Masculinity and male sexual behaviour in Mozambique

Like many countries in sub-Saharan Africa, Mozambique is facing a severe HIV epidemic. Evidence suggests that male sexual behaviour is one of the driving forces behind the epidemic. Yet, there is limited understanding of how notions of masculinity influence such behaviour in the context of HIV. Using data collected through focus group discussions and in-depth interviews with sexually active men and women, this paper investigates how notions of masculinity influence the risk of HIV infection among men. The study findings suggest that traditional norms of masculinity, the man as the main provider and figure of authority, continue to exert a strong influence on male attitudes and behaviour. Alternative approaches are urgently needed in HIV programming that take into consideration notions of masculinity in order to reduce risky sexual behaviour.     

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.     

Improving HIV prevention programs: the role of identity in shaping healthy sexual behavior of rural adolescents in South Africa

A large body of literature highlights the role of culture and identity in how individuals manage and maintain health. Disappointingly there was no statistically significant decline in HIV prevalence in the 15–24 years age group in South Africa since 2007, Millennium Development Goal 6 indicator. This warrants a new approach to youth HIV prevention, which considers identity and culture, in male-dominant environments. We used identity-based motivation theory, which predicts that possible identities have a crucial influence on health-promoting behavior, to argue that girls are not currently attaining their low risk possible identities because sociocultural factors influence their behavior and compromise their health and economic outcomes. This study employed a cross-sectional survey among 285 rural black South African adolescents (mean age 16.7 years; 48.8% boys) to determine the salient social identity and the associated possible identities. We then tested whether youth behave in accordance with their possible identities. The dependent variables are non-risky behavior, risky behavior, and confidence to discuss sex. The independent variables are age, previous sex experience, and poverty. The adolescents chose gender as the most prominent social identity. Girls chose a safer possible identity than boys did, and girls do not actualize their possible identities while boys do. For girls, no dependent variables were significant. These results show that sociocultural barriers prevent the girls from actualizing their non-risky possible identity. Future adolescent HIV prevention programs aimed at reducing HIV should promote rights and responsibilities and consider cultural norms and beliefs to create a more gender-equal society that embraces less risky sexual behavior, in line with the idealized identity of girls. This to convince both male and female adolescents of the benefits, risks, and social harms embedded in certain traditional practices in a high HIV-prevalent environment.     

HIV/AIDS and cultural practices in western Kenya: the impact of sexual cleansing rituals on sexual behaviours

This paper reports on an exploratory study examining the role of sexual cleansing rituals in the transmission of HIV among the Luo community in western Kenya. Data were collected using both in‐depth interviews and focus group discussions. The study population consisted of 38 widows, 12 community elders and 44 cleansers. Data were collected on non‐behavioural causes, behavioural causes and behavioural indicators associated with sexual rituals. Content analysis revealed five central themes: the effect of the ritual on sexual behaviours; factors contributing to the continued practice of the ritual, including a sub‐theme on the commercialization of the ritual; the inseparable relationship between the sanctity of sex, prosperity and fertility of the land; and the effects of modernization on the ritual, including a sub‐theme on the effects of mass media on HIV‐prevention awareness campaigns. Causal factors of unchanging sexual behaviours are deeply rooted in traditional beliefs, which the community uphold strongly. These beliefs encourage men and women to have multiple sexual partners in a context where the use of condoms is rejected and little HIV testing is carried out.     

Sex-related alcohol expectancies and high-risk sexual behaviour among drinking adults in Kampala,Uganda

Alcohol consumption, a risk factor for HIV transmission in sub-Saharan Africa, is considered high in Uganda. A cross sectional study was conducted to determine whether sex-related expectations about the effects of alcohol explain the association between alcohol use and risky sexual behaviours in a population-based sample of adults in Kampala. Associations between alcohol use (current and higher risk drinking) and high-risk sexual behaviours (multiple regular partners and casual sex) were tested. In age–sex-adjusted models, having multiple regular partners was associated with current drinking (odds ratio [OR] = 2.76, 95% confidence intervals [CIs] = 1.15, 6.63) and higher risk drinking (OR = 3.35, 95% CI = 1.28, 8.71). Associations were similar but not statistically significant for having a causal sex partner. Sex-related alcohol outcome expectancy was associated with both alcohol use and high-risk sexual behaviour and attenuated relationships between multiple regular partners and both current drinking (OR = 1.94, 95% CI = 0.57, 6.73) and higher risk drinking (OR = 2.44, 95% CI = 0.68, 8.80). In this setting sexual behaviours related with alcohol consumption were explained, in part, by sex-related expectations about the effects of alcohol. These expectations could be an important component to target in HIV education campaigns.     

HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches

HIV infection and AIDS are disproportionately afflicting ThirdWorld countries, especially the countries of Africa, where substantialadult communities and villages are literally being annihilated.Because there is no known cure for HIV/AIDS, and because ofthe high costs of current antiviral therapy (e.g. AZT), it isa cost-effective use of health resources for the economicallypoor countries of Africa to use health promotion/ educationto intervene and control the incidence of HIV infection andAIDS. Crucial to any effective health promotion effort is athorough knowledge about the epidemiological specifics and distributionof HIV/AIDS in Africa, the known at-risk segments of the population,and the known at-risk conditions (e.g. male–female relationships,stress) and behaviours (e.g. peer and other pressures to engagein unprotected sex) for HIV infection. For health promotionto be successful it has to be unrelentingly applied to all at-riskgroups in African societies, region-specific and culturallysensitive, and it has to acquire active cooperation from allmembers of the community of African nations.     

四川省HIV感染者/AIDS患者性行为特征分析

目的了解HIV感染者／AIDS患者(People Living With HIV and AIDS，PLWHA)的性行为现状及特征，为进行行为干预提供依据。方法在四川省资中县、昭觉县及西昌市对已确诊的PLWHA及其性伴、以及当地健康对照人群进行问卷访谈调查。结果资中县PLWHA中有15．0％的人有临时性伴。该比例在西昌和昭觉分别为57．9％和18．9％。在与固定性伴的性活动中，资中的36．8％PLWHA回答“经常使用”安全套；与临时性伴的性活动中。66．7％回答“从不使用”安全套。西昌地区的相应比例分别为65．4％和72．7％；昭觉为97．1％与100．0％。结论PLWHA的性活动较非PLWHA人群复杂，但该人群的性行为现状具有明显的共性，是行为干预和健康教育的突破口。推广安全套的使用尤为重要；应将防制HIV性传播工作的重心逐渐由城市移向乡镇。     

Early HIV treatment and labour outcomes: A case study of mining workers in South Africa

This study examines whether labour outcomes of HIV‐infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4⁺ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time. Also, we find that workers initiating antiretroviral therapy at CD4 ≥ 350 have an 8% lower risk of absence prior to treatment. Although many companies and the South African government have adopted universal test‐and‐treat policies aiming to initiate all HIV‐infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.     

512名女性性工作者的艾滋病相关知识、行为及HIV感染情况分析

目的了解汕头市潮南区女性性工作者的艾滋病相关知识、行为以及HIV、梅毒感染状况,为开展健康教育和行为干预提供依据。方法采用方便抽样方法,对汕头市潮南区18家宾馆里有商业性行为的女性性工作者进行匿名问卷调查,了解其艾滋病相关知识及危险行为,同时采集其5mL静脉血样进行HIV及梅毒抗体检测。结果共调查512人,其对艾滋病相关知识的总知晓率为63.48%,多因素非条件logistic回归分析显示,20～30岁年龄组知晓率高于其他年龄组（OR=2.568）,未婚者知晓率高于已婚者和离异及丧偶者（OR=1.983）,文化程度高者的知晓率高于文化程度低者（OR=2.349）,城镇户籍者的知晓率高于农村户籍者（OR=1.897）。首次性行为小于18岁者占67.97%（348/512）,且首次性行为使用安全套者仅占2.3%。最近1次与客人发生性行为时使用安全套者占60.95%（281/461）,而未用安全套的主要原因为客人增加付费（占31.11%）、感观认定客人无病（占25.0%）。最近1个月内与客人发生性关系时每次都使用安全套者仅占28.52%。检测325名女性性工作者的HIV抗体,结果均为阴性,检出梅毒抗体阳性13例（占4.0%）。结论汕头市潮南区部分女性性工作者对艾滋病相关知识的知晓率不高,且在商业性行为中安全套使用率很低。在开展健康教育、行为干预时,重点应纠正错误观念,增强保护意识,提高安全套的使用率,改变其高危行为。     

Young people, HIV/AIDS and the promotion of sexual health

In the lay and professional literatures on HIV and AIDS, youngpeople are frequently characterized as being at high risk ofinfection. Their social immaturity, their spontaneity, theiremotional volatility and their propensity to risk-take is saidto render them specially vulnerable. This paper questions theappropriateness of such a view and argues for a more sociallydifferentiated understanding of young people and their HIV/AIDShealth promotion needs. It reviews aspects of relevant Europeanepidemiology, describes dominant ideologies of youth and adolescenceand their impact upon HIV/AIDS work, and identifies key implicationsfor policy and practice.     

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.     

Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects

After a decline in enthusiasm for national community health worker (CHW) programmes in the 1980s, these have re-emerged globally, particularly in the context of HIV. This paper examines the case of South Africa, where there has been rapid growth of a range of lay workers (home-based carers, lay counsellors, DOT supporters etc.) principally in response to an expansion in budgets and programmes for HIV, most recently the rollout of antiretroviral therapy (ART). In 2004, the term community health worker was introduced as the umbrella concept for all the community/lay workers in the health sector, and a national CHW Policy Framework was adopted. We summarize the key features of the emerging national CHW programme in South Africa, which include amongst others, their integration into a national public works programme and the use of non-governmental organizations as intermediaries. We then report on experiences in one Province, Free State. Over a period of 2 years (2004--06), we made serial visits on three occasions to the first 16 primary health care facilities in this Province providing comprehensive HIV services, including ART. At each of these visits, we did inventories of CHW numbers and training, and on two occasions conducted facility-based group interviews with CHWs (involving a total of 231 and 182 participants, respectively). We also interviewed clinic nurses tasked with supervising CHWs. From this evaluation we concluded that there is a significant CHW presence in the South African health system. This infrastructure, however, shares many of the managerial challenges (stability, recognition, volunteer vs. worker, relationships with professionals) associated with previous national CHW programmes, and we discuss prospects for sustainability in the light of the new policy context.     

Disclosure of parental HIV/AIDS to children in rural China

Abstract

The purpose of this study is to examine the complex issue of disclosure of parental HIV/AIDS to children in rural China. Semi-structured interviews were conducted with children affected by HIV/AIDS aged 8–17 (n?=?16), their caregivers (n?=?16) and key informants in the community (n?=?5). Findings showed that most children were shielded from knowing the HIV/AIDS status of their parents, although many children may have drawn their own conclusions through observation or sources outside the family. Caregivers felt discouraged and hesitated to discuss parental HIV/AIDS with children due to societal stigma and lack of knowledge and skills. Interventions are needed to improve caregivers' skills to communicate about HIV/AIDS with children. Interventions are also needed to reduce the stigma and discrimination towards people living with HIV/AIDS and their families.     

Convergence of behaviour change models for AIDS risk reduction in sub-Saharan Africa

There is increasing programme focus on the impact of HIV and AIDS and the advances in biomedical research that are taking central stage even in sub-Saharan Africa. Perhaps out of frustration, communication and behaviour change efforts are receiving lesser attention. But as long as heterosexual intercourse remains the predominant means of transmission of HIV in sub-Saharan Africa, there is the inherent danger of more people getting infected thus mopping up the gains from other approaches. This paper therefore argues for evidence based behaviour change interventions in sub-Saharan Africa, revisits the behaviour change theories and their relevance to the African situation. It proposes an integration of models based on the convergence of three existing theories of social learning, diffusion of innovation and social networks and the author's understanding of some African culture. The beauty of the model is based on the fact that 'social norms are best understood and influenced at the level of social networks'; existing chains of communication and the naturalness of exchange of information. A case is made for application of the 'model' to precipitate sexual behaviour change and HIV reduction in sub-Saharan Africa.     

Third Italian national survey on knowledge, attitudes, and sexual behaviour in relation to HIV/AIDS risk and the role of health education campaigns

AIM: The survey, supported by the National Health Institute (ISS), investigates on sources of information for HIV/AIDS and sexual behaviour of the Italian general population. METHODS: The survey was carried out in four different Italian provinces with different geographical, social, and epidemiological patterns of HIV/AIDS: Bari, Milan, Parma, and Perugia. A self-administered questionnaire was used to interview a sample of 2000 people, aged 18-49 years, chosen using a quota-sampling, considering age, sex, and level of education. RESULTS: A total of 1985 persons filled in the questionnaire. Among them, 73.2% reported Ministry of Health as their main source of information and 76.7% TV/radio advertising as their main means of information. Sexually active subjects, experiencing occasional sexual intercourse, were 22.4%; of them 34.6% did not refer a systematic use of condom. Among sexually active people, half (45.7%) reported as irrelevant their risk of infection, 6.9% as high. Being male (OR = 6.175) and having the first sexual intercourse before 18 years (OR = 2.076) were significantly associated with sexual behaviour at risk (males having unsafe sexual intercourses with prostitutes or during partners' menstrual period; both sexes having unsafe occasional sexual intercourses or anal sex), while living in Northern Italy (OR = 0.672) was significantly protective. Subjects with sexual behaviour at risk were about 40%. CONCLUSIONS: The need for further education campaigns, and their consequent evaluations, is relevant. Monitoring sexual behaviour of general population, focusing on risk behaviour rather than risk groups, is fundamental nowadays in preventing HIV.     

Thrills and spills: Young people's sexual behaviour andattitudes in seaside and rural areas

This paper reports on a qualitative study which explored attitudes to sexual risk-taking among young people in rural and seaside areas in England. The research was undertaken in three sites, each comprising a seaside resort and its rural hinterland. Data were collected through group discussions with 341 young people in secondary schools in England and through individual interviews with young people outside school settings, with young parents and with professionals working in the field of sexual health and education. Data analysis adopted a grounded theory approach and incorporated the views of local young people's advisory groups. Key features of the study which appeared specific to the locales studied were the influence of the seaside entertainment industry on young people's sexual behaviour and the high visibility experienced by young people in rural areas. Gender was also identified as playing a crucial role in determining perceptions of risk and influencing behaviour. Sexual health services and health promotion strategies need to acknowledge the relevance of factors such as gender and stigma for young people as well as being responsive to the specific features of local contexts.