Negotiation of risk in sexual relationships and reproductive decision-making amongst HIV sero-different couples

The paper focuses on the ways in which medical discourses of HIV transmission risk, personal bodily meanings and reproductive decision-making are re-negotiated within the context of sero-different relationships, in which one partner is known to be HIV-positive. Eighteen in-depth interviews were conducted with 10 individuals in Northern Ireland during 2008-2009. Drawing on an embodied sociological approach, the findings show that physical pleasure, love, commitment, a desire to conceive without medical interventions and a dislike of condoms within regular ongoing relationships, shaped individuals' sense of biological risk. In addition, the subjective logic that a partner had not previously become infected through unprotected sex prior to knowledge of HIV status and the added security of an undetectable viral load significantly impacted upon women's and, especially, men's decisions to have unprotected sex in order to conceive. The findings speak to the importance of reframing public health campaigns and clinical counselling discourses on HIV risk transmission to acknowledge how couples negotiate this risk, alongside pleasure and commitment within ongoing relationships.     

Love and intimacy in relationship risk management: HIV positive people and their sexual partners

This paper is about intimacy and its role in relationship risk management. Drawing on qualitative interviews with HIV positive people and their primary sexual partners it becomes apparent that a key tension in relationship risk management is the balance struck between 'relationship safety' and 'viral danger'. We find 'love' and 'intimacy' to be key features of relationship survival, with relationship intimacy and security signalled or strengthened by unprotected sex. Focusing on 'discordant' partnerships in particular, we note that relationship risk management is a fragile process characterised by contradiction and anxiety, at once involving risk reduction and risk opportunity. We conclude that the intimate relationship is a prime source of everyday risk management which may be defended, even at potentially high cost, in the time of sexual epidemic. We also note that previous research has painted an overly calculative picture of risk decision-making in which the lived experiences of intimacy and emotions are largely missing.     

广东省吸毒者HIV感染状况和危险因素调查

目的 了解广东省吸毒HIV感染及相关危险行为因素。方法 对广东省戒毒所内戒毒和社区吸毒进行面对面调查，并采集静脉血5ml进行HIV、HCV抗体检测。结果 共调查655名吸毒，HIV感染率为29．0％，HCV感染率为91．6％；吸毒对有关艾滋病传播途径的综合知晓率为65．3％；在最近一个月中，98．6％的吸毒有静脉注射吸毒行为。且42．1％有共用针具行为。共用针具的主要原因是毒瘾发作时没有注射器，占80．5％；吸毒与临时性伴的安全套使用率为21．3％，与固定性伴的使用率仅为9．5％。结论 广东省吸毒有较高的HIV和HCV感染率，感染HIV的相关危险行为普遍存在。应尽快采取有效措施。控制艾滋病的进一步蔓延。     

Reporting recent sexual practices: Gay men's disclosure of HIV risk by questionnaire and interview

AIDS-related research relies primarily on self-reports of sexual practices. Therefore, determining which data collection methods yield more candid information is critical. Data from a study of gay men's sexual adaptations to the AIDS epidemic provided an opportunity to explore the congruence of data collected using a self-administered questionnaire with data from an unstructured face-to-face interview designed to facilitate report of sexual risk behavior. We examined (i) the concordance of questionnaire and unstructured interview risk ratings when the two data sources are scored for the same 16 sexual behaviors; (ii) the concordance of questionnaire ratings and ratings obtained when all information on recent sexual practices available from the unstructured interview is considered; (iii) the relationship between serostatus and both concordance patterns between methods; and (iv) the difference by serostatus of reported risk level within method. Riskiest behaviors were reported on the questionnaire for all serostatus groups. Riskier behaviors were more likely to be reported on the questionnaire while more characteristic, safer behaviors were discussed in interview, regardless of HIV serostatus. The advantages of a combined methods—questionnaire/interview—strategy for sexual practice research are discussed.This work was supported by a grant from the National Institute of Mental Health (MH42275).     

Strength-based interventions for HIV prevention and sexual risk reduction among girls and young women: A resilience-focused systematic review

ABSTRACT

Despite significant public health efforts, girls and young women still face gender-specific barriers to achieving optimal physical and mental health. Public health interventions have historically addressed the health needs of girls and young women using risk-focused, or deficit-based, approaches. Emerging research in public health and prevention provides an alternative approach, focusing instead on strengths and resilience. However, evidence remains limited regarding strength-based interventions to improve health outcomes for young women, including outcomes within the critically important areas of sexual and reproductive health. To address this gap in evidence, this review analyses the evidence base for intervention research using a strength-based resilience-focused approach to reduce HIV and sexual risk for girls and young women globally. A systematic search of published literature identified 35 articles, representing 25 unique interventions (N?=?25). These interventions employed in-person, and other engaging methods, to deliver intervention content aimed at fostering resilience and changing sexual risk behaviours. Results also highlight gaps in measurement and study design, as well as variation in geographic setting and level of behaviour change. This review draws attention to the potential growth of strength-based intervention research, and offers future directions for developing and expanding research on resilience as an urgent global public health priority.     

Attitudes towards and perceptions of reproductive health needs of persons living with HIV/AIDS in rural Kilimanjaro,Tanzania

The introduction of antiretroviral treatment has resulted in the resumption of socially productive and sexually active lives of people living with HIV/AIDS, together with the desire for children. However, factors affecting the reproductive health needs of people living with HIV/AIDS are not well understood. With this in mind, the aim of this paper was to investigate factors associated with these health needs using a qualitative approach. Findings indicate that attitudes and perceptions about reproductive health needs are influenced by fertility beliefs, the central role of family, procreation and the perceived social and clinical consequences of pregnancies among people living with HIV/AIDS. While there was mixed opinion about acceptability of people living with HIV/AIDS, having children, marriage and family were institutions important for partnerships maintenance and procreation. These findings suggest that living with HIV in a community with strong pro-life attitudes is challenging for people living with HIV/AIDS who do not have children. Apart from having to grapple with potential stigma of not having children, people living with HIV/AIDS also face social challenges in realising their reproductive choices. Interventions to address stigma, societal changes and the integration of reproductive-health education into HIV care and treatment are needed.     

HIV vulnerability and sexual risk among African youth in Windsor,Canada

This paper examines how patients with HIV and their doctors jointly interpret 'viral load'. We show that the term 'viral load' is multiply coded: It calls up the idea of a biological property of the HIV positive body, but the term is also used as an indicator of drug treatment effectiveness, of patient compliance, and of overall wellness. Such multiple codings can be problematic because they index multiple and potentially conflicting discourses. Three distinct discourses which inform HIV medicine are identified: health measurement, health care, and health experience. These are described in terms of their semantic, lexicogrammatical and interactional patterns to illustrate how doctors and patients navigate their paths through them. In practice, what a viral load result is taken to mean depends on the alignment of patient and doctor in terms of their respective interdiscursive positions. The ability to recognize and flag discursive shifts should be considered a central component of doctors' professional expertise, particularly as a means of supporting patients in contributing their own expertise to clinical decision making.     

Preventing mother-to-child transmission in Guayaquil,Ecuador: HIV knowledge and risk perception

Abstract

An important step in preventing mother-to-child transmission is testing pregnant women for HIV. Health literacy measures, such as HIV knowledge and risk perception, may determine which women are tested in prenatal clinics where routine opt-out testing is not available. A survey was conducted in Guayaquil, Ecuador in 2006 (n=485), where approximately 0.7% of HIV tests in prenatal clinics were positive. Pregnant women over the age of 18 were invited to complete the survey in the waiting rooms at four city hospitals. There were 67.2% of women reported being tested previously for HIV. The most notable finding was that women who perceived a risk were 1.74 times more likely to request testing (p=0.021), but a woman's risk perception was not related to established risk factors. In addition, a physician's recommendation would result in the testing of nearly all women (94.3%). This data suggest that interventions in prenatal care clinics should incorporate educational strategies to increase accurate perception of personal risk. These efforts must occur in conjunction with increasing the access to HIV tests to achieve the goal of universal prenatal testing.     

HIV单阳异性固定性伴HIV性传播的研究进展

HIV单阳异性固定性伴即异性固定性伴双方,一方HIV抗体阳性,另一方HIV抗体阴性.异性固定性伴HIV性传播是HIV性传播的重要组成部分,该类研究主要集中在非洲地区,我国研究较少,此文简要综述了国内、外异性固定性伴HIV性传播的感染率、血清阳转率、影响因素与行之有效的预防措施,以及对我国未来HIV单阳异性固定性伴HIV经性传播研究的展望.     

Cultural factors in young heterosexual men's perception of HIV risk

This paper analyses why HIV risk perceptions vary in a sample of 19-year-old Glaswegian men. The main approaches to explain risk behaviour can be characterised as: individual cognition theories, cultural theories and phenomenology. To date there have been few empirical applications of cultural theory. This paper explores how far a cultural approach can explain the variability in HIV risk perceptions and behaviour, focusing on two key socio-cultural factors: current occupation and stage in partnership career. The analysis shows that young men's perceptions of HIV risk are shaped in part by the cultural meanings associated with their lifestyles and friendship groups, which largely arise from their occupational paths, and in part by the meanings that come with a particular stage of their partnership career. Recognising the role of cultural factors in lay people's response to a new health threat has broader implications for health promotion.     

244名HIV感染者/AIDS病人及其性伴的性行为特征分析

目的了解艾滋病感染者和病人及其性伴的性行为现状及特征,为进行干预提供依据。方法在云南省澜沧县对已确诊的HIV/AIDS进行问卷调查。结果 52.87%的感染者有临时性伴,HIV/AIDS与固定性伴、非商业非固定性伴和商业异性性伴性生活频率比感染前明显下降,性生活中安全套坚持使用率分别为40.00%、25.00%和62.50%;78例HIV/AIDS的性伴中检出13例HIV阳性,部分性伴存在多性伴现象。结论澜沧县部分HIV/AIDS及其性伴存在多性伴现象、性生活活跃,今后要进一步加强艾滋病经性途径传播的宣传和干预,减少HIV经性传播。     

Cultural heuristics in risk assessment of HIV/AIDS

Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study, we identify some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in‐depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV/AIDS behaviour change interventions, knowledge of cultural heuristics is essential.

Résumé

Les modèles de changement de comportements dans la prévention du VIH tendent à se construire sur l'hypothèse que les comportements sexuels à risque reflètent les évaluations des risques, et qu'en changeant ces dernières, on peut changer les comportements. Pourtant l'évaluation des risques est une construction culturelle. Certains individus ont recours à des heuristiques ou à des dispositifs cognitifs limités, ancrés dans des systèmes plus larges de signification culturelle, pour rationaliser l'incertitude. Dans cette étude, nous identifions certaines des heuristiques culturelles employées par des hommes migrants à Goa, en Inde, pour évaluer leurs risques de contamination par le VIH, liés au multipartenariat sexuel. Les données proviennent d'une série d'entretiens en profondeur et d'une enquête locale. Les heuristiques culturelles identifiées comprennent les heuristiques visuelles, celles du rôle des genres, de la vigilance et de la confiance. L'article soutient que pour des interventions mieux culturellement informées sur les changements des comportements sexuels vis‐à‐vis du VIH/sida, la connaissance des heuristiques culturelles est essentielle.

Resumen

En los modelos de cambios de comportamiento con respecto a la prevención del sida, normalmente se considera que los comportamientos sexuales de riesgo son un reflejo de las valoraciones de riesgo y que si se cambian éstas también variará el comportamiento. Sin embargo la valoración del riesgo se construye en función de los valores culturales. Para racionalizar esta incertidumbre, los sujetos usan instrumentos heurísticos o cognitivos definidos a partir de sistemas de significado cultural más amplios. En este estudio, identificamos algunas de las capacidades heurísticas culturales que los hombres inmigrantes en Goa, India, usan para evaluar su riesgo de infección del VIH con diferentes compañeros sexuales. Recabamos los datos a partir de una serie de entrevistas exhaustivas y un estudio con información local. En este estudio identificamos heurísticos culturales, por ejemplo, los heurísticos visuales, los heurísticos del rol de sexos, y los heurísticos de vigilancia y de confianza. En este ensayo argumentamos que es de vital importancia tener conocimiento de los heurísticos culturales para poder elaborar intervenciones en el cambio de conducta sobre el VIH/sida con un mayor fondo cultural.     

新疆艾滋病单阳配偶性传播综合干预效果评价

目的 探索适合新疆特点的艾滋病单阳配偶干预方式,减少家庭内经性途径的感染风险。方法 选择依从性较好的艾滋病病毒(HIV)感染者阴性配偶开展为期1年的综合干预,分别在基线与终期进行问卷调查,同时每季度1次进行采血检测。结果 新疆单阳配偶HIV年阳转率为2.17%(8/368),每季度阳转人数有逐步下降趋势;艾滋病知晓率由干预前的87.9%(471/536)上升为91.0%(405/445);最近1年安全套每次使用率由干预前的65.5%(311/475)上升为81.8%(324/396);最近1次安全套使用率由干预前的80.6%(382/474)上升为90.7%(359/396);最近1年未发生醉酒后性行为比例由干预前的18.8%(89/474)下降为12.4%(49/396);最近1年吸毒后性行为比例由干预前的11.4%(54/475)下降为7.1%(28/396);最近1年接受卫生工作者宣传教育、定期从卫生工作者处获取安全套以及接受艾滋病检测的比例均有明显上升。结论 在新疆针对单阳配偶进行综合干预效果明显。     

随访艾滋病毒感染高危人群的影响因素及其对策

对艾滋病毒(HIV)感染及艾滋病(AIDS)高危人群的防治研究工作已在国内广泛开展,由于观察防治效果需要进行长期的随访,对高危人群开展招募随访的工作往往会遇到许多困难,文中对国外相关工作中遇到的问题及采取的对策进行综述。     

Fertility intentions among HIV-infected,sero-concordant couples in Nyanza province,Kenya

Research in sub-Saharan Africa has shown significant diversity in how HIV influences infected couples' fertility intentions. Supporting HIV-infected, sero-concordant couples in sub-Saharan Africa to make informed choices about their fertility options has not received sufficient attention. In-depth interviews were conducted among 23 HIV-positive, sero-concordant married couples in Kenya, to better understand how HIV impacted fertility intentions. HIV compelled many to reconsider fertility plans, sometimes promoting childbearing intentions in some individuals but reducing fertility plans among most, largely due to fears of early death, health concerns, stigma, perinatal HIV transmission and financial difficulties (particularly in men). Preferences for sons and large families influenced some couples' intentions to continue childbearing, although none had discussed their intentions with healthcare providers. Additional support and services for HIV-infected, sero-concordant couples are needed. Family planning counselling should be tailored to the unique concerns of HIV-infected couples, addressing perinatal transmission but also individual, couple-level and socio-cultural fertility expectations. Community-level programmes are needed to reduce stigma and make HIV-infected couples more comfortable in discussing fertility intentions with healthcare providers.     

西安市高危人群HIV病毒携带现状调查

目的：调查西安市高危人群性传播性HIV／AIDS携带情况，了解西安市高危人群中HIV（成人免疫缺陷病毒）病毒携带分布状况，为艾滋病的预防和控制实验依据。方法：采取西安市美容美发、桑拿按摩人员（21人）、歌舞娱乐服务人员（75人），性病门诊病人（109人）血样，进行酶联免疫吸附实验（ELISA）检测抗HIV抗体。结果：发现被调查人员HIV检出率为1．95％。结论；提示HIV已向性乱人群传播，应加强对该人群的疫情监测，并开展针对艾滋病的干预活动。     

A question of maturity: The participation,decision-making and rights of children in the context of HIV/AIDS

This article examines international, regional and national sources of law with respect to the rights of children and considers how a strict age of majority affects adolescents' access to health care. Using Rwanda as a case study, this article outlines how a high age of majority, combined with mandatory parental consent, creates barriers for Rwandan adolescents to prevent human immunodeficiency virus (HIV) transmission, learn their status and receive treatment for the disease. It further examines the relevant legal and policy framework of the Rwandan Government in order to suggest successful methods to gauge a child's maturity level for Rwanda and other countries. The article argues for the improvement of adolescents' level of participation in making health decisions, and thereby also increasing their access to HIV/acquired immune deficiency syndrome (AIDS) services.     

男男性行为者艾滋病知识及高危性行为调查

目的了解男男性行为者（MSM）艾滋病相关知识状况以及与高危性行为之间的关系,为在该人群中开展行为干预提供依据。方法对同志吧经营者和服务人员进行培训,由他们对到同志吧消费的MSM进行匿名问卷调查。结果了解艾滋病知识的主要来源是报纸、杂志、网站、电视和广播,MSM对传播途径知识掌握的较好,正确率为78.1%～98.9%。而基本知识情况较差,正确率只有12.6%～67.8%。经常登陆同性恋网站、25岁年龄组性取向为同性、居住本市超过6个月的MSM艾滋病传播途径得分均高于不经常登陆网站、25岁年龄组和31岁年龄组、非同性和居住时间少于6个月MSM,差异有统计学意义（P〈0.01）。经常登陆同性恋网站的MSM艾滋病基本知识得分高于不经常登陆网站的MSM,差异有统计学意义（P〈0.01）。艾滋病基本知识性传播途径得分在高危性行为和多性伴中的分布差异无统计学意义。结论该人群中有关HIV知识水平总体不高,知识得分水平与多性伴和高危性行为无关联。