ANTICIPATORY AND ACTUALIZED IDENTITIES: A Cultural Analysis of the Transition from AIDS Disability to Work

Throughout the course of their lives, many people living with HIV/AIDS have prematurely retired onto AIDS disability. A new trend, however, has swept across the nation. Where once people were getting sick, leaving work, and embracing inevitable death, now, with advances in medical technology, many people with HIV/AIDS are renewing their lease on life and discovering a desire to go back to work. To learn how gay men's identities are impacted as they transition from AIDS disability back to the labor market, I conducted three months of fieldwork at an employment placement agency in San Francisco. During fieldwork I distributed informal questionnaires to 120 gay men and then formally interviewed 10 additional gay men who had either transitioned or were considering transitioning from AIDS disability back to work. Analyses reveal that cultural, structural, and medical contradictions typify the return to work. As gay men experience and live through these contradictions, their identities split into anticipatory and actualized components. By facilitating a reassessment of meanings and values, anticipatory identities cognitively and emotionally prepare individuals as they brave the road back to work. This version of identity represents a romanticized confluence of worker (role) identity, gay (status/master) identity, and overall sense of self (self-concept). Personal experiences with stigma, shame, and discrimination along with complexities of the workplace and medical services, however, prevent the maturation of anticipatory identities when seeking reemployment. This results in loosely coupled and situationally informed actualized identities . The relationship between these two identities suggests that many people living with HIV/AIDS—and indeed others who experience stressful life transitions—face complex choices between quality-of-life issues and the ability to survive according to external cultural and structural constraints.     

Greater involvement of people living with HIV/AIDS in South Africa

This study reports on a pilot project, the greater involvement of people living with HIV/AIDS Workplace Model, which places trained fieldworkers living openly with HIV/AIDS in selected partner organisations sectors, where they set up, review or enrich workplace policies and programmes. The project adds credibility to partners' HIV/AIDS programmes and creates a supportive environment for people living with HIV/AIDS (PLWHA) and others to speak about HIV/AIDS. Eleven men and women living with HIV, aged between 30 and 45, and with varied life experiences and education levels, shared a willingness to speak about their HIV status in their workplace. They worked in very different environments but their collective experiences showed that PLWHA can add value to workplace HIV/AIDS programmes in a way that is relevant, effective, efficient, sustainable and ethical. They made companies and communities more aware of the intense need for HIV/AIDS policies and encouraged care and support for infected and affected people.     

'All red in the face': students' views on school-based HIV/AIDS and sexuality education

School-based HIV/AIDS and sexuality education is a fraught area, the site of struggles around moral values, knowledge, the nature of childhood and adolescence and pedagogy. The dominant discourses on HIV/AIDS and sexuality education in Australian secondary schools, as evident in policy documents, are currently predominantly libertarian and therapeutic, championing the need for 'openness' in the interests of the students' emotional maturity and social responsibility and their good health. However, Policy does not always translate readily into practice. This article draws upon a study involving focus group discussions with Australian senior high school students concerning their responses to the school-based HIV/AIDS and sexuality education programmes in which they have taken part and other sources of knowledge about HIV/AIDS. The article focuses in detail upon the students' valorizing of openness, trust and expertise in the face of the embarrassment, their perception of surveillance and their fears of lack of confidentiality that characterize their experience of HIV/AIDS and sexuality education. It is concluded that the nature of the teacher-adolescent relationship tends to work against the achievement of the objectives of such education.     

Canada's Migrants without History: Neoliberal Immigration Regimes and Trinidadian Transnationalism

Temporary migration programmes have re‐emerged as a preferred mechanism for regulating labour migration in many migrant‐receiving countries in the past decade. In this paper, I consider the role of shifting Canadian immigration policies, notably the expanded streams for temporary workers, in the changing flow of migrants from Trinidad to Canada. Temporary programmes can bring workers to Canada relatively quickly, but they limit access to permanent residency and citizenship, in sharp contrast to most of Canada's earlier immigration policies. Ethnographic fieldwork reveals that Trinidadians actively seeking to make the move to Canada have little interest in new temporary work programmes. Rather, they continue to plan futures in Canada that they expect to be years in the making. I consider some reasons for this apparent refusal to submit to the new migration realities. I show that present‐day Trinidadian emigrant desires and practices are deeply connected to individual, familial and national emigration and immigration histories. Trinidadians are declining to participate in new immigration regimes and are restricting their migration practices to those forms that are historically familiar and have been proven successful. I attempt to show how ethnographic approaches that take seriously migrants' agency can assist in developing a fuller understanding of the ways in which migration flows are changing. These approaches reveal what are otherwise the silences and invisibility surrounding those whose previous access to permanent migration streams has been diminished through neoliberal restructuring of migration policy. I argue that temporary worker policies disregard long‐standing histories of migration and engagement with capitalist processes for people in particular regions of the world, rendering them, for policy purposes, effectively “people without history” (Wolf, 1982).     

“Empowered Criminals and Global Subjects”: Transnational Norms and Sexual Minorities in India

In this paper, I comparatively examine the influence of transnational advocacy on legal struggles around sex work and homosexuality in contemporary India. While transnational scholars of sexuality understand globalization as a contradictory and uneven process, there has been little attention to how this unevenness is manifest in the realm of sexual rights and law. Based on qualitative research, I show how transnational discourses on health—in particular, HIV/AIDS interventions—and on human rights interact unevenly with national discourses on sexuality. Whereas discourses regarding HIV/AIDS enable sex workers to mobilize at the national level, global anti-trafficking discourses effectively reduce sex workers to “victims.” For Indian LGBTQ groups, discourses regarding the HIV/AIDS epidemic and global human rights enable these groups to problematize the anti-sodomy law in national politics. However, national legal discourses effectively reduce LGBQ individuals to “criminals,” and legal advancements in this arena are uneven. Focusing on this unevenness produced by transnational advocacy this paper highlights how sexual rights are articulated in context of asymmetric and uneven globalizations.     

Sex education and HIV/AIDS: political conflict and legal resolution

Throughout the last decade sex education has been a site of intense political struggle. This article identifies how the legal regulation of sex education operates in such a way as to incorporate conflicting discursive problematisations of HIV/AIDS and childhood sexuality through the construction of distinct categories within the sex education curriculum and the legitimisation of distinct roles for parents, teachers and health professionals within those categories. In particular it seeks to explain why sex education in schools fails at present to be a primary source of information about HIV/AIDS for young people and, consequently, identifies the urgent need for new guidance from the Department of Education and Employment.     

Concern, Caution, and Care: HIV Risk Perception among Hospital Nurses

Nurses routinely confront uncertainties surrounding the risk of occupationally transmitted HIV, particularly in the context of hospital AIDS care. Nurses respond to their perception of this HIV risk with a mixture of concern, caution, and care. This study empirically examines HIV risk perception based on a survey of hospital nurses in U.S. cities with high HIV seroprevalence rates. There is variation in the degree to which hospital nurses worry about HIV at work, despite widespread use of universal precautions. Occupational HIV risk perception is associated with knowledge of workplace transmission vectors, comfort with AIDS patients, AIDS care experience, and working conditions. Results show that nurses on AIDS care units are more habituated to HIV risk, whereas those with less AIDS care knowledge, tolerance, and experience are more concerned about HIV Consequently, nurses who worry less about being infected with HIV are more willing to perform AIDS care, predict plans to continue AIDS care in the future, and report more equal treatment of people with AIDS. Supportive workplaces which reduce stress and emotional exhaustion, together with enhanced and improved training for hospital nurses, may temper provider concerns and improve the continuity and quality of care.     

A systematic review of education for the prevention of HIV/AIDS among older adults

Through a comprehensive literature search, the authors of this systematic review identified 21 articles focused on primary prevention of HIV/AIDS for adults aged 50 and over. Three major challenges to providing HIV/AIDS education for older adults include health professionals' ageism, older adults' reluctance to discuss sexuality, and their misconception of their HIV risk. Clinical guidelines for social workers, nurses, and physicians identified the importance of sharing information and assessing risk, considering cultural diversity, and devising creative delivery strategies. Three models of HIV/AIDS education include group education programs delivered by social workers or other health professionals, peer education models, and one-on-one early intervention models including HIV/AIDS testing. Additional outreach and research on HIV/AIDS prevention among older adults is needed.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Calendars on the Wall

This study explores the evidence of social and personal forces in discussions concerning sexuality in client/provider interactions about HIV/AIDS. It unravels the complex ways that such forces influence the interactions, each other, and, in turn, how interactions can influence the forces themselves. The interactions were observed using participant observation techniques, and were analyzed using a framework suggested by Giddens (1979) and augmented by the author. Analysis suggested that such forces as societal norms about sexuality, promiscuity, and monogamy and the guilt associated with their violation influence client/provider interactions about HIV/AIDS. Unraveling the mutual influences of the forces may provide an opportunity to identify possibilities for altering the reproduction of the system.     

An ethnography of HIV/AIDS and sexuality in the People's Republic of China

China's HIV epidemic is now a growing reality, yet there is virtually no evidence of it in the HIV/AIDS literature. This report documents ethnographic and epidemiologic findings from field visits conducted in Beijing, Chengdu, and Kunming; the latter in Yunnan province, site of China's most severe nidus of HIV infection. This report also elaborates those cultural, social, and political factors involved in China's attempt to manage its growing HIV epidemic. Contemporary attitudes toward sexuality in China which impinge upon such management, as revealed through ethnographic interviews, are reviewed. Data from the First Sino‐American Management of HIV Disease Symposium (to which the author was a delegate) are also blended with the ethnographic material to further clarify the cultural and epidemiologic status of HIV/AIDS in China. It is the conclusion of this report that HIV/AIDS and its management pose a transforming, ineluctable challenge to China's traditional attitudes toward sexuality.     

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.     

Producing and Reducing Gender Inequality in A Worker‐Recovered Cooperative

Decades of feminist scholarship documents the persistence of gender inequality in work organizations. Yet few studies explicitly examine gender inequality in collectivist organizations like worker cooperatives. This article draws on the “theory of gendered organizations” to consider how gender operates in a worker‐recovered cooperative in contemporary Argentina. Based on ethnographic and archival research in Hotel B.A.U.E.N., this article finds that although gender remains a salient feature of the workplace, the cooperative has also adopted policies that take steps toward addressing gender inequality. It concludes by offering an updated theoretical framework for the future study of “gendered organizations.”     

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.     

Physical abuse in early childhood and transition to first sexual intercourse among youth in Cape Town, South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape area panel survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

Physical Abuse in Early Childhood and Transition to First Sexual Intercourse among Youth in Cape Town,South Africa

This study examined the relationship of physical abuse in early childhood and timing of first sexual intercourse among young South Africans aged 14 to 22 in Cape Town. Using the Cape Area Panel Survey and applying log-normal models, time ratios were estimated to show how rapidly or slowly youth experience first sexual intercourse. Results indicated that boys who experienced physical abuse in early childhood had faster timing to first sex. Boys and girls with violent school environments had faster timing to first sex. Race moderated the effects of physical abuse. Compared to Blacks, Coloreds who experienced higher levels of physical abuse in early childhood had faster timing to first sex. Youth with greater knowledge about HIV/AIDS and those with greater risk perception of contracting HIV/AIDS delayed first sex. On the basis of these findings, policy makers are encouraged to consider the early childhood experiences of youth when designing policies toward HIV/AIDS prevention in South Africa.     

HIV/AIDS-Core competencies for practice: A framework for the education and training of social workers

This article identifies the increasing relevance of HIV and AIDS for social work practice in the 1990s and argues that the topic should be included as a core component of all DipSW qualifying programmes. It identifies direct work with people affected by the virus, health education and the politics of AIDS in relation to anti-discriminatory practice as key features of this training. The new educational-agency partnerships developing around DipSW are welcomed as having the potential to ensure a continuum of training for social workers. Local authorities, for instance, should have sufficient influence upon basic training to ensure that workers enter employment with a basic awareness of HIV and AIDS and the complex issues which it raises for practice generally. Agencies can then focus on planning effective training strategies which meet the specific and specialist needs of workers arising out of particular areas of practice.

The importance of maximising upon the symbiotic relationship between agencies and educational institutions is stressed, in order to ensure that the rhetoric of partnership is translated into action.     

Sex,drugs and matrices: Mathematical prediction of HIV infection

The purpose of this paper is to consider a very simple model of the AIDS epidemic. This model illustrates how the spread of AIDS can be affected by parameters whose values, at the present time, are very imprecise or unknown. Of particular interest are the data related to sexual encounters and practices, data which are often unreliable or ambiguous. In this regard, the present model also suggests that the epidemiology of AIDS is particularly sensitive to the limitations in the assessment of sexuality/drug‐related behavior. Using a system of elementary differential equations, the present paper illustrates (using 3 examples) that depending upon the value of critical parameters, one could predict either very rapid increases of seropositivity or a decreasing rate of seropositivi‐ty. Thus, in order to diminish the ambiguity, it becomes crucial to make careful estimates of the sexual “interaction” coefficients, along with all other parameters, to insure that reasonable predictions can be made.     

Violence in the workplace and ergonomic prevention

There is a growing problem of violence in the workplace that should not be ignored. An estimated 6,359 deaths occur per year in the workplace [8] and an average one million each year are assaulted while at work [3]. Workplace violence is detrimental to both the employer and employee. It causes decreased worker productivity which results in monetary loss for businesses and the worker. Prevention programs can and should be implemented to address workplace violence. Prevention strategies that incorporate ergonomic and occupational therapy concepts can increase work productivity and job satisfaction. Certain occupations, such as health care and social service workers, are at a high risk for violence in the workplace. Violence in the workplace may never be eliminated, but steps can be taken to hinder the problem from growing.     

HIV/AIDS and return to work: a literature review one-decade post-introduction of combination therapy (HAART)

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000-950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the US, issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns. The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.