather than the more conventional hypothesis‐driven approach of the past. The new biology has led to the development of new sets of tools for the scientist to use in the quest to solve mysteries of human disease, biomolecular structure‐function relationships, and other burning biological questions. Nevertheless, the impact of the new biology on the field of AIDS investigation has been minimal, predominantly because many of the tools in the HIV field of study were developed before the full advance of the new biology was felt in the biomedical community. Many of the high‐cost megaprojects that involve large technological advances and are marketed as projects of promise to the biomedical community are not likely to significantly impact the field of HIV/AIDS research and cannot serve as a substitute for direct funding to the HIV/AIDS scientists working for vaccine development, an understanding of mechanisms of disease causation, and new tools for therapeutic intervention.