Risk, sexuality and economy

From the mid 1980s onwards HIV/AIDS became a new subject of work reform, with a range of experts producing new knowledges on work and the worker in regard to HIV/AIDS and workplace organizations putting in place workplace HIV/AIDS policies and programmes. To date, much of the discussion in sociology in regard to such policies and programmes has focused on the issue of effectiveness and has been concerned with making such policy 'better'. In this article however, and with particular reference to sexuality, I suggest that such approaches fail to register that workplace HIV/AIDS policies concern new conceptualizations of worker identities. Specifically, I suggest that such policies may be viewed as part of an assemblage of work reforms which are reworking worker identities as risk identities. Thus I argue that workplace HIV/AIDS policies and programmes are best understood as risk rationalities. Further, I consider the alignment between such rationalities and neo-liberal modes of rule, and in particular consider the ways in which workplace HIV/AIDS policies render both HIV/AIDS and sexuality calculable and governable in terms of notions of risk, self-responsibility and self-management.     

‘Before HIV you're a human being’ – PLWHA and reproduction in Jamaica

HIV sensitisation campaigns often aim to empower people living with HIV or AIDS (PLWHA) to enable them to cope with their illness by getting on with normal life as best as they can. However, contained within these messages are implicit assumptions about the needs of PLWHA. This research found that in Jamaica PLWHA's reproductive health needs are considered to be met largely by condoms. However, PLWHA respondents in this study expressed desires to have children and felt that their right to this was being denied. As such, dominant HIV sensitisation messages fail to respond to Jamaican PLWHA's own perceptions of their needs. This information is of importance, as the focus of the international HIV response moves away from simply preventing new infections to supporting those who have already been infected through locally appropriate interventions. As part of this, local perceptions need to be acknowledged ‘up-stream’ in HIV programming.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

‘Pain on Top of Pain,Hurtness on Top of Hurtness’: Social Discrimination,Psychological Well-Being,and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT

This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than $10,000 per year (80%), and acquired HIV through heterosexual sex (58%). Analyses demonstrated that social discrimination manifested in the women's lives as poverty, HIV/AIDS-related stigma, and gender inequality. These experiences caused intense psychological distress and limited WLH/A's ability to implement the safer-sex skills that they learned during the intervention. We discuss the applied and theoretical implications of our findings, advocating for HIV and sexual risk-reduction interventions that are based on an ecological framework that addresses holistically the individual, relational, and sociostructural factors that affect women's sexual risk behaviors.     

HIV/AIDS stigma in Chinese Internet forums: a content analysis approach

This study examines the stigmatization of HIV/AIDS and people living with HIV/AIDS (PLHA) on three popular Chinese Internet forums. A corpus of 275 entries discussing AIDS and PLHA was coded, based on a scheme of five stigmatizing behaviors. A high percentage of postings showed at least one and often several stigmatizing behaviors. These findings suggest that participants openly revealed their fears and biases about AIDS and PLHA online. In addition, when sexual behaviors were identified in the entries, a higher likelihood to stigmatize, a greater absence of empathy, and more intense negative emotions were shown. Further investigation of the five variables of stigmatization shows that labeling, negative attribution, and responsibility were the most frequent stigmatizing behaviors in these messages. Implications of this tendency to feel free to stigmatize HIV/AIDS and PLHA in online forums are discussed. The study also provides suggestions to health practitioners and policy makers for how to address online AIDS stigmatizing behavior.     

Evaluation of HIV/AIDS peer education projects in Zambia

This 1998 evaluation assessed the peer education programmes of HIV/AIDS projects run by four non-governmental organisations. A mini-case study approach was used and analysis was based on cross-case itemistic variables. The projects were assessed only in terms of immediate developmental outcomes to target groups rather than on long-term impact. The study concluded the following: (1) The projects had raised community awareness of HIV/AIDS; (2) Basic knowledge of HIV/AIDS was for the most part accurate; (3) There was anecdotal evidence of behavioural changes in terms of partner-reduction as reported by the projects, though the evidence was sometimes conflicting; and (4) There was evidence that certain traditional practices, which contributed to the spread of the virus (e.g. sexual cleansing and scarification), were becoming modified over time. The programmes were also instrumental in protecting human rights and enabling people living with HIV/AIDS to maintain human dignity.     

Social support on Weibo for people living with HIV/AIDS in China: a quantitative content analysis

The Internet has recently become an important source of social support. People living with HIV/AIDS (PLWHA) in China created an online support group (the HIV/AIDS Weibo Group) on Weibo, the Chinese equivalent of Twitter, in January 2011. To investigate social support in the HIV/AIDS Weibo Group, the content of all 7215 messages posted in this Weibo group since its launch on 18 January 2011, was analyzed. The analysis demonstrates that the majority of messages fell into the category of social support. Moreover, social support provisions were far more frequent than social support requests. The results also show that informational support, compared with emotional and instrumental support, was the most frequently requested and provided type of support in this Weibo group.     

Who Can Help People with HIV/AIDS in Africa? Governance of HIV/AIDS and Civil Society

This paper locates NGOs dealing with HIV/AIDS problems in sub-Saharan Africa into the larger governance context within which they function. This aims at a theoretical shift to assess the aspirational characteristics for the agency of NGOs that are used to legitimate contracting out implementation of internationally designed HIV/AIDS policies to these organizations. The paper interrogates the nature and impact of the governance structure on NGOs and then looks at the implications of this for HIV/AIDS. The questioning is based on a juxtaposition of the perspective of international policy fora in relation to civil society organizations with the way NGO work is perceived by the people at the receiving end of the policies. The paper suggests that as part of the international governance structure, NGOs are limited within the policy frameworks created by this structure. Furthermore, due to their organizational characteristics, NGOs lack capacity to establish sustainable long-term interventions relevant for sociocultural change as perceived by people themselves.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

Qualitative evaluation of HIV/AIDS IEC activities in Madagascar

UNICEF commissioned a qualitative evaluation of a program in which two partners conducted prevention activities concerning HIV/AIDS and STIs amongst youth in Madagascar. The evaluation assessed project activities and conducted a practical exercise in focus group methodology, following a workshop on evaluation techniques. Information was collected from a wide range of people, including 441 participants in 46 focus groups in nine sites. Six sites were areas of project activities and three sites were targeted for future activities. Clubs that integrated HIV/AIDS and STI information into their regular activities were most successful in their information, education and communication activities. A more participatory approach is recommended, to achieve a better match between target groups and messages delivered, and to foster trust and support. Another challenge remaining is to address fears and stigma through advocacy for the care and support of affected people.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Internet Use Among People with HIV/AIDS

ABSTRACT

The Internet offers people with HIV/AIDS timely information about treatment advances and supportive social contacts for this stigmatized disease, yet little is known about Internet use patterns among people with HIV/AIDS. This study of 120 persons with HIV/AIDS in the U.S. found approximately 19% used the Internet for HIV/AIDS-related purposes, much lower than the rate for general Internet use among the U.S. population. Lower incomes were associated with lower rates of use, echoing the “digital divide” found in the general population. Access from home was most common and information sought was primarily on medical treatments and medications. Possible reasons for low access rates, strategies for increasing access, and implications for other client groups are discussed.     

The Economics of HIV/AIDS: A Survey

This article surveys the main economic issues associated with the HIV/AIDS epidemic, paying special attention to sub–Saharan Africa. It explores the economic and behavioural determinants of HIV transmission, the microeconomics of market failures associated with high HIV prevalence, the prospects for regional development from a macroeconomic perspective and the efficient design of policies for coping with the epidemic. In line with the recent appeal by the UN Secretary General, the article argues that, without a decisive effort to halt HIV/AIDS, people living in the region are bound to experience a further fall in their standard of living in both relative and absolute terms. However, to be effective, anti–AIDS programmes must be rooted in sound economic principles.     

Stigma Management Among Gay/Bisexual Men with HIV/AIDS

People with HIV infection are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. To manage the stigma of their disease, they mount complex coping strategies. This paper reports results from a qualitative study that examined gay/bisexual men's experiences of living with HIV infection. Unstructured interviews from a diverse sample of 139 men were analyzed to examine how men coped with AIDS-related stigma. We discerned a variety of stigma management strategies that could be arranged along a continuum from reactive to proactive based on the extent to which they implicitly accepted or challenged the social norms and values that underlie the stigmatization of HIV/AIDS. Reactive strategies to cope with stigma involve defensive attempts to avoid or mitigate the impact of stigma, but imply acceptance of the underlying social norms and values that construct the stigma. Examples of reactive strategies include hiding one's HIV status, presenting one's illness as a less stigmatizing one (e.g., cancer), or distancing one's self from more damaging aspects of AIDS-stigma (e.g., attributing infection to blood transfusion). Proactive strategies challenge the validity of the stigma and imply disavowal and resistance of the social norms and values that underlie the stigma. Examples of proactive strategies include engaging in public educational efforts that address misperceptions about HIV transmission and social activism to change the social and political conditions that affect PWA/HIV.     

An impact evaluation of student teacher training in HIV/AIDS education in Zimbabwe

Zimbabwe introduced a nation-wide program to teach AIDS education in 1994. This paper evaluates changes in student teachers' level of knowledge about transmission, symptoms and prevention of STDs and HIV/AIDS; their attitude towards persons living with AIDS; and their sensitivity to the impact of the epidemic and to discussing and teaching about these issues. There was an increase in knowledge of HIV prevention and in teachers' ability to discuss reproductive health and sexual issues. However, as students were exposed to other HIV material outside the programme, not all of this change is due to the programme. Course attendance needed to be enforced and the curriculum needed to be updated with student participation. Peer educators and participatory techniques are needed to get students to internalise positive attitudes and behaviour. The education materials need to address the lack of female empowerment in making decisions and negotiating for safer sex.     

Gendered Economic,Social, and Cultural Challenges to HIV/AIDS Prevention and Intervention for Chinese Women

ABSTRACT

China is experiencing the most rapidly expanding HIV prevalence in the world, with the percentage of Chinese women living with HIV/AIDS also increasing significantly. Chinese women's risk of HIV infection is heavily influenced by patriarchal cultural beliefs, Confucian doctrines, and rapid social and economic changes in China. Chinese women generally have a low level of awareness of HIV/AIDS. With inherent inferior social status and economic disadvantage, their vulnerability to HIV infection is heightened by adverse impacts of massive rural-to-urban migration, explosion of the commercial sex industry, and prevalence of gender-based violence. In order to target HIV/AIDS prevention and treatment programs for Chinese women, their specific needs and gendered obstacles must be addressed and tackled. These include strategies that aim to fight against poverty, improve education, enhance HIV/AIDS awareness, facilitate new life-skills acquisition and behavior change, make available woman-centered services for testing and treatment of HIV, and eradicate gender-based discrimination and violence. There is also an urgent need to further develop various public health infrastructure in China, especially in remote and rural areas. The pool of gender experts in China should also be expanded to conduct a thorough gender analysis and design a national response to address the evolving HIV/AIDS epidemic in Chinese women.     

Sifting Through Trauma: Compassion Fatigue and HIV/AIDS

This article explores the compassion fatigue of the author and the graduate students he supervised while conducting psychotherapy with persons living with HIV/AIDS at a counseling center in Atlanta, Georgia. The metaphor of a sifter is suggested to represent the self-care strategies that providers employ to avoid and manage compassion fatigue. Several vignettes are presented and discussed from the perspective of the provider. The vignettes facilitate an examination of the contribution of trauma experienced by persons living with HIV/AIDS to the compassion fatigue of social service providers. The author recommends a renewal of research in the area of compassion fatigue among social service providers working with these clients.     

Participatory Action Research with Youth in Bosnia and Herzegovina

SUMMARY

Sparked by a global UNICEF initiative, Bosnia and Herzegovina launched a participatory action research process in which 75 young people in three towns explored local understandings, needs, and actions about HIV/AIDS, drug use, human rights, and other issues. This article chronicles the research process, the action recommendations generated by young people, and the current status of the project. It reflects on the commitments and efforts which are required when large, adult-directed organizations decide to promote youth participation, and on the institutional changes necessary to support sustained youth participation that benefits ordinary youth rather than a selected few.