AIDS‐Related Stigma in Individuals With Other Stigmatized Identities in the USA: A Review of Layered Stigmas

AIDS‐related stigmas have profound negative impacts on people living with and those affected by HIV/AIDS. While a considerable body of work examines AIDS‐related stigma, it is less clear how AIDS stigmas affect individuals in relation to other stigmatized identities, particularly ethnic minorities. This review examines the literature on AIDS‐related stigma among these groups. The limited available research indicates that AIDS stigmas can seriously interfere with HIV testing, treatment, and care. In addition, prevention studies conducted with incarcerated adolescents, a group characterized by stigmatized identities and high risks for HIV, indicate that interventions for this population do not address stigmatized identities and demonstrate limited effects on risk reduction outcomes. Research is needed to examine stigma in primary prevention of HIV with an at‐risk stigmatized group.     

HIV/AIDS Awareness of In—School Adolescents in Nigeria: Implications for Adolescence Sexuality

This study investigated HIV/AIDS awareness of in-school adolescents in Nigeria to determine their risk for contracting HIV/AIDS. A total of 892 purposively selected adolescents (mean age = 16. 5 years; SD = 5. 2; males = 492; females = 400) participated in the study. The participants responded to the HIV/AIDS Awareness Inventory (HAAI). The questions on the survey included the following aspects: meaning of HIV/AIDS; prevalence; mode of transmission; consequences and prevention. Differences in gender, age, school location and father's educational background in understanding HIV risk were examined. A group means comparison procedure revealed a significant difference in HIV awareness by gender, age, school location and father's educational background. Female adolescents, the older adolescents, those living in urban centres and those whose fathers are literate had higher HIV/AIDS awareness than their counterparts from rural areas. Nigerian adolescents need education regarding HIV/AIDS awareness.     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior.     

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.     

HIV risk factors,condom use,and HIV antibody testing among heterosexual Hispanics: the National AIDS Behavioral Surveys (NABS)

Although Hispanics comprise only 9% of the US population, they account for 16% of AIDS cases. This study used data from the 4390 heterosexual Hispanics interviewed as part of the 1990-91 National AIDS Behavioral Survey to determine the prevalence and demographic correlates of HIV antibody testing and condom use among Hispanics at risk for HIV. Overall, 16.4% of respondents reported an HIV risk factor, primarily two or more sexual partners in the last 12 months (64%) or a high-risk main sex partner (26%). Those at risk tended to be highly acculturated unmarried males aged 18-29 years of European Spanish, South American, or Caribbean origin, with more than 12 years of education, an annual income under US$10,000, and infrequent church attendance. 35.3% of these high-risk persons had been tested for HIV; male gender and middle-income status were the strongest predictors of testing. Condoms were used at least half the time with a primary partner by 22.4% and with secondary partners by 44.7%, with higher use rates among acculturated Hispanics. The low prevalence of condom use and HIV testing among high-risk Hispanics underscores the need for campaigns that reinforce the acceptability of condom use as a social norm. Because US Hispanics are a heterogeneous group, such campaigns should target specific subgroups, including different national origins and levels of acculturation.     

What do pre-adolescents and adolescents understand about HIV/AIDS?

Abstract

Pre-adolescents and adolescents (N= 80, aged 10, 12, 15, and 18 years) were tested on their knowledge of HIV/AIDS. Knowledge was assessed using a self-report questionnaire (examining levels of factual knowledge) and a semi-structured interview (examining cognitive developmental levels of understanding). Examination of the developmental shifts in understanding of HIV/AIDS revealed an increase in conceptual complexity on causal and prevention dimensions. The main conceptual changes included a shift from single cause to multiple cause solutions and a shift from identifying surface or immediate features to implicating less salient features. Additionally, with age, concepts about HIV/AIDS were increasingly organised around internal, physiological principles. Questionnaire responses yielded significant age-related increases in knowledge. Level of knowledge, as measured by the questionnaire, was higher than that assessed by the interview for the three youngest age groups. Thus, factual information acquired about HIV/AIDS is not automatically accompanied by understanding. In light of these findings the past conclusion that adolescents have high levels of knowledge of HIV/AIDS is questioned.     

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.     

Information and attitudes about HIV/AIDS in Portuguese adolescents: state of art and changes in a four year period

The incidence of infection with HIV/AIDS among the heterosexual population has been increasing in young adults. The goal of this research was to deepen knowledge of preventive sexual behavior in Portuguese adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2006. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children (HBSC), a collaborative WHO study. The study provides national representative data of 7093 Portuguese adolescents, randomly chosen from those attending 8th and 10th grade of high school. Results showed there was an increase in the age of first sexual intercourse and a decrease in the number of teenagers who reported having had sexual intercourse, also in the level of information regarding HIV/AIDS transmission/prevention and in positive attitudes towards people with HIV/AIDS. In general, adolescents have good knowledge about how to protect themselves from becoming infected. However, comparing to 2002, there was a reduction of knowledge and consequent increase in the doubts regarding HIV/AIDS. Given the incipient state of sex education in 2006, the results cannot be attributed to sex education, but they will be relevant for comparison with the 2010 HBSC results.     

Differential Risk Perceptions for Unintended Pregnancy,STDs, and HIV/AIDS Among Urban Adolescents: Some Preliminary Findings

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.     

Factors affecting behaviors that address HIV risk among senior secondary school pupils in South Africa.

The purpose of this study was to identify factors affecting HIV risk reduction among senior secondary school pupils in South Africa. The sample included 460 Grade 12, Secondary School pupils whose ages ranged from 16 to 30 years (M = 19.7 yr., SD = 2.5) and who were chosen at random from the total Grade 12 population throughout one region in the Northern Province of South Africa. Measures were of sexual behavior and condom use, knowledge about correct condom use, intention of condom use, behavioral norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS vulnerability (likelihood to get it) and severity of the illness in the country, and condom use self-efficacy. Bivariate analysis gave positive significant relations among normative beliefs, subjective norms, and attitudes towards condom use as well as HIV/AIDS vulnerability and HIV risk behavior. Regression analysis indicated that for boys, younger age at first vaginal intercourse, less intention for condom use, and HIV/AIDS vulnerability were predictive for HIV/AIDS risk behavior and explained 39% of the variance. It is suggested that these predictors should be included in intervention programs for HIV prevention.     

Neurological and developmental effects of HIV and AIDS in children and adolescents

HIV-related encephalopathy is an important problem in vertically infected children with HIV. Infected infants may manifest early, catastrophic encephalopathy, with loss of brain growth, motor abnormalities, and cognitive dysfunction. Even without evidence of AIDS, infected infants score lower than serorevertors on developmental measures, particularly language acquisition. Children with perinatal or later transfusion-related infection generally are roughly comparable developmentally to their peers until late in their course. Symptoms similar to adult AIDS dementia complex are occasionally seen in adolescents with advanced AIDS, including dementia, bradykinesia, and spasticity. Opportunistic CNS infections such as toxoplasmosis and progressive multifocal leukoencephalopathy are less common in children and adolescents than in adults. Increasing evidence suggests that aggressive antiretroviral treatment may halt or even reverse encephalopathy. Neuroimaging changes may precede or follow clinical manifestations, and include early lenticulostriate vessel echogenicity on cranial ultrasound, calcifying microangiopathy on CT scan, and/or white matter lesions and central atrophy on MRI. Differential diagnosis of neurological dysfunction in an HIV-infected infant includes the effects of maternal substance abuse, other CNS congenital infections, and other causes of early static encephalopathy. Initial entry of HIV into the nervous system occurs very early in infection. The risk of clinical HIV encephalopathy increases with very early age of infection and with high viral loads. Virus is found in microglia and brain derived macrophages, not neurons. The neuronal effect of HIV is probably indirect, with various cytokines implicated. Apoptosis is the presumed mechanism of damage to neurons by HIV.     

Knowledge and Concern about STIs/HIV and Sociodemographic Variables Associated with Getting Tested for HIV Among the General Population in Spain

HIV testing is important in terms of prevention and treatment. However, HIV testing rates in the Spanish general population remains low. Therefore, HIV testing promotion constitutes a key issue. A high level of knowledge about HIV/AIDS is associated with having been tested for HIV. The general aim of this study was to determine the prevalence of people who had ever been tested for HIV in Spain. The sample consisted of 1,106 participants from the general population — 60.0% females and 40.0% males — aged between 17 and 55 years old. The assessment instruments were a questionnaire on sociodemographic data and HIV testing, a scale of knowledge about STIs and HIV/AIDS, and a scale of concern about STIs/HIV. Results showed that greater knowledge about STIs and HIV was associated with a greater likelihood of being tested for HIV (OR = .77; 95.0% CI = .73–.82; p < .05). In addition, higher concern about HIV/AIDS decreased the likelihood of not having been tested for HIV (OR = .87; 95.0% CI = .83–.92; p < .05). In fact, the higher participants concern about STIs was, the lower their likelihood of not having been tested for HIV was (OR = .87; 95.0% CI = .83–.91; p < .05). It is necessary to promote HIV testing in the general population as well as to consider their socio-demographic and psychological characteristics.     

HIV/AIDS in South Africa: a review of sexual behavior among adolescents

South Africa has a fast-growing HIV/AIDS rate, with the highest prevalence among young people (15 to 24 years), especially females. This paper is a comprehensive analytical review of available research concerning the sexual behavior of adolescents in South Africa. It offers insight into HIV infection among adolescents and provides an important base for educational interventions aimed at behavior change and reducing further transmission. The most important conclusion is that, despite the research (however limited) that has been done, there has been no significant change in the rate of infection among adolescents in South Africa. A new generation of behavioral interventions, involving both factual knowledge and life skills to promote behavioral risk reduction, is recommended.     

School adjustment of adolescents affected by HIV and AIDS: A case study

The study examined the school adjustment of South African adolescents affected by HIV and AIDS . Participants were a convenient sample of 60 adolescents from a secondary school in a major South African city (females = 73 .33%, 50% affected by HIV and AIDS, grade 8 = 40%, grade 9 = 30%, grade 10 = 30%, age range = 16–18 years) . Data on their personal functioning were gathered using the Beck Youth Inventory^TM and the Enhanced School Support Inventory (ESSI) . The data analysis comprised between-group and within-group comparisons, using the t-test statistic . Findings suggest that adolescents affected by HIV and AIDS had significantly lower psychological and behavioural functioning than their typical other peers . Results also show that these affected learners had lower school adjustment than their typical peers . The schools environment can support comprehensive interventions to addresses psychosocial vulnerability among adolescents affected by HIV and AIDS .     

Personality Pathways to Unsafe Sex: Personality,Condom Use,and HIV Risk Behaviors

Few studies have considered the importance of enduring personality characteristics in influencing health and HIV/AIDS risk behaviors. The current study examined relations between a comprehensive measure of personality, the Revised NEO Personality Inventory, and condom use and other HIV risk behaviors. The study sample consisted of 201 disadvantaged, primarily African American participants of an HIV risk reduction program in the Arkansas delta region. The sample was stratified into three risk groups. The low-risk group (n = 43) had 0% engaging in various risky sexual and substance use practices. Between 3% and 52% of the high-risk group (n = 62) engaged in these practices (e.g., shared needles, sex with partner who shoots drugs, received anal sex). The medium-risk group (n = 96) was intermediate. Results indicated that high Neuroticism, low Conscientiousness, and low Agreeableness are associated with HIV risk behaviors. Thus, high-risk behavior is associated with emotional distress, poor self-control, and hostile and antagonistic attitudes and behaviors. The high-risk group differed from the medium- and low-risk groups on the Neuroticism facet of Impulsiveness, indicating an inability to resist cravings and urges. The high-risk group also scored lower in Competence (i.e., feelings of self-efficacy), Self-Discipline (i.e., motivation to carry tasks through to completion), and Achievement Striving (i.e., aspiration levels). The current study, by identifying several personality traits that contribute to sexual risk behavior, raises important public health implications. Successful intervention in these AIDS-related behaviors may require interventions tailored to these basic tendencies. Such an approach may be a crucial element in attempts to lower HIV risk behavior.     

Differential risk perceptions for unintended pregnancy, STDs, and HIV/AIDS among urban adolescents: some preliminary findings

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.     

AIDS and intimate relationships: Adolescents’ knowledge and attitudes

The knowledge level about HIV/AIDS among American adolescents aged 16 to 19 has been assessed on several occasions, showing that in recent years their knowledge base has improved. The knowledge bases of British adolescents and of adolescents younger than 16 have been largely ignored. In attempting to assess the likely impact on present or future behaviors of increasing adolescents’ knowledge base about AIDS it is important to also know something of adolescents’ attitudes to intimate relationships and to sex within those relationships. Previous studies have not linked these two aspects. In this study two hundred London schoolchildren aged 14 and 15 years completed a questionnaire tapping both their knowledge about HIV infection and its transmission and their attitudes to intimate relationships. Their answers revealed that they had absorbed the simple media messages about AIDS, that it kills and that use of a condom during sex offers protection. However they were less well informed on detailed aspects of prevention, although, worryingly, they believed that they knew all that they needed to about preventive measures. The majority had attitudes to intimate relationships that were compatible with the message of restricting their number of sexual partners; however, a significant minority did not. The latter were more likely to deny the risk associated with promiscuity. It is suggested that school-based AIDS education programs should help individuals to develop new attitudes to intimate relationships that are compatible with risk avoidance.     

Exploring risk and protective mechanisms associated with HIV infection among adolescents in South Africa

This study explored South African adolescents’ perceived risk and protection for HIV infection. Adolescents (N=28) with a mean age of 14.6 years receiving mental health care participated in Focus Group Discussions (FGDs) to engage in an in-depth exploration of their perceived risk and protective mechanisms for HIV prevention. The data were analysed using thematic content analysis. Themes that emerged from the FGDs associated with risk for HIV infection were: Alcohol and illicit drug use; Non-condom use; Prostitution and risky sexual activity with multiple partners; and Non-disclosure of HIV status. Themes that emerged as protective mechanisms included: HIV knowledge and appropriate HIV risk reducing behaviour; and Proactive parental attitudes and behaviour. These findings highlight the importance of ascertaining the perceptions of adolescents about risk and protection from HIV infection in order to inform future programs for HIV prevention among adolescents.