Cultural and gender issues related to HIV/AIDS prevention in rural Swaziland: a focus group analysis

HIV/AIDS is a serious public health problem in Swaziland, a small land-locked Southern African country. The epidemic affects all subpopulations, but women are increasingly at risk for contracting the disease. Focus groups were conducted in a rural area to obtain qualitative information on the rural dimensions of HIV/AIDS, vulnerability to HIV/AIDS, and sociocultural factors influencing the spread of AIDS. Five themes were identified from analyses of the focus groups that are relevant in developing an AIDS prevention program for this population in Swaziland. Implications for future research and health care practice focus on gender-sensitive cultural research (e.g., women and men's roles and responsibilities in rural Swaziland society) and how social, economic, and cultural factors impact the spread of AIDS. Recommendations include reorienting and allocating resources for health, education, and social services to address the relative neglect of rural areas and strengthening policies and programs to achieve the equal participation of all women in all aspects of society's decisions. Specifically, policies related to economic and food security should result in programs to improve local access by women to all resources.     

CULTURAL AND GENDER ISSUES RELATED TO HIV/AIDS PREVENTION IN RURAL SWAZILAND: A FOCUS GROUP ANALYSIS

HIV/AIDS is a serious public health problem in Swaziland, a small land-locked Southern African country. The epidemic affects all subpopulations, but women are increasingly at risk for contracting the disease. Focus groups were conducted in a rural area to obtain qualitative information on the rural dimensions of HIV/AIDS, vulnerability to HIV/AIDS, and sociocultural factors influencing the spread of AIDS. Five themes were identified from analyses of the focus groups that are relevant in developing an AIDS prevention program for this population in Swaziland. Implications for future research and health care practice focus on gender-sensitive cultural research (e.g., women and men's roles and responsibilities in rural Swaziland society) and how social, economic, and cultural factors impact the spread of AIDS. Recommendations include reorienting and allocating resources for health, education, and social services to address the relative neglect of rural areas and strengthening policies and programs to achieve the equal participation of all women in all aspects of society's decisions. Specifically, policies related to economic and food security should result in programs to improve local access by women to all resources.     

Assessing the National HIV/AIDS Strategy Evaluation

The report is a useful compilation of data on Australia's HIV/AIDS epidemic and the response to it. The report produces firm evidence for endorsing Australia's success in limiting the spread of HIV by a number of routes. Australia has been successful in preventing iatrogenic spread, spread through commercial sex and spread through injecting drug use. In the latter case however, the hepatitis C epidemic cautions against complacency. The report, unfortunately, does not recognise very serious weaknesses in the evidence it uses as a basis for its endorsement of current efforts against HIV in the male homosexual community and the general heterosexual community. The report recognises failure of current policies in Aboriginal and Torres Strait Islander communities and recognises the threat posed here by HIV but recommends no major policy change. There is some recognition of the limitation of the data, but no recommendation for increased surveillance. The report ignores methods of prevention other than public health education. In my view, there is sufficient evidence to recommend routine neonatal circumcision, at least in Aboriginal and Torres Strait Islander communities. There is a clear need for a more effective approach to STD control, particularly in these communities. ^19,24–28 Adequate STD and HIV control may well require contact tracing and surveillance using traditional public health methods. Measurement of objective indicators of the success of HIV prevention campaigns needs to be improved with more comprehensive collection of data on HIV and STD incidence and condom sales, stratified by relevant covariates. Survey evidence of behavioural change should be collected from those too young to be affected by the selective mortality factor. The international comparisons await a proper statistical study which may be able to identify the elements of an effective approach to AIDS. In future reviews of the effectiveness of Australia's response to AIDS, all methods of limiting the spread of the epidemic should be considered objectively. It is unacceptable for the AIDS program to be declared optimal simply because it accords with current public health ideology.     

Epidemic in the war zone: AIDS and community survival in New York City

The characteristics and consequences of the AIDS/HIV epidemic in New York City are examined, with special attention to its impact on inner-city communities. The high numbers of AIDS cases are the source of increasing stress on public and community treatment and family and neighborhood networks of support. As the epidemic deepens (8 to 10 thousand new cases per year are expected by 1992) these resources, already weakened by years of underfunding, are becoming overwhelmed and are in danger of collapse. The high rates of HIV infection in these communities (5 to 20 percent of adults aged 25 to 45) and their linkage to widespread drug use prefigure the development of endemic levels in several population subgroups, with substantial risk of heterosexual spread. Simultaneously, there is a steady diffusion of infection to adjacent urban areas and, via migration patterns, to localities quite distant from New York City (e.g., Puerto Rico). Some hope can be found in the advent of more effective methods of early intervention for presymptomatic HIV infection. These offer an opportunity for combining clinical care with public health strategies that may restrict the spread of HIV while providing humane care for large numbers of people with AIDS and support for their families.     

Risk and vulnerability reduction in the HIV / AIDS pandemic

An estimated 13.2 million men, 10 million women, and 2.7 million children worldwide have been infected with HIV since the beginning of the pandemic, and more than 10,000 people daily acquire HIV infection. 67% and 19% of these infections have occurred in sub-Saharan Africa and Southeast Asia, respectively. Even though the annual number of new HIV infections appears to have reached a plateau in Western Europe and the Caribbean and may be approaching one in sub-Saharan Africa, and the rise of new infection seems to be on the decline in North America, Oceania, and the southeastern Mediterranean, the HIV/AIDS pandemic has not been controlled anywhere in the world and its major impact has yet to come. Prevention activities undertaken by individuals, communities, nations, and international bodies have shown that the spread of HIV can be effectively reduced. Public health interventions against HIV/AIDS emphasize risk reduction strategies through the provision of HIV/AIDS-related information about safe behavior and the promotion of prevention methods. Exclusive reliance upon risk reduction strategies, however, fails to address the contextual issues in which the pandemic is rooted. In order to significantly affect the pandemic, short-term risk reduction interventions must be expanded considerably, adapted to local needs, and replicated worldwide. An expanded response to the pandemic also calls for medium- and long-term risk reduction interventions, including the linking of HIV/AIDS prevention, care, and support work with other actions in the health and social sector, and the remodeling of services to respond more effectively to growing needs. Until recently, such interventions have been neglected or misconstrued as the process of spreading thinly and irresponsibly HIV/AIDS actions within health and social programs. The sustainability and eventual success of HIV prevention will depend upon the capacity of health systems to integrate HIV/AIDS-related activities with other initiatives, while retaining the ability to track the epidemic and account for what is done about it. The influence of contextual factors on vulnerability to HIV/AIDS is discussed.     

Studying the cost of HIV-related illnesses: reflections on the moving target

Although medical care costs of the HIV epidemic by 1991 may reach $6 billion, or 1.2 percent of all estimated personal health care expenditures in the United States, costs per patient of treating AIDS appear to be declining. Calculating the epidemic's costs is difficult, however, in that data are lacking on health care expenditures for HIV-infected persons other than those with AIDS, intravenous drug users, women, and children. Shifts in demographic segments affected, changes in medical treatments, and diffusion beyond initial urban centers will alter the economics of AIDS. Prospective studies at both national and local levels are needed to gauge the epidemic's costs and demands on health services.     

Care and secrecy: Being a mother of children living with HIV in Burkina Faso

Home care has become a central component of the response to the HIV/AIDS epidemic, displacing caregiving work onto women. While increasing interest has been paid to HIV/AIDS care with a focus on ailing adults and orphan foster care, the issue of caring for children living with HIV has received little attention in the social sciences. Based on ethnographic material gathered in Burkina Faso between November 2005 and December 2006, the aim of this paper was to gain understanding of women who mother and care for children living with HIV in resource-limited countries. The study involved participant observation in community-based organizations in Burkina Faso and semi-structured interviews with 20 women mothering HIV-positive children as well as 15 children infected with HIV, aged between 8 and 18 years. In daily care mothers face many great challenges, ranging from the routine of pill-taking to disturbing discussions with children asking questions about their health or treatment. The results also show how HIV/AIDS-related stigma adds an additional layer to the burden of care, compelling mothers to deal with the tension between secrecy surrounding the disease and the openness required in providing care and receiving social support. As mothers live in fear of disclosure, they have to develop concealment strategies around children's treatment and the nature of the disease. Conversely, some mothers may share their secret with kin members, close relatives or their children to gain social support. As HIV/AIDS care is shaped by secrecy, these findings shed light on mothers' isolation in child care within a context of changing patterns of family bonds and lack of formal psychosocial support addressing child-related issues. Finally, women's engagement in child care invites us to look beyond the essentialist approach of women's vulnerability conveyed by international discourse to characterise the situation of women facing the HIV/AIDS impact.     

A short term projection of HIV infection and AIDS cases in Cameroon.

By September 1991 Cameroon had reported 650 cases of the acquired immune deficiency syndrome (AIDS). The results from the sentinnel surveillance system showed a seroprevalence of human immunodeficiency virus (HIV)1 of 1.3% among pregnant women, 2.5% in people attending sexually transmitted disease clinics and 3.5% in tuberculosis patients in 1990. The estimated number of persons infected with HIV varies between 10,000 and 30,000. The World Health Organization projection model was used to make a short-term projection of HIV infection and AIDS cases; it indicated that the number of persons infected with HIV will double by the year 1995, with an estimated 8500 AIDS cases. Even in a low prevalence country such as Cameroon, the impact of the HIV epidemic is important and will result in a burden for the health care system.     

HIV infection: growing concern for safe motherhood and child survival

AIDS has reached pandemic level. Never before in the history of mankind has a disease been so devastating. Considering its rapid spread, AIDS is the first truly global epidemic, necessitating a global strategic response. The AIDS pandemic has forced us to re-examine existing health and social problems and their root causes. The majority of health problems are generated socially. For example, the behavioral phenomena of multi-partner sexual contact, IV drug use, and the commercial sale of blood by professional donors are the three major modes by which HIV is transmitted and contracted. Safe motherhood and child survival are deeply rooted within the socioeconomic context in which people live. Fear of and concern for AIDS in the context of mother and child health care are therefore extremely important. The low status of women and AIDS worldwide and in India are discussed.     

AIDS deaths shift from hospital to home. AIDS Mortality Project Group.

OBJECTIVE. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health care usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). METHODS. Sixteen health departments collected death certificates for 55,186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. RESULTS. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men, Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). CONCLUSIONS. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support.     

Women and AIDS in developing countries.

It is estimated that 8-10 million people worldwide are infected with HIV, the virus causing AIDS; a large proportion live in developing countries. A review of the recent literature reveals that the impact of HIV/AIDS is particularly great on women in developing countries for four reasons. (1) Stereotypes related to HIV/AIDS have meant that women are either blamed for their spread or not recognized as potential patients with the disease. The consequences can be: delayed diagnosis and treatment, stigmatization, loss of income and violations of human rights. (2) Women are at increased risk of exposure to HIV infection for reasons related indirectly and directly to their gender. (3) The psychological and social burdens are greater for women than men in a similar situation. These include: problems related to pregnancy and motherhood; rejection as marital partners, loss of security and income (if they or their partners are seropositive); and greater demands to cope with the effects of the epidemic, both as lay persons and professionals. (4) Women's frequently low socioeconomic status and lack of power make it difficult for them to undertake prevention measures. Prevention programs targeting sex workers have begun and need to be continued. However, more programs are needed for women in general, including older women, men, traditional health practitioners and opinion leaders, incorporating seropositive women wherever possible. In addition, HIV/AIDS-related research regarding women must be increased as well as their access to adequate health services and income-earning opportunities.     

Understanding the Promise: Considering the Experiences of Women Living with HIV to Maximize Effectiveness of HIV Prevention Technologies

BackgroundThe United States' response to HIV was designed primarily to meet the needs of single men without dependent children and its prevention strategies focused primarily on individual behavior change with little attention to the social, cultural, and economic factors fueling HIV risk, especially among indigent and marginalized women. In 2012, the President's Advisory Council called for an updating of the National HIV/AIDS Strategy's Implementation Plan to “achieve specific, targeted and measurable goals for reducing HIV incidence and … improving health care access and health outcomes for women living with HIV.”Outcome MeasuresWomen living with HIV and those at greatest risk of HIV generally live side by side in the same communities and under the same conditions, separated in status only by a positive HIV test and its consequences. Thus, women openly living with HIV constitute an identifiable and accessible source of first-hand information regarding the barriers that keep women out of HIV prevention and care. Their insights, rooted in lived experience, can vitally inform the development of realistic HIV prevention goals and strategies for the successful integration of HIV prevention into the services already accessed by high-risk women. Their expertise, however, is largely untapped.ConclusionsIn this article, women living with HIV summarize the substantial deficits that exist with regard to woman-focused HIV prevention efforts nationally and the policy and practice changes needed to reduce the domestic impact of the HIV epidemic on women and girls. They also outline opportunities for movement in this direction as implementation of the National HIV/AIDS Strategy proceeds.     

Health and disease in southern Africa: a comparative and vulnerability perspective

Using a vulnerability and comparative perspective, this paper examines the status of health in southern Africa highlighting the disease complex and some of the factors for the deteriorating health conditions. It is argued that aggregate social and health care indicators for the region such as life expectancy and infant mortality rates often mask regional variations and intra-country inequalities. Furthermore, the optimistic projections of a decade ago about dramatic increases in life expectancy and declines in infant mortality rates seem to have been completely out of line given the current and anticipated devastating effects of the HIV/AIDS pandemic in southern Africa. The central argument is that countries experiencing political and/or economic instability have been more vulnerable to the spread of diseases such HIV/AIDS and the collapse of their health care systems. Similarly, vulnerable social groups such as commercial sex workers and women have been hit hardest by the deteriorating health care conditions and the spread of HIV/AIDS. The paper offers a detailed discussion of several interrelated themes which, through the lense of vulnerability theory, examine the deteriorating health care conditions, disease and mortality, the AIDS/HIV situation and the role of structural adjustment in the provision of health care. The paper concludes by noting that the key to a more equitable and healthy future seems to lie squarely with increased levels of gender empowerment.     

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.     

Women and HIV/AIDS: barriers and new challenges

Women have been placed at a vulnerable situation regarding the HIV epidemic. Recent advances in antiretroviral therapies have placed in evidence the gender disparities and the new challenges to overcome them. The mortality of AIDS has decreased dramatically in the United States and Puerto Rico as a consequence of new combination therapies. Still, women constitute the fastest growing group of AIDS cases. There are gender differences in access to treatment and care, economic income and social and personal power. Among women's barriers to care are the lack of knowledge about AIDS in women by health providers, the family responsibilities and the burden and fear of disclosure. The authors suggest the need for empowerment as strategy for attaining better health and improving the quality of life in women living with HIV.     

喀什市社区维吾尔族妇女艾滋病认知现状调查

目的 了解新疆喀什市社区维吾尔族妇女人群对艾滋病的认知水平．为在这一人群中开展艾滋病健康教育提供依据。方法 采用定量（问卷调查）与定性研究（小组访谈）相结合的方法时社区维吾尔族妇女人群进行调查。结果 约1／3的人认为日常生活接触可以传播艾滋病，84．1％的人认为艾滋病病毒感染者值得同情和关心。大多数社区维吾尔族妇女愿意参加到防治艾滋病的活动中。结论 喀什市社区维吾尔族妇女艾滋病知识缺乏，应加强对这一人群的艾滋病健康教育。并充分考虑新疆是维吾尔族聚集区，在内容和方法上要不断改进。     

Stigmatization, HIV/AIDS, and communities of color: exploring response to human service facilities

HIV and AIDS are rapidly becoming leading causes of death for men and women in large cities across the US. Epidemiological data indicate that persons of color in particular have been disproportionately affected by HIV/AIDS. The continuing growth in the incidence of HIV/AIDS among persons of color implies that human service facilities will be needed in close proximity. However, there has been little research exploring response to human service facilities associated with HIV/AIDS in communities of color. This paper explores community response to facilities associated with HIV/AIDS by analyzing in-depth interviews with fifteen Vietnamese and Latino/Latina informal opinion leaders in Orange County, California. These interviews indicate that the stigma surrounding HIV/AIDS emanates to a large degree from the social construction of "HIV/AIDS as homosexuality". Even with the deviance and marginalization associated with HIV/AIDS, however, creative coping strategies have been developed by families within the Latino and Vietnamese communities to enable the maintenance of family ties with persons living with HIV/AIDS.     

Developing an HIV intervention for indigent women substance abusers in the United States Virgin Islands

As the HIV/AIDS epidemic continues to expand and penetrate new communities around the globe, risk reduction intervention initiatives must continue to evolve and adapt to new challenges and populations. This is especially true in theCCaribbean Basin, where the feminization of the HIV epidemic is tied to a cultural milieu characterized by pervasive gender inequality. HIV intervention programs in the Caribbean must treat women’s risks as a function of the social context, standards, and meanings of sexual behaviors and practices in the local community. As such, this article describes an initiative to develop an HIV prevention-intervention protocol for the cultural context of substance abusing women in the US Virgin Islands. Through street-based survey research combined with focus groups and in-depth interviews with such “cultural insiders” as members of the substance-abusing target population, members of the local public health and social services system, and community leaders, a culturally sensitive HIV/AIDS protocol was developed which addresses the supports and barriers to risk reduction faced by substance abusing women in the Virgin Islands.     

Women's Rights and Women's Health During HIV/AIDS Epidemics: The Experience of Women in Sub-Saharan Africa

Twenty-five years have passed since HIV/AIDS was recognized as a major public health problem. Although billions of dollars are spent in research and development, we still have no medical cure or vaccination. In the early days of the epidemic, public health slogans suggested that HIV/AIDS does not discriminate. Now it is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalized, women, colonized, and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS demands the need to travel extra miles. My objective in this article is to promote the need to go beyond the biomedical model of “technical fixes” and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. In this article, I argue that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders.     

Women--the missing persons in the AIDS epidemic. Part II

In the Winter 1989 issue, Anastos and Marte wrote about the neglect of women in defining and treating AIDS. Women in the AIDS epidemic, they wrote, are considered mainly as vectors of transmission to men or children, not as people who are themselves HIV-infected and victims of transmission. They are predominantly women of color who, by the dictates of poverty and racism, live in communities at high risk for HIV infection. They are subjected to demeaning attitudes, poor health care services, and tragically late diagnosis in many cases. In this article the authors examine the issues of reproductive rights and HIV testing in women hospitalized for childbirth. Wendy Chavkin continues the discussion on p. 19, focusing on the efforts of AIDS prevention programs to target women solely because of their reproductive function and on the lack of services available for women who are tested.