HIV discrimination and the health of women living with HIV

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

Women, reproductive rights, and HIV/AIDS: issues on which research and interventions are still needed

From 2002 to 2005, two literature reviews identified a number of reproductive health issues that appeared to be relatively neglected in relation to HIV/AIDS: contraceptive information tailored to the needs of HIV-positive people; voluntary HIV counselling and testing during antenatal care, labour, and delivery; parenting options for HIV-positive people besides pregnancy through unprotected intercourse (i.e. assisted conception and legal adoption or foster care); unwanted pregnancy; and abortion-related care. An additional finding was that stigma and discrimination were frequently cited as barriers to enjoyment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initiated in which non-governmental organizations (NGOs) in developing countries used benchmarks to ascertain whether these neglected issues were addressed in local programmes and interventions serving women affected by HIV and AIDS. The benchmarks also assessed whether policies and programmes paid attention to the human and reproductive rights of HIV-positive women. This paper describes the main findings from the two exercises in relation to contraception for women living with HIV or AIDS, abortion-related care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of recommendations on topics to be incorporated into the international research agenda, policies, and programmes in the field of HIV/AIDS.     

Cultural Expectations and Reproductive Desires: Experiences of South African Women Living With HIV/AIDS (WLHA)

We explored factors influencing sexual and reproductive (SR) decisions related to childbearing for women living with HIV/AIDS (WLHA) in South Africa. We conducted four focus group interviews with 35 women living with HIV/AIDS. Our results show that the SR health care needs of women were not being addressed by many health care workers (HCWs). Additionally, we found that health care decisions were influenced by partners and cultural expectations of motherhood. Given the importance of motherhood, it is necessary for HCWs to address the diverse sexual needs and reproductive desires of WLHA.     

广州市艾滋病阳性者自杀行为及社会心理因素分析

  目的  了解广州市艾滋病病毒阳性者自杀意念和自杀行为现状,探讨其影响因素,分析社会心理因素与之的相关性。  方法  在广州市六区抽取HIV阳性成人患者进行横断面调查,收集社会人口学特征、HIV感染情况、自杀意念、自杀行为、社会心理因素等信息,以自杀意念、自杀行为为因变量,进行单因素和多因素Logistic回归分析。  结果  464名调查对象中,5.2%和17.4%分别有过自杀行为与自杀意念。其中,感染途径、抑郁、焦虑、社会歧视、自我歧视与自杀行为的发生有关（均有P < 0.05）;年龄、健康状况、配偶感染、抑郁、焦虑、社会支持、社会歧视、自我歧视与自杀意念的发生有关（均有P < 0.05）。多因素logistic回归分析模型显示抑郁、自我歧视与自杀行为发生有关（均有P < 0.05）,抑郁、社会歧视与自杀意念发生有关（均有P < 0.05）。  结论  广州市HIV阳性成人患者的自杀意念与行为发生率较高,应在HIV阳性者中针对性地开展抑郁、社会歧视、自我歧视相关的心理咨询、风险评估并尽早干预治疗。     

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM)

ABSTRACT

In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.     

High-risk behaviors in women who use crack: knowledge of HIV serostatus and risk behavior

PURPOSE: To determine whether crack cocaine-using women who are aware of their HIV serostatus have made modifications in risk behaviors, we compared known HIV-positive (HIV+) and HIV-negative (HIV-) users with respect to sexual risk behaviors, prevalence of sexually transmitted infections (STIs) and vaginitis, and correlates of unprotected sex. METHODS: We used a cross-sectional design with street outreach, recruitment, and interviews of sexually active crack cocaine using women. Women received testing for HIV, STIs, and vaginitis. RESULTS: Sixty-one HIV+ and 117 HIV- women were enrolled. HIV+ women were significantly more likely to be African-American. There were no significant differences in drug use, types of sexual partners, number of paying partners, attitudes regarding condoms, or STI diagnoses. HIV+ women were less likely to engage in unprotected sex compared with HIV- women (56% vs. 75%, adjusted odds ratio [AOR], 0.36; 95% confidence interval [CI], 0.13-0.99). Among HIV+ women, unprotected sex was negatively associated with stronger beliefs regarding the protective value of condoms (AOR, 0.07; 95% CI, 0.01-0.67) and concurrent injection-drug use (AOR, 0.19; 95% CI, 0.04-0.99). CONCLUSIONS: Although the majority of crack using HIV+ crack using women in this sample continued to engage in high-risk sexual activities, they were less likely to do so than HIV- women. Interventions targeting this population are needed.     

HIV感染者和AIDS病人自杀意念现状及其影响因素研究

目的了解HIV感染者和AIDS病人（PeopleLivingwithHIV／AIDS,PLWHA）自杀意念现状,探讨其影响因素,为制定关怀干预对策提供客观依据。方法采用《自杀意念自评量表》（SIOSS）和评价方法,以2012年5月至2012年12月在广州市番禺区CDC艾滋病VCT门诊就诊的PLWHA为调查对象,进行面对面问卷调查,调查其人口学特征及对其是否持有自杀意念进行评价。采用多因素logistic回归分析对PLWHA的自杀影响因素进行统计学析。结果在调查的144例PLWHA中,男性占67．36％（97／144）,女性占32．64％（47／144）;平均年龄（36．9±10．8）岁。29．17％（42／144）患者有自杀意念。在自杀意念发生率方面,无业／待业者为（50．00％,9／18）高于有工作者（26．29％,33／126）、中专／高中及以下者为（32．52％,40／123）高于大专及以上者（9．52％,2／21）、独居者为（58．33％,7／12）高于非独居者（26．52％,35／132）、CD。细胞计数~〈200cells／μL者为（47．83％,11／23）高于〉200cells／μL者（25．62％,31／121）,差异均有统计学意义（均P〈0．05）。多因素logistic回归分析结果显示就业状况和居住方式为产生自杀意念的危险因素,其调整的OR值和95％CI分别为：4．813（1．250—18．526）和8．832（1．330～58．661）。结论PLwHA普遍存在自杀意念,应在随访关怀过程中,建立有效的综合支持体系,以改善PLWHA心理状况。     

Risk perception and vulnerability to STIs and HIV/AIDS among immigrant Latin-American women in Canada

This paper describes the migratory experiences of Latin American migrant women living in Canada, their perceptions of the risk of HIV, AIDS and other sexually transmitted infections (STIs) and barriers to accessing healthcare services. We conducted 25 in-depth interviews with Latin American migrant women living in Montreal, Canada. The majority of participants were permanent residents and refugee status claimants. Women’s experiences in Canada were characterised by uncertainty, deception and fraud, separation from their families and feelings of discrimination. Women’s risk perception of HIV/AIDS/STIs involved relations of gender inequalities of power. Women who did not perceive themselves to be at risk were those who had a stable partner who they felt they could trust. The majority of women reported difficulties in accessing sexual and reproductive health services. Women’s vulnerability to HIV/AIDS/STIs was determined by: experiences during their lifecourse; their migratory status, which was associated with sexual abuse, abuse at work, language barriers and lack of social support networks; and their ability to access health services. The provision of health services to this population must focus on sexual and reproductive health needs and should do so from a multicultural perspective that takes into account the changes associated with the migration process.     

Experiences of harassment, discrimination, and physical violence among young gay and bisexual men

OBJECTIVES: We examined the 6-month cumulative incidence of anti-gay harassment, discrimination, and violence among young gay/bisexual men and documented their associations with mental health. METHODS: Gay/bisexual men from 3 cities in the southwestern United States completed self-administered questionnaires. RESULTS: Thirty-seven percent of men reported experiencing anti-gay verbal harassment in the previous 6 months; 11.2% reported discrimination, and 4.8% reported physical violence. Men were more likely to report these experiences if they were younger, were more open in disclosing their sexual orientation to others, and were HIV positive. Reports of mistreatment were associated with lower self-esteem and increased suicidal ideation. CONCLUSIONS: Absent policies preventing anti-gay mistreatment, empowerment and community-building programs are needed for young gay/bisexual men to both create safe social settings and help them cope with the psychological effects of these events.     

Factors that influence vulnerability to STDs and HIV/AIDS among Hispanic women

Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18-44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =.42, p =.001), although only the latter was related to condom use among single women (r =.29, p =.01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.     

Psychosocial Correlates of Unprotected Sex Without Disclosure of HIV-Positivity among African-American,Latino, and White Men Who Have Sex with Men and Women

African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.     

Correlated risk factors for suicidal ideation in aboriginal Southern Taiwanese women of childbearing age

Suicide and non-accidental poisoning are two important causes of death of female aborigines in Taiwan. The purpose of this study was to estimate the prevalence of suicidal ideation and then to identify factors relating to this for female aborigines of childbearing age. Using stratified random sampling 212 female aborigines, aged between 20 and 49, were recruited into this study. Participants were interviewed at their homes by trained interviewers who used a structured questionnaire. The Suicidal Ideation Screening Questionnaire (SIS-Q) was used to help predict which participants would be more likely to have suicidal ideation. The prevalence rate of suicidal ideation within the previous 12 months was 20.3% (95% CI 14.9-25.7%). Significant related factors of suicidal ideation, which were analyzed by multiple logistic regression, revealed that women suffering depressive mood, living within a extended family, and perceiving poor health status were more likely to have suicidal ideation. Results generated from this study may be used, in primary care, for guidance as to how to prevent suicide. Outreach community programs incorporating a valid and sensitive screening instrument, such as the SIS-Q, should be implemented to help prevent suicides in aboriginal communities.     

Women living with HIV: Disclosure, violence, and social support

This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a face-to-face interview. Women in the sample were 33 years old on average; 92% were African-American; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HIV-positive women.     

HIV/AIDS, reproductive and sexual health, and the law

The law is a frequently overlooked tool for addressing the complex practical and ethical issues that arise from the HIV/AIDS pandemic. The law intersects with reproductive and sexual health issues and HIV/AIDS in many ways. Well-written and rigorously applied laws could benefit persons living with (or at risk of contracting) HIV/AIDS, particularly concerning their reproductive and sexual health. Access to reproductive health services should be a legal right, and discrimination based on HIV status, which undermines access, should be prohibited. Laws against sexual violence and exploitation, which perpetuate the spread of HIV and its negative effects, should be enforced. Finally, a human rights framework should inform the drafting of laws to more effectively protect health.     

FACTORS THAT INFLUENCE VULNERABILITY TO STDS AND HIV/AIDS AMONG HISPANIC WOMEN

Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18–44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =. 42, p =.001), although only the latter was related to condom use among single women (r =. 29, p =. 01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.     

Collective Efficacy and HIV Prevention in South African Townships

South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.     

AIDS患者感染结果告知、歧视知觉、社会支持与自杀意念的关系

  目的  分析AIDS患者的歧视知觉和自杀意念,以及歧视知觉、自杀意念和HIV感染结果告知及社会支持之间的关系。  方法  采用一般特征调查表、领悟社会支持量表(perceived social support scale, PSSS)、歧视知觉量表(self-stigma scale, SSS)和贝克自杀意念量表中文版(Beck scale for suicide ideation-Chinese version, BSI-CV)对某省会城市1 276名AIDS患者进行匿名调查。  结果  54.2%(692/1 276)的样本报告自己在过去1周或抑郁最严重时有过自杀意念。多因素分析显示,控制其他因素,歧视知觉(OR=0.57, 95% CI: 0.45~0.72, P < 0.001)与社会支持呈负相关,感染结果告知(OR=1.47, 95% CI: 1.12~1.92, P=0.005)与社会支持呈正相关。歧视知觉(OR=5.53, 95% CI: 4.21~7.27, P < 0.001)与自杀意念呈正相关,社会支持(OR=0.58, 95% CI: 0.45~0.76, P < 0.001)与自杀意念呈负相关。感染结果告知在患者的歧视知觉与社会支持间起部分中介作用(中介效应占总效应比例为29.0%);社会支持在患者的歧视知觉与自杀意念间起部分中介作用(中介效应占总效应比例为17.5%)。  结论  AIDS患者当中有自杀意念的比例较高。低歧视知觉、将感染结果告知家人、朋友及固定伴侣的患者领悟到的社会支持更高。高歧视知觉、低社会支持的患者自杀意念较强。感染结果告知在患者的歧视知觉与社会支持间起部分中介作用,而社会支持则在患者的歧视知觉与自杀意念间起部分中介作用。     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

The effects of HIV/AIDS intervention groups for high-risk women in urban clinics.

OBJECTIVE. This study reports the results of a behavior change intervention offered to women at high risk for human immunodeficiency virus (HIV) infection seen in an urban primary health care clinic. METHODS. Participants were 197 women randomly assigned to either an HIV/acquired immunodeficiency syndrome (AIDS) risk reduction group or a comparison group. Women in the HIV/AIDS intervention group attended five group sessions focusing on risk education; skills training in condom use, sexual assertiveness, problem solving, and risk trigger self-management; and peer support for change efforts. Women in the comparison group attended sessions on health topics unrelated to AIDS. RESULTS. At the 3-month follow-up, women in the HIV/AIDS intervention group had increased in sexual communication and negotiation skills. Unprotected sexual intercourse had declined significantly and condom use had increased from 26% to 56% of all intercourse occasions. Women in the comparison group showed no change. CONCLUSIONS. Socially disadvantaged women can be assisted in reducing their risk of contracting HIV infection. Risk reduction behavior change interventions should be offered routinely in primary health care clinics serving low-income and high-risk patients.     

菏泽市艾滋病病毒感染者生存现状的研究

[目的]了解HIV感染者及AIDS病人的生存环境和生活质量,以建立适合我市实际的家庭和社会关怀及支持体系。[方法]采取典型调查的方式调查已确认的HIV/AIDS患者,在知情、保密的情况下进行个人访谈;另外采用现况调查的方法,选择存在HIV感染者和AIDS病人的村庄或附近村庄的居民,调查社区内存在的相关歧视及原因。[结果]HIV/AIDS患者存在着健康状况恶化、就医困难、经济窘迫、遭受歧视等的生存危机。[结论]应有计划、有步骤地扩大全民健康教育;认识和重视歧视及不尊重HIV/AIDS病人权利的危害性,真正消除对艾滋病恐惧;建立对感染者和病人的保护机制;提供关怀、护理、社会和情感支持等的预防控制措施。