Health work, female sex workers and HIV/AIDS: global and local dimensions of stigma and deviance as barriers to effective interventions

This paper addresses the near global attribution of stigma and deviance to female sex workers, and the salience of this attribution for health interventions in HIV/AIDS. A conceptual frame is developed as a guide to comparative sociological study in this area, and the importance of explanation at the level of social structure emphasized. After a general review of the empirical literature, more sustained attention is paid to specific aspects of female sex work in three contexts or figurations, the cities of London, Bangkok and Kolkarta. It is argued that norms of shame and blame and the labelling process with which they are bound up always arise within a structure nexus. We emphasis, in particular, the figuration-specific tensions between the global and the local, system and lifeworld and, the relationship between structure, agency and culture. The article concludes with a discussion of attempts to empower female sex workers and with a series of five orienting themes comprising a research programme for the future.     

An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance

This study uses the 2006 replication of the 1996 General Social Survey Mental Health Module to explore trends in public beliefs about mental illness in the USA. Drawing on three models related to the framing of genetic arguments in popular media, the study attempts to address why tolerance of the mentally ill has not increased, despite the growing popularity of a biomedical view. The key to resolving this paradox lies in understanding how genetic arguments interact with other beliefs about mental illness, as well as the complex ideational implications of genetic frameworks. Genetic arguments have contingent relationships with tolerance. When applied to schizophrenia, genetic arguments are positively associated with fears regarding violence. Indeed, in this regard, attributing schizophrenia to genes is no different from attributing schizophrenia to bad character. However, when applied to depression, genetic arguments are positively associated with social acceptance. In addition to these contingencies, genetic explanations have discontinuous relationships with beliefs regarding treatment. Although genetic arguments are positively associated with recommending medical treatment, they are not associated with the perceived likelihood of improvement. The net result of these assorted relationships is little change in overall levels of tolerance over time. Because of the blunt nature of the forces propelling a biomedical view-including the growing popularity of psychiatric medications-altering beliefs about the etiology of mental illness is unlikely, on its own, to increase tolerance.     

The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana

Adherence to antiretroviral therapy among HIV patients is the most important patient-enabled factor related to virological failure and can lead to drug resistance. It is important to avoid virological failure, especially in resource-limited settings where treatment options are limited and the effects of treatment failure are profound. This qualitative study aimed to identify the psycho-social factors related to adherence behaviour in Gaborone, Botswana, a high prevalence setting in southern Africa. One-to-one, in-depth interviews were conducted with adult antiretroviral patients in the private and public health sectors who had been on antiretroviral therapy for a minimum of 6 months. A grounded theory approach was adopted and patients were selected purposively and theoretical sampling determined the final sample size. Thirty-two patients were interviewed, 22 from the public-sector, the mean age was 9.5 years and 53% were women. We found that acceptance of HIV-status, the ability to avoid internalising stigmatising attitudes and identification of an encouraging confidante were key factors related to good adherence. Encouraging confidantes (including clinicians) and contributed to promoting hope and acceptance of HIV-status, enabling patients to develop a positive therapeutic relationship with their antiretrovirals and make lifestyle changes that promoted adherence. Active participation in a social network and a desire to avoid being thin and visibly identifiable as HIV-positive were also adherence-motivating factors. Conversely, participants who expressed some degree of denial about their HIV-status tended to express emotions associated with depression, and internalised stigma that inhibited the development of a relationship with a confidante. We feel it is important to identify individuals with HIV who are still in some degree of denial about their status and to identify depression among patients on antiretrovirals. This will enable more targeted, individualised support in the management of individuals' HIV disease.     

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.     

Rethinking theoretical approaches to stigma: a Framework Integrating Normative Influences on Stigma (FINIS)

A resurgence of research and policy efforts on stigma both facilitates and forces a reconsideration of the levels and types of factors that shape reactions to persons with conditions that engender prejudice and discrimination. Focusing on the case of mental illness but drawing from theories and studies of stigma across the social sciences, we propose a framework that brings together theoretical insights from micro, meso and macro level research: Framework Integrating Normative Influences on Stigma (FINIS) starts with Goffman's notion that understanding stigma requires a language of social relationships, but acknowledges that individuals do not come to social interaction devoid of affect and motivation. Further, all social interactions take place in a context in which organizations, media and larger cultures structure normative expectations which create the possibility of marking "difference". Labelling theory, social network theory, the limited capacity model of media influence, the social psychology of prejudice and discrimination, and theories of the welfare state all contribute to an understanding of the complex web of expectations shaping stigma. FINIS offers the potential to build a broad-based scientific foundation based on understanding the effects of stigma on the lives of persons with mental illness, the resources devoted to the organizations and families who care for them, and policies and programs designed to combat stigma. We end by discussing the clear implications this framework holds for stigma reduction, even in the face of conflicting results.     

Exploring HIV-related stigma among HIV-infected men who have sex with men in Beijing,China: a correlation study

Human immunodeficiency virus (HIV)-related stigma among HIV-infected men who have sex with men (MSM) has been associated with adverse health outcomes, including poor adherence to antiretroviral therapy and care, and increased participation in behaviors linked to higher rates of HIV transmission. In China, the incidence of HIV is growing more rapidly among MSM than among other subgroups. This study characterizes and quantifies HIV stigma among HIV-infected MSM in Beijing, China, which arguably may be driving this epidemic. A cross-sectional survey study was performed among 266 HIV-positive MSM in Beijing, China, in 2014. The Berger HIV Stigma Scale was used to measure levels of HIV-related stigma. Participants additionally answered questions regarding socio-demographic characteristics and HIV-associated risk factors; previously validated Mandarin-language scales assessed depression, coping style, and social support networks. Multivariable linear regression models were used to identify variables significantly associated with HIV stigma. The mean overall HIV stigma score among the study population was 112.78?±?18.11 (score range: 40–160). Higher HIV stigma scores were positively associated with depression (β?=?7.99, 95% CI:3.69, 12.29, p?β?=?0.64, 95% CI:0.21,1.08, p?β?=??6.45, 95%CI:?11.80, ?1.11, p?β?=??0.12, 95%CI:?0.22, ?0.02, p?相似文献   

Online and in-person health-seeking for infertility

Using data from Wave 1 (2004–2006) of the National Survey of Fertility Barriers (NSFB), a national probability sample of women ages 25–45, we examine online information-seeking among ever-infertile women. Of the 1352 women who met criteria for infertility, 459 (34%) neither talked to a doctor nor went online for information, 9% went online only for information, 32% talked to a doctor but did not go online, and 25% did both. Guided by Chrisman's Health-Seeking Model and previous research on Internet use to obtain health information, we employ multinomial logistic regression to compare these four groups of ever-infertile women. Findings generally support Chrisman's model. Infertile women tend to seek information online as a complement to, rather than as a substitute for, in-person health-seeking. Greater faith in the ability of medical science to treat infertility and greater perceived stigma were associated with higher odds of using the Internet to obtain information about infertility. In general, women who perceived the symptoms of infertility as more salient had higher odds of using both online and in-person or only in-person health-seeking compared to online health-seeking. Women with greater resources had higher odds of using online sources of information. Strong network encouragement to seek treatment was associated with higher odds of in-person health-seeking and combining in-person and online health-seeking compared to only going online or doing nothing.     

维吾尔药养心达瓦依米西克蜜膏的质量标准

目的:建立养心达瓦依米西克蜜膏的质量标准.方法:采用TLC法对处方中西红花、肉桂进行定性鉴别,并用RP-HPLC法测定西红花中西红花苷Ⅰ的含量;采用Luna C18(4.6 mm×250 mm,5μm)色谱柱,甲醇-水(45∶55)为流动相,流速1.0 mL·min-1,柱温35℃,检测波长440 nm,进样量10μL.结果:薄层鉴别专属性强,分离效果好.西红花苷Ⅰ在0.019 2 ～0.153 6μg呈良好的线性关系(r=0.999 9),平均回收率为98.7％(n=6),RSD 1.51％.结论:方法简便、准确、重复性好,可作为养心达瓦依米西克蜜膏的质量控制方法.