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.     

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p?<?.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M?=?6.39) than the common cold control condition (M?=?5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.     

Embedded Systems: The Case of HIV/AIDS Nonprofit Organizations in New York City

In this paper the notion of an embedded system is developed as an analytic model to examine how state–nonprofit relations develop and become differentiated, using the case of HIV/AIDS nonprofit organizations. Drawing on extensive fieldwork among three prominent HIV/AIDS nonprofit organizations in New York City, this paper shows how the kinds of relationships these nonprofit organizations are likely to form with state agencies are based on their embeddedness in the state–nonprofit system of relations. Three forms of embeddedness are distinguished according to the type and regularity of state–nonprofit contact—direct, outsider, and mediating. Importantly, it is shown how the configuration of relations within which an organization is embedded determines many of the organization's constraints and opportunities.     

Women in India: The Context and Impact of HIV/AIDS

ABSTRACT

The response to the HIV/AIDS epidemic on the Indian subcontinent has been hampered by several factors, including societal stigma, lack of educational resources, lack of economic opportunities, and the competing priorities for a nation just growing and developing an infrastructure for education, industry, and health. In particular, Indian women are silent victims in this epidemic because they do not readily have a respected voice in decision making and priority setting for the government. The epidemic is increasingly affecting and infecting Indian women (e.g., female commercial sex workers, married women, and pregnant women). The status of Indian women has placed them at extreme disadvantage because India is a country with socially progressive laws but has been slow to change its social norms. The reported HIV prevalence is low although many researchers agree a large amount of underreporting occurs. For India to address this emerging epidemic among women appropriately, it should focus on three intervention areas: (1) short-term solutions such as treatment options for those already infected with HIV to prevent further infection to sexual partners and children; (2) intermediate solutions such as education for those who are uninfected but engaging in behaviors that may put them at risk, such as injection drug use, engaging in commercial sex work, engaging in extramarital sexual relations, and having sexual partners who are not monogamous; and 3) long-term solutions such as addressing the root causes of inequality (e.g., disparities in education and employment and unwillingness to change social norms).     

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

Fallout from Communism: The Role of Feminism in Fighting HIV/AIDS among Women in Russia

ABSTRACT

I have no political platforms. I don't like the system of rules the word ‘feminist’ implies.

—Roza Khatskelevich, New York Times, 2003     

Challenges and Opportunities in HIV/AIDS Counseling: A Case of Jharkhand

The study highlights the challenges and opportunities in HIV/AIDS counseling. The major challenges are recruiting the right individuals and their capacity building and retention. The finding shows that most of the counselors are not befitting in terms of qualification and experience besides motivation, remuneration, and other issues. The study suggests that to ensure the effective counseling to reverse the epidemic, it is important to focus on such issues through appropriate policy interventions.     

Marketing the Damaged Self: The Construction of Identity in Advertisements Directed Towards People with HIV/AIDS

This paper explores the identities projected in advertisements directed towards HIV positive individuals and people with AIDS. Fifty such advertisements were collected from three popular American magazines for gay men over a period of seven months. Analysis of the ads reveals a paradoxical presentation of people with HIV/AIDS, which offers simultaneous conflicting images of hope and fear, power and weakness, innocence and guilt. An interactive sociolinguistic model through which this contradictory discourse might be understood is presented, drawing on Goffman's insights on stigma management and the presentation of the self in social interaction. Advertisements directed towards people with HIV/AIDS, it is suggested, present a contradictory discourse in which the advertisers are positioned as 'the wise', offering to mediate the conflicting identities of the stigmatized. The identity values enacted in this contradictory discourse are further measured against American conceptions of communication and the self as observed by Carbaugh and others. The possible consequences of these positionings on the roles made available to people with HIV/AIDS in the wider social context are discussed.     

The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer

Does the impact of stigma on the self differ by illness type? This study focuses on a comparison of the effects of the stigma associated with HIV/AIDS and cancer on self-esteem, body image, and personal control. We test the hypothesis that individuals' perceptions of stigma account for significant differences in the impact of an illness on the self. We examine four dimensions of perceived stigma: social rejection, internalized shame, social isolation, and financial insecurity. In turn, we consider how these dimensions medicate the effects of HIV/AIDS and cancer. Our sample includes 130 persons with HIV/AIDS and 76 persons with cancer. We control for illness severity by including a measure of functional health status that is based on participants' subjective perspectives of the severity of their symptomatology. Our findings provide additional support for modified labeling theory; however, our findings also point to the dimensionality of stigma and its differential negative impact on particular elements of the self, regardless of illness type.     

Finding the sweet spot: Developing,implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees

Medical trainees are at high risk for developing burnout. Introducing trainees to the risks of burnout and supporting identification and proactive responses to their ‘warning’ signs of compassion fatigue (CF) is critical in building resiliency. The authors developed and evaluated a burnout and CF program for third year trainees at a Canadian Medical School. Of 165 medical trainees who participated in the burnout and CF program, 59 (36%) provided evaluation and feedback of the program and its impact throughout their year. Participation included self-utilization of a validated CF and burnout tool (ProQOL) across three time-points, workshop feedback, and focus group participation. Results highlighted the importance of 1) Recognizing Individual Signs & Symptoms of Stress, CF and Burnout; 2) Normalizing Stress, CF and Burnout for Students and Physicians; 3) Learning to Manage One’s Own Stress. A decrease in compassion satisfaction and increase in burnout between beginning and end of third year were found. Further outcomes highlighted the importance of learning, living and surviving CF and burnout in clerkship. Emergent theory reveals the important responsibility educators have to integrate CF and burnout programs into ‘the sweet spot’ that third year offers, as trainees shift from theoretical to experiential practice as future clinicians.     

Lived Experience and Interpretation in Narrative Theory: Experiences of Living with HIV/AIDS

Narrative analysis builds on the strengths of qualitative research by examining the construction of meaning and symbolic systems in a framework that is explicitly temporal and that links research in the humanities with that in the social sciences. Qualitative methodologies often assume reported data accurately reflects the realities of lived experience. On the other hand some research drawing on cultural studies argues that the facts of a person's life are irrelevant. This paper argues for a middle way based on narrative theory that explores the interaction of objective events and their subjective interpretation. Further, narrative analysis enables exploration of the temporal structure of people's experiences focusing on both how a person's memories of the past and anticipations of the future influence their understanding and actions in the present. These points are developed drawing on the theory and methodology of both Symbolic Interactionism and Paul Ricoeur's Hermeneutics. The experiences of people living with HIV/AIDS are used to illustrate and explicate the usefulness of narrative analysis.     

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.     

Smooth Machinery: Global Governmentality and Civil Society HIV/AIDS Work in Rwanda

In recent years there has been a massive influx of aid to civil society HIV/AIDS work in Africa. Drawing on fieldwork in Rwanda, this article explores, through a governmentality perspective, the rationalities and technologies of government that accompany the new funding schemes. The paper feeds into contemporary debates on the relevance of governmentality studies in Africa and on the complicated relationship between state, civil society, and international donors in the particular context of Rwanda. Despite the country's known record of authoritarian politics, the paper argues that Rwandan civil society organizations are in fact largely subject to advanced liberal rule, rendering them responsible and active in their own government. This global governmentality, in turn, unfolds through a post-political machinery that effectively blurs boundaries between international donor, state, and civil society institutions. Ultimately, this means that researchers interested in resistance must be prepared to extend their visual field considerably.     

The Socio‐Economic Determinants of HIV/AIDS Infection Rates in Lesotho,Malawi, Swaziland and Zimbabwe

Using data from the Demographic and Health Survey, this article analyses the relationship between HIV status and the socio‐economic and demographic characteristics of adults in Lesotho, Malawi, Swaziland and Zimbabwe. It constructs the risk profile of the average adult, computes the values of age, education and wealth where the estimated probability of infection assumes its highest value, and determines the percentage of adults for whom these three factors are positively correlated with that probability. It finds that in all four countries: (i) the probability of being HIV‐positive is higher for women than for men; (ii) the likelihood of infection is higher for urban than for rural residents; and (iii) there is an inverted‐U relationship between age and HIV status. Also that, unlike gender, rural/urban residence and age, the relationship between the probability of infection and wealth, education and marital status varies by country. The results provide support for country‐specific and more targeted HIV policies and programmes.     

Children orphaned by HIV and AIDS in middle childhood in Potchefstroom,Northwest: The role of a social worker

ABSTRACT

The effects of HIV and AIDS have devastated families and communities in South Africa. The scourge has also left many children orphaned in the country. Given the vulnerability of orphaned children, social workers are in the forefront of ensuring that these children are cared for and protected from any harm. Hence, the purpose of this paper was to explore the role of a social worker in issues related to children orphaned by AIDS in their middle childhood. This study was situated within a qualitative research paradigm utilizing purposive, non-probability sampling of 10 participants recruited from Potchefstroom in the Northwest Province of South Africa. A semi-structured interview schedule was employed as a research tool, and in-depth one-on-one interviews were adopted as the method of data collection. A thematic content analysis was used to analyze the data collected during the interviews. The main findings point towards the need to educate children about HIV and AIDS and to empower their caregivers. The primary conclusion drawn from this study is that social workers play various key roles which contribute towards the well-being of orphaned children. Recommendations are posed in relation to social work service providers, government interventions, and future research.     

Midlife and Older Gay Men Living with HIV/AIDS: The Influence of Resiliency and Psychosocial Stress Factors on Health Needs

HIV/AIDS research has mostly focused on younger gay men. This cross-sectional study originated from a larger study of 316 respondents to include a subsample of 38 midlife and older gay men living with HIV/AIDS. The study explores physical and mental health utilization rates, including physical and mental health status. Resiliency, internal health locus of control beliefs, and psychosocial stressors of age and sexual orientation discrimination, stigma, and internalized homophobia were also examined. A total of 65.8% of the HIV/AIDS participants received no mental health services the past year, despite reporting higher mental health distress. Of those reporting an HIV status, 10.5% indicated having no health visits in the preceding year and more delays in seeking care when needed and unmet health needs for which services were not sought. Participants reporting higher resiliency indicated less mental health distress and better health access indicators. Stigma and internalized homophobia negatively affected resiliency. Implications for practitioners working with midlife and older gay men are provided.     

Donor withdrawal and local civil society organizations: An analysis of the HIV/AIDS sector in Vietnam

The impact of international donor arrival on local civil society organizations (CSOs) is well researched. Less well understood is how local CSOs react and adapt to donor withdrawal. This article explores this phenomenon in the context of the HIV/AIDS sector in Vietnam. Using data from government, donor and CSO sources in Vietnam, it examines how current and planned cuts in donor funding, including donor exit, impact local CSO agency and effectiveness. It finds that while donor withdrawal may reduce CSO capacity and independence, it can also prompt local innovations that—if successful—may improve CSOs’ responsiveness to local stakeholders.     

An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: The significance of patient privacy,psychological health,and social stigma to care

We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care.     

Self-determined goals in a solution-focused batterer intervention program: Application for building client strengths and solutions

ABSTRACT

The present study explores the content and characteristics of self-determined goals developed by violent offenders as part of a court-mandated treatment program. Data were collected from 89 domestic violence offenders enrolled in a solution-focused batterer intervention program. The data were analyzed using content analysis, and the emergent themes included (1) emotional regulation, (2) personal growth, (3) improve family relationships, and (4) improve communication. The findings from this study offer preliminary insight into the type of goals, the usefulness and importance of developing goals, and how goals might be helpful in reinforcing the change process while in treatment.     

The African Evaluation Guidelines: 2002. A checklist to assist in planning evaluations, negotiating clear contracts, reviewing progress and ensuring adequate completion of an evaluation

A review of the US ‘program evaluation standards’ (PES), undertaken in a series of workshops and meetings of networks of evaluators in Africa, resulted in modifications to those standards. The result was presented to a plenary session of the Inaugural Conference of the African Evaluation Association in September 1999, attended by over 300 evaluators from 35 countries. The AfrEA Conference decided that a systematic effort should be made to produce a list of African evaluation guidelines, similar to the PES, and that this checklist should be reviewed by national evaluation associations and networks in Africa and field tested in several countries. Ten national and regional networks and associations suggested modifications to the text and endorsed the final version of the guidelines.