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.     

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。     

Is there None Left to Say Anything?

Abstract. Remarks made by Lutheran leaders in Africa indicate that the churches have not been responding to the crisis of the HIV/AIDS pandemic sufficiently. In this essay I ask how the churches would be better prepared to act and also, more broadly, how the churches act to begin with. The dialogue between religion and science can assist us with both tasks as we consider the challenge of HIV/AIDS as a focus for this dialogue. First, analysis by social scientists can uncover what problems face any effort to motivate churches to act—and, for that matter, any individual member of a church group. I argue, further, that we can discover the difficulties associated with producing action by religious communities by looking not at abstract theological ideas but by investigating the way those ideas are conveyed in worship. I explore the worship patterns of Lutherans to show what sort of view is actually produced by the week‐to‐week messages of liturgical texts. I contend that a different approach both to worship and to action can be produced by reconsidering our views of reality as seen through the eyes of contemporary science.     

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.     

Development of the HIV/AIDS Stress Scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS; hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS were interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms, reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal, and differs from controllability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.     

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 Infection and the Central Nervous System: A Primer

The purpose of this brief review is to prepare readers who may be unfamiliar with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and the rapidly accumulating changes in the epidemic by providing an introduction to HIV disease and its treatment. The general concepts presented here will facilitate understanding of the papers in this issue on HIV-associated neurocognitive disorders (HAND). Toward that end, we briefly review the biology of HIV and how it causes disease in its human host, its epidemiology, and how antiretroviral treatments are targeted to interfere with the molecular biology that allows the virus to reproduce. Finally, we describe what is known about how HIV injures the nervous system, leading to HAND, and discuss potential strategies for preventing or treating the effects of HIV on the nervous system.     

Preventing HIV infection among injecting drug users: Intuitive and counter-intuitive findings

The disease now called AIDS was first reported among injecting drug users in 1981. This article reviews the last 15 years of research on preventing HIV infection and AIDS among injecting drug users. Many of the findings were surprising in the context of previous understandings of the illicit injection of psychoactive drugs—both with respect to the much-larger-than-expected size of the epidemic and the much-greater-than-expected potential for behavior change among drug injectors (IDU). The research is reviewed within a framework of eight issues: the importance of the problem in the United States, the global diffusion of injecting drug use, the global diffusion of HIV among IDUs, potential rapid spread of HIV among IDUs, risk reduction among IDUs, community-level prevention, syringe exchange programs, and developing a public-health perspective on psychoactive drug use.     

Preventing HIV infection among injecting drug users: Intuitive and counter-intuitive findings

The disease now called AIDS was first reported among injecting drug users in 1981. This article reviews the last 15 years of research on preventing HIV infection and AIDS among injecting drug users. Many of the findings were surprising in the context of previous understandings of the illicit injection of psychoactive drugs—both with respect to the much-larger-than-expected size of the epidemic and the much-greater-than-expected potential for behavior change among drug injectors (IDU). The research is reviewed within a framework of eight issues: the importance of the problem in the United States, the global diffusion of injecting drug use, the global diffusion of HIV among IDUs, potential rapid spread of HIV among IDUs, risk reduction among IDUs, community-level prevention, syringe exchange programs, and developing a public-health perspective on psychoactive drug use.     

The colour of AIDS

Abstract

The African debate on HIV/AIDS has been approached in terms that either foreground its biomedical implications, on the one hand, or its economic challenges, on the other. From the biomedical perspective, HIV/AIDS is a health problem, calling for appropriate behaviour modification strategies; from the economic perspective, however, HIV/AIDS in Africa is viewed as a structural effect of capitalist-induced poverty. This article aims at providing a philosophical basis for understanding the African debate on HIV/AIDS. Its primary contention is that, in order to understand the African experience of HIV/AIDS, we need to overcome the crippling legacy of the modernist-colonialist discourse on Africa, in which “reason” is invariably regarded as the exclusive privilege of the (“white”) Western philosophical “mind”.     

Introduction to the Symposium

Abstract. The articles in this section were presented at the conference “Toward a Theology of Disease” sponsored by the Zygon Center in October, 2002. This was a second conference designed to address the question of what the science‐religion dialogue could contribute to the larger discussion of the rapid spread of HIV/AIDS. The conference brought a wide range of perspectives to this question from different religious traditions. I draw them together here around the idea that Philip Hefner introduced in his keynote address: our fragmented experience of the world. The notion of fragmentation opens the door for both a recognition of several possible approaches to building a theology of disease and the pluralism of religious traditions, as well as providing a framework for integrating our full awareness that HIV/AIDS is a problem without solutions and requiring a level of humility in posing any real answers. The essays clearly suggest that the question remains perplexing but that our efforts do show that a multifaith, multidisciplinary religion‐science dialogue can contribute significantly to the larger discussion.     

Introduction: symposium on Brooke Ackerly’s Just Responsibility: A Human Rights Theory of Global Justice

ABSTRACT

This symposium brings together normative and empirical scholars in dialogue on Brooke Ackerly’s innovative and compelling recent monograph, Just Responsibility. Contributors discuss the book’s distinctive grounded normative theory methodology, its arguments for how individuals can take appropriate responsibility for global structural injustices, and its potential for practical impact.     

A problem-posing educational methodology for the prevention of HIV / AIDS

The problem-posing methodology of Brazilian educator Paulo Freire, using the reading circle approach previously deployed in successful literacy campaigns in developing countries, is introduced for application in AIDS information programs. The basis of this educational process is the dialogue where those to be educated resolve their problems by evaluating information critically, capturing concepts by codification and decodification, and transmitting information by creating relevant educational materials. Health circles are organized with women as educators to impart knowledge about AIDS and HIV: definitions, epidemiological components (sex, age, and risk behavior), means of transmission, stages of the progression of AIDS, prevention of HIV infection, and tests for detecting HIV antibodies. The dialogue explores knowledge and feelings about AIDS and how it affects life in the community reveals personal experiences and accounts of knowing someone who was HIV-positive, and develops action plans to minimize AIDS cases in the community. The Latin population of California, mainly of Mexican origin, with low levels of education, income, and acculturation and a high incidence of AIDS, is an appropriate target of such intervention. In 1980, there were 12.3 million people of Hispanic origin in the US. In August 1990, there were 143,280 persons diagnoses with AIDS according to the Centers for Disease Control. 78,878 of these (55%) were Anglos, and 21,752 (15%) were Hispanics. Among the Anglos, the incidence was 300/million inhabitants, while among Hispanics, it was 1059/million, a 3-field higher rate.     

The Theological Structure of Christian Faith and the Feasibility of a Global Ecological Ethic

Scientific evolutionary/ecological thinking is the basis for today's understanding that we are now in an ecological crisis. Religions, however, often resist reordering their thinking in light of scientific ideas, and this presents difficulties in trying to develop a viable global ecological ethic. In both the West and Asia religiomoral ecological concerns continue to be formulated largely in terms of traditional concepts rather than in more global terms, as scientific thinking about ecological matters might encourage them to do. The majority of this article is devoted to the kind of reformulation of Western Christian conceptions of God, humanity, and the relation between them that is necessary to address this problem. The question is then raised whether similar critical thinking about religiomoral issues raised by today's evolutionary/ecological scientific thinking is going on in Asian religions and whether it would be too presumptuous (in view of our colonial history) for us Westerners to ask for such rethinking. This leads to a final question: Without such transformations in religious traditions East and West, is the development of a truly global ecological ethic really feasible?     

AIDS: Globalization and Its Discontents

Abstract. HIV/AIDS has changed from a disease of white gay men in the United States to a pandemic that largely involves women and dependent children in developing countries. Many theologies of disease are necessary to cope with the variety of expressions of this pandemic. Christian theoethical reflection on HIV/AIDS has been largely focused on sexual ethics, with uneven and mainly unhelpful results. Among the ethical issues that shape future useful conversations are globalized economics and resource sharing, the morality and economics of the pharmaceutical industry, and the need for sex education and access to reproductive choice. Considering such issues in international, interreligious, multiscientific contexts is a concrete next step for the religion‐and‐science dialogue. It will put the powerful tools of both fields to the service of the common good.     

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.     

Religion in the Context of Culture, Theology, and Global Ethics

The theme of this symposium is distinctive and challenging, because it incorporates the dimensions of interreligious reflection, theology, science, and ethics. This article presents a palette of issues that are both challenge and resource for approaching the theme. Three sets of issues are considered: (1) the role of religion in culture, (2) theological interpretation of nature, disease, and evil, and (3) the fashioning of a global ethic.     

African American Clergy Share Perspectives on Addressing Sexual Health and HIV Prevention in Premarital Counseling: A Pilot Study

This exploratory qualitative pilot study examined the extent to which seven African American clergy discussed and promoted sexual health dialogue with couples preparing for marriage. We explored the following topics: (a) clergy perspectives on disclosure; (b) clergy awareness about HIV/AIDS and (c) the extent to which clergy awareness about HIV is translated into their premarital counseling programs. Our results suggest that greater awareness and comfort level with discussions about sexuality mediate the inclusion of sexual health and promotion of HIV testing in premarital counseling.     

Confidentiality Limits With Clients Who Have HIV: A Review of Ethical and Legal Guidelines and Professional Policies

The publication of the first counseling articles addressing confidentiality limits of clients who have HIV (human immunodeficiency virus) and continue to be sexually active with an uninformed partner occurred 4 years ago. Since that time, dialogue about whether a helping professional may ethically and legally breach confidentiality has not resolved the dilemma but instead has created more questions and controversy for counselors. In this article the authors highlight the barrage of ethical issues regarding HIV and Acquired Immune Deficiency Syndrome (AlDS), review ethical and legal guidelines pertaining to HIV and AIDS and confidentiality, summarize HIV and AIDS confidentiality policies of the major helping professional organizations, articulate questions that contribute to the confidentiality dilemmas, and challenge the American Counseling Association (ACA), formerly the American Association for Counseling and Development (AACD), to develop specific guidelines for counselors.     

Perceived Church-Based Needs and Assets for HIV/AIDS Prevention in an Urban Nigerian Community

Health intervention programs have the potential to use church-based assets to address a wide range of health issues. This study examined the assets Nigerian church members believed their churches needed, including the assets they thought they had to engage in HIV/AIDS prevention activities. Eight hundred and thirty members from 83 churches completed a questionnaire designed from forum focus group data. Respondents were males and females aged 18 years old and above, with primary, secondary, university, or vocational education, and were more likely to be married than single (never married), separated, divorced, widowed or remarried. The data revealed that church members needed access to health promotion assets, including the expertise of members who are health professionals to engage in HIV/AIDS prevention activities. We recommend an intensive HIV/AIDS prevention reorientation-training workshop for church leaders to ensure a sustainable plan to address HIV/AIDS prevention needs.