Beyond stigma? Young children's responses to HIV and AIDS

This paper explores the manifestation of HIV-related stigma in seven- and eight-year-old white South African children's responses to HIV and AIDS. Drawing from elements of ethnographic and interview data, it shows how young children's responses to HIV and AIDS are inscribed within popular accounts of contagion and articulate gendered, sexual, raced and classed discourses in South Africa. Rejecting static accounts of stigma, the paper shows how children resist and confirm power inequalities involving intense self-regulation as well as inscribing within discourses of care and concern for others infected with HIV and AIDS. The findings have implications for scaling up educational efforts to address awareness of HIV and AIDS and stigma, but also to build on positive insights that young children demonstrate with regard to the disease.     

Risks, stigma and Honduran Garífuna conceptions of HIV/AIDS

The HIV/AIDS epidemic along Honduras' north coast has intensified in recent years and become particularly severe in Garífuna communities. Based on a qualitative study in the community of Las Espinas and comparison with results from an earlier knowledge, attitudes, beliefs and practices survey, this article explores Garífuna ideas about the disease, focusing on issues of risk perception and stigma. Using correspondence analysis with data from systematic elicitation techniques we abstract the local schema of HIV/AIDS, showing how accurate knowledge of transmission co-occurs with cultural judgments about safe partners, increasing chances for infection. Despite broad familiarity with the disease in the community it remains highly stigmatized, suggesting continuing problems in coming to terms with the epidemic as treatment becomes more widely available in Honduras. Questions of power, sexuality and affective expectations about partners complicate the situation for women hoping to prevent infection. Given the broader risk environment characterized by labor migration and transnational movement, vital interventions and educational efforts in Garífuna communities will need to be complemented with prevention efforts in contexts where men make a living.     

Senegalese religious leaders’ perceptions of HIV/AIDS and implications for challenging stigma and discrimination

Senegal has been heralded as a model country in the fight against HIV/AIDS because of the low prevalence in the general population and concerted prevention efforts since the start of the epidemic. Despite its success, stigma and discrimination remain a reality for people living with HIV/AIDS as HIV transmission remains linked to lifestyle and perceived morality. Because religious teaching and the participation of religious leaders in HIV prevention is reported as partially responsible for Senegal's success, the present study seeks to deepen the understanding of their role in psychosocial aspects of care and support of people living with HIV/AIDS. Interviews were conducted with 87 religious leaders. Muslim, Catholic and Protestant leaders differ in their involvement in HIV/AIDS education, their opinions of condom use and their counselling techniques for people living with HIV/AIDS. Most religious leaders in each group believed that addressing the HIV/AIDS epidemic and the reduction of HIV/AIDS-related stigma and discrimination are priorities, yet some leaders still hold beliefs about HIV/AIDS that may ostracise people living with HIV/AIDS. Organisations working to sensitise religious leaders on HIV/AIDS should focus more on the everyday experience of people living with HIV/AIDS, promote the value of condom use, even if solely among married couples, and reinforce religious leaders’ roles as spiritual counsellors.     

Do area-based markers of poverty accurately measure personal poverty?

Area-based markers of deprivation (e.g., postal codes) are commonly used to identify groups of people with low socioeconomic status (SES); the validity of this approach, however, remains unknown. In this study, we determined the accuracy of using income quintile groups calculated on the basis of the median family income of each forward sortation area (1996 Canadian census) to identify those living in poverty (i.e., annual family income of < $12,620). The sensitivity and specificity of using the lowest income quintile to capture those in poverty were 26% and 83%, respectively (likelihood ratio (LR) of 1.49; 99% CI, 1.49 to 1.50). Among those in non-metropolitan and metropolitan areas, the LRs were 1.26 (99% CI, 1.26 to 1.27) and 2.01 (99% CI, 2.01 to 2.02), respectively. The use of postal codes as the only marker to identify people with low SES may result in substantial misclassification of personal poverty, particularly in non-metropolitan areas.     

Is globalization reducing poverty and inequality?

Over the past 20 years or so, India, China, and the rest of East Asia experienced fast economic growth and falls in the poverty rate, Latin America stagnated, and the former Soviet Union, Central and Eastern Europe, and sub-Saharan Africa regressed. But what are the net trends? The neoliberal argument says that world poverty and income inequality fell over the past two decades for the first time in more than a century and a half, thanks to the rising density of economic integration across national borders. The evidence therefore confirms that globalization in the context of the world economic regime in place since the end of Bretton Woods generates more "mutual benefit" than "conflicting interests." This article questions the empirical basis of the neoliberal argument.     

Do stigma,blame and stereotyping contribute to unsafe sexual behaviour? A test of claims about the spread of HIV/AIDS arising from social representation theory and the AIDS risk reduction model

In the context of social representation theory and the AIDS risk reduction model, it has been claimed that stigmatizing, blaming and stereotyping attitudes make people feel less at risk of contracting HIV/AIDS, and that this, in turn, results in them taking fewer precautions in their sexual behaviour. Previous research has failed to provide convincing evidence to support these claims. The present study provided a test of the claims that addressed some of the methodological issues identified in the earlier research. A sample of 460 young people from Ghana, ranging in age from 15 to 28 years (mean = 18), completed a questionnaire that measured the relevant constructs. The results supported the claims in relation to stigmatizing and intended sexual risk behaviour, but not stigmatizing and actual sexual risk behaviour. Although the latter two were correlated, this was not mediated by reduced perceptions of vulnerability. Claims in relation to blaming and stereotyping were not supported. Contrary to expectation, specific blaming and stereotyping attitudes that constructed HIV/AIDS as a sexual disease were associated with safer intended sexual behaviour, and this relationship was mediated by feeling at greater risk.     

Why is poverty unhealthy? Social and physical mediators

Socioeconomic status is associated with mortality, yet does not fully explain health disparities. This study analyzed data from the Project on Human Development in Chicago Neighborhoods (PHDCN), in the USA, to identify neighborhood-level factors associated with premature mortality. 1990 US Census data and mortality data from Chicago were merged with data from PHDCN, a study of 8782 residents in 343 Chicago neighborhoods. We performed a multivariate analysis to determine the association between premature mortality and concentrated disadvantage, residential stability, immigrant concentration, "collective efficacy" (a measure of willingness to help out for the common good), and "broken windows" (boarded up stores and homes, litter, and graffiti). Both collective efficacy and broken windows appeared to mediate the effect of concentrated disadvantage on all-cause premature mortality and mortality from cardiovascular disease and homicide, but there was also an interaction between broken windows and collective efficacy. Non-income characteristics associated with poverty should be further investigated. Interventions to determine whether these factors are causally related to health are needed.     

Do medical out-of-pocket expenses thrust families into poverty?

This paper estimates the impact of medical out-of-pocket expenses on families' well-being using the Survey of Income and Program Participation. Medical out-of-pocket expenses include the out-of-pocket costs from medical services and the family's share of health insurance premiums. Demographic characteristics, insurance status, and medical usage of the family are analyzed to determine which characteristics are most likely to impoverish a family. Families impoverished because of medical out-of-pocket expenses are far more likely to have older heads of the family, at least one family member in poor health, or some adults without health insurance. Families without at least one person who worked full time for the entire year were also likely to be impoverished. However, children in the family had little effect on the probability that the family became impoverished. This odd result is probably due to the high correlation between parental health insurance coverage and the health insurance coverage of their children.     

Meticillin-resistant Staphylococcus aureus infection--the infectious stigma of our time?

The article discusses ethical aspects related to isolation of patients with infectious diseases. The empirical basis is a textual analysis of two national guidelines on prevention of spreading of patients with meticillin-resistant Staphylococcus aureus. The analysis shows that even though both documents are founded upon updated scientific evidence on epidemiology and infectious diseases they lack explicit ethical argumentation on several aspects relevant for treatment and care under isolation or other constraints. Presuming that written guidelines make important frames for reflection and learning among practitioners, the authors suggest that such guidelines not just in Scandinavia but internationally should show how ethical considerations can be included into the individual risk assessments concerning patients under isolation.     

非洲AIDS与欧洲AIDS流行病学的异同

最早在非洲人中发现AIDS病是在1982年下半年,是从侨居或去比利时就诊的非洲男女病人中发现的。到1985年9月,经欧洲8个国家(主要为比利时、法国和瑞士)诊断为AIDS病的非洲患者达157例,分属22个非洲国家(其中扎伊尔占63％,刚果10％),它们占欧洲报道的AIDS病总例数的10％(1573例)。其特点是男女之比为2:1,且大多数非洲国家的患者(14l/157)不是同性恋者     

AIDS家庭青少年AIDS知识知晓率及其人际关系研究

目的探讨艾滋病流行地区AIDS/HIV家庭青少年艾滋病知识知晓率以及人际关系变化情况,为进一步对艾滋病家庭青少年进行干预提供依据。方法在安徽省6个艾滋病综合防治项目县(萧县、利辛、界首、临泉、濉溪、郎溪)选取168名AIDS家庭青少年作为研究组,同时以同村、同年龄、同性别的130名青少年作为对照组,使用自编的艾滋病基本知识、人际关系、一般项目问卷进行调查。结果艾滋病家庭组青少年的受教育程度显著低于非艾滋病家庭组,而失学率显著高于非艾滋病家庭组(P值均<0.05)。2组青少年AIDS/HIV基本知识的知晓率在40.5%~86.3%之间,仅有少数项目2组间知晓率差异有统计学意义。艾滋病家庭青少年在其家庭成员感染HIV后,与邻居、亲戚、同学或朋友的关系与先前相比更为亲密者所占的比例明显减少。艾滋病家庭青少年中,有36.9%在其家庭成员感染HIV后与别人交往时“心理总是有些胆怯”,6.5%的人“觉得无脸见人,很是羞涩”。14.3%的艾滋病家庭青少年认为其家庭成员感染HIV使其“非常伤心,但还是主动接触”,7.7%“非常伤心,主动接触明显少”。结论安徽省艾滋病流行区青少年艾滋病知识知晓率较低,艾滋病歧视依然存在。     

AIDS与游泳池

许多公众担心病毒引起的获得性免疫缺陷综合征(AIDS)可能在游泳池和水疗池中散播。现时被称为人类免疫缺陷病毒(HIV)的AIDS病毒,可通过性交、输注血液和血液制品以及共用受污染的注射器和针头而传播。然而,尚无证据证明,通过社会性接触、共用洗涤用具、餐具和饮水杯子等会引起病毒传播,也不会经由咳嗽和喷嚏的飞沫而传播感染。 WHO及其它国际组织对病毒污染水和土壤问题给予极大关注。受污染的水中(往往远离污染源)可能     

AIDS和AIDS相关复合症患者的真菌感染

在侵犯AIDS和AIDS相关复合症(ARC)患者的许多传染过程中(包括病毒、原虫和分枝杆菌等一组特殊疾病),有真核真菌(真菌)引起的机会性感染。在美国和欧洲的AIDS患者中,卡氏肺囊虫肺炎最为多发,在非洲则为口-食管念珠菌病、隐球菌脑膜炎或脓毒症、巨细胞病毒性脉络膜视网膜炎和皮肤粘膜单纯疱疹。真菌感染的临床表现包括由轻型浅表疾病到侵犯多种器官系统的严重危及生命的疾病。因此真菌病在AIDS或ARC的临床表现中起重要作用。此外,对ARC患者的前瞻性研究也表明,AIDS的危险个体发生其他意外真菌病(口腔鹅口疮、播散性组织胞浆菌病),可预示以后将发生显性AIDS。真菌感染激活已感染AIDS病毒的T淋巴细胞,可作为发     

AIDS的基因治疗

一、ＡＩＤＳ基因治疗的可能性：近些年来,ＡＩＤＳ基因治疗的研究取得了一些进展,ＮＩＨ重组ＤＮＡ顾问委员会（ＲＡＣ）已先后批准多个ＨＩＶ感染的基因治疗的临床研究方案———１９９３年７月批准ＮｏｂｅｌＧ等人把插入Ｒｅｖ１０基因的ＣＤ＋４Ｔ细胞用于临床研究;当年９月又批准了ＧｒｅｅｎｂｅｒｇＰＤ的临床实验计划,把针对ＨＩＶ－１抗原特异性的携带自杀基因的ＣＤ＋８Ｔ细胞用于过继转移治疗ＨＩＶ感染;于此前后,ＷａｎｇＳＦ等人采用ＬＮＬ６载体将ＨＩＶ－１先导序列ｈａｉｒｐｉｎ核酶基因导入ＣＤ＋４Ｔ细胞以研究转…     

AIDS基因治疗策略

人类免疫缺陷病毒（HIV）是获得性免疫缺陷综合征（AIDS）的病原体，目前的抗HIV药物治疗仍有其局限性。且当前的AIDS流行态势十分严峻，迫切需要寻找治疗AIDS的新途径。以基因工程技术为基础的基因治疗，在理论上具有较好的抗HIV能力，是一种新型的抗HIV方法，本篇综述列举当前处于试验阶段的多种AIDS基因治疗策略，这些策略都在一定程度上显示出抑制HIV复制的能力，在AIDS的治疗领域有广阔的前景。     

AIDS的基因治疗

近些年来,AIDS基因治疗的研究取得了一些进展,NIH重组DNA顾问委员会(RAC)已先后批准多个HIV感染的基因治疗的临床研究方案———1993年7月批准NobelG等人把插入Rev₁₀基因的CD₄⁺T细胞用于临床研究;当年9月又批准了GreenbergPD的临床实验计划,把针对HIV-1抗原特异性的携带自杀基因的CD₈⁺T细胞用于过继转移治疗HIV感染;于此前后,WangSF等人采用LNL₆载体将HIV-1先导序列hairpin核酶基因导入CD₄⁺T细胞以研究转化细胞在患者体内的行踪方法也获批准。将表达gp160的反转录病毒重组体直接注入患者体内的基因治疗已进入Ⅰ期临床试验阶段。这些结果展示了AIDS基因治疗的光明前景。     

Subjective wellbeing and ‘felt’ stigma when living with HIV

Purpose

The impact of stigma on subjective wellbeing was explored in adults living with HIV in Australia and the USA. It was hypothesised that this population would report poorer subjective wellbeing than the general population and that ‘felt’ stigma would contribute significantly to reported levels of subjective wellbeing.

Methods

A total of 274 participants were recruited through Australian AIDS councils and HIV-specific online support groups. Participants completed a composite questionnaire comprising the personal wellbeing index—adult (PWI-A), the HIV version of the unsupportive social interactions inventory (USII) and demographic and health-related items. The PWI-A total score was used to form a personal wellbeing index, ranging from 0 to 100.

Results

Participants reported mean PWI-A total scores of 54.7, considerably below the normative range of 70–80 for Western populations. There was a strong negative correlation between PWI-A total scores and USII total scores with the experience of high levels of unsupportive social interactions being associated with reduced levels of subjective wellbeing.

Conclusions

Our study suggests that despite antidiscrimination legislation, ‘felt’ stigma in the form of unsupportive social interactions continues to exert a negative impact on subjective wellbeing. Reduced subjective wellbeing may increase the risk of adverse health behaviours, such as medication non-adherence, substance abuse, risky sexual behaviours and non-disclosure of HIV serostatus.     

AIDS误诊典型病例

患女，38岁，因受凉后开始出现阵发性咳嗽，咯白色粘痰，痰量不多发热，体温波动不定，尤以下午及夜间为甚，伴全身乏力，纳差，胸闷，气促，体重下降，1月内体重下降了10公斤左右，当时曾被诊断为“肺结核”，予“异烟肼、利福平”等药治疗1月后症状无缓解且病情呈加重趋势。询问病史，既往体健，否认有肺结核史，长期在家务农，否认到过疫区，无吸毒和性乱史。