AIDS stigma among inmates and staff in a USA state prison

We examined AIDS stigma among male inmates and male and female staff at a state prison in the southern region of the USA. Inmates and staff rated people with AIDS more negatively than someone with other diseases (diabetes, cancer, heart disease and high blood pressure). Inmates and staff were concerned about being treated differently if they tested seropositive. They also described AIDS stigma as a barrier to seeking HIV testing. Both instrumental (inaccurate beliefs about casual contact causing transmission of the virus) and symbolic factors (negative attitudes about injection drug use) predicted AIDS stigma. Negative attitudes about homosexuality predicted AIDS stigma among Caucasian prison staff and inmates, but not among African American staff and inmates. The results indicate the need to address HIV/AIDS stigma in developing HIV treatment, care and prevention programs in the prison environment.     

青岛市监狱服刑人员艾滋病健康教育研究

目的调查青岛市在押人员艾滋病（AIDS）防治知识、态度及行为状况，并探讨在该人群中开展艾滋病健康教育和行为干预的可行性。方法对青岛市两所监狱新人狱的862名服刑人员，用A、B两种问卷进行艾滋病知识匿名调查，由艾滋病防治专业人员集中对其进行艾滋病相关知识讲解及健康教育与行为干预。结果在押人员入狱前有婚外（非配偶）性行为的占52．9％，吸毒的占13．1％，入狱后有同性性行为的占3．2％。通过进行艾滋病知识宣传教育，在押人员对艾滋病知识的知晓率、态度有显著的改变。结论在押人员是艾滋病传播的高危行为人群，加强艾滋病知识的宣传教育和行为干预是可行的，可减少狱中和刑满释放后的高危行为，减少危害，有效地预防和控制艾滋病的传播。     

Prolonged incubation period of AIDS in intravenous drug abusers: epidemiological evidence in prison inmates

Fourteen heterosexual inmates who developed acquired immunodeficiency syndrome (AIDS) while incarcerated in New York state prisons were studied. All 14 had regularly used illicit drugs intravenously in New York City prior to imprisonment. Leukocyte counts on admission to the state prison system--when all of these inmates were well--were depressed by one-third when compared with those in matched intravenous drug-using inmates used as controls (mean leukocyte counts, 4,430 vs. 6,320 cells/mm3, respectively; P less than .005); twelve (86%) of the 14 inmates who developed AIDS had counts of less than 5,000 cells/mm3, compared with only six (14%) of the 42 controls (P less than .00001). The 14 inmates developed AIDS symptoms a mean of 22.6 +/- 9.6 months after imprisonment. We conclude that leukopenia is frequently to be found in presymptomatic AIDS infection and that the minimum mean incubation period of AIDS in intravenous-drug abusers is quite prolonged.     

Awareness and attitudes towards HIV/AIDS among residents of Kandy,Sri Lanka

Currently, interventions for HIV/AIDS control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18–64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/AIDS-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/AIDS but the knowledge on HIV/AIDS was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/AIDS. The participants showed more positive attitudes towards HIV/AIDS and people living with HIV/AIDS (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/AIDS-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/AIDS to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/AIDS-related knowledge score, targeted HIV/AIDS-related health education interventions maybe recommended in this regard.     

Concern,perceived risk and attitudes towards HIV/AIDS in Scottish prisons

Four hundred and eighty male prisoners and 500 male staff from 7 Scottish prisons took part in a study assessing perception of risk and attitudes towards HIV/AIDS. Prison staff were found to perceive prison as a higher-risk environment for HIV/AIDS than outside prison, whereas prisoners perceived the opposite. Prisoners perceived less personal risk of HIV/AIDS inside prison than staff. Staff and prisoner concern towards HIV/AIDS was greater than perceived risk of HIV/AIDS, and concern was found to be associated with a number of demographic variables, whereas perceived risk was less influenced by such variables. These findings suggest that the process of risk perception may operate on more than one level. Factor analysis of attitudes towards HIV/AIDS produced four factors for both staff and prisoners: 'Interacting with people with HIV/AIDS'; 'Social control of HIV/ AIDS'; 'HIV/AIDS prevention for high-risk groups'; and 'Response to HIV/AIDS high-risk behaviour'. For both staff and prisoners, greater concern and perceived risk towards HIV/AIDS was associated with a lower tolerance for interacting with people with HIV/AIDS and more support for strict social control measures against people with HIV/AIDS.     

四川省凉山州HIV/AIDS患者污名化与焦虑抑郁的关系

目的 了解四川省凉山州艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS患者)污名化与焦虑、抑郁的关系.方法 采用自制一般资料问卷、简版污名化量表、广泛性焦虑障碍量表(GAD-7)、抑郁症筛查量表(PHQ-9)对751例HIV/AIDS患者进行问卷调查.采用线性回归进行统计学分析.结果 本次研究有...     

Knowledge, attitudes, beliefs, and practices about HIV/AIDS in Kuwait.

This survey is aimed at assessing knowledge, attitudes, beliefs and practices in Kuwait regarding AIDS/HIV. Structured face-to-face interviews were conducted during the year 1995 on a sample of 2,219 subjects, aged 18 to 60, health professionals were excluded. The survey instrument included 26 questions on AIDS/HIV knowledge, 6 about attitudes and beliefs, and 6 about behavior and practice. The remaining 22 items dealt with sociodemographic characteristics, role of religion, source of information, and satisfaction about AIDS control programs. Two thirds of subjects had good knowledge about the main modes of HIV/AIDS transmission. Using a multiple regression model, the knowledge score was positively associated with level of education, age, years of hearing about AIDS, and socioeconomic status. The multiple logistic regression showed that subjects tend not to change their behavior related to AIDS if they were less than 40 years old, had low education, were females, single, had a lower socioeconomic status, had heard about AIDS for less than 3 years, and had a low level of knowledge about AIDS. More than half of the participants were satisfied with the government's action for AIDS prevention. The majority of subjects thought that religion was important in dealing with daily life problems. In conclusion, while most of the people in Kuwait were aware of the main modes of AIDS transmission, a gap existed about modes that did not transmit the disease. This was reflected in their attitudes and practice toward AIDS patients. The study calls for a greater role for medical professionals, mass media, and religion in AIDS prevention and control.     

HIV risk behaviour correlates among injecting drug users in Greek prisons

Aims. To identify the correlates of injecting drug use within prison. Design. A national cross-sectional study, participation being voluntary and anonymous. Setting. Ten Greek prisons. Participants. A representative sample of 1000 male inmates; 861 questionnaires were completed and analysed. Measurement. A self-report questionnaire for demographics, penal history, drug use and sharing injecting equipment. Findings. Two hundred and ninety inmates (33.7%) reported injecting drugs at some time in their lives, of whom 174 (60%) had injected while imprisoned. Among those who had injected while imprisoned, 145 (83%) had shared equipment while incarcerated. Logistic regression analysis suggested that total time in prison, previous drug conviction, being a convict (as opposed to on remand) and having multiple female sexual partners 1 year before incarceration were significant HIV risk behaviour correlates. For every year of imprisonment, the risk of injection in prison increased by about 17% \[OR = 1.17 (95% CI: 1.07-1.27)]. Inmates with a previous drug-related conviction were about twice as likely to inject within prison \[OR = 1.97 (95% CI: 1.16-3.33)]. Finally, convicted inmates were marginally significantly more prone to inject in prison \[OR = 1.58 (95% CI: 0.92-2.74)]. Conclusions. Variables related to the inmates' prison career influence HIV risk behaviours within prison. There is a need to assist IDUs in reducing the likelihood of high-risk behaviour by considering factors such as frequency of incarceration, length of time incarcerated and availability of detoxification programmes within prison.     

Adherence to antiretroviral therapy among HIV-infected prison inmates (Spain)

This cross-sectional study was carried out in two Spanish prisons. A group of 177 HIV-infected prison inmates were interviewed. Standardized personal interviews using a structured questionnaire were conducted to assess sociodemographic features and prison setting characteristics, clinical variables, social support and drug consumption. A simplified four-item questionnaire for self-reported adherence was used. A total of 24.3% were non-adherent. Predictors of non-adherence in the multivariate analysis included poor or lack of ability to follow the prescribed treatment regimen, no visits in a month, anxious and/or depressed mood, difficulty in taking medication, receiving methadone treatment, cannabis consumption and robbery as the reason for imprisonment. Adherence to antiretroviral therapy was higher than in the wider community. However, other variables related to the correctional setting, such as assignments within the facility, adaptability of the prison system to authorize the cell being opened in the event of missed medication, or legal situation had no effect on adherence for inmates with HIV disease.     

Intravenous drug use and HIV transmission amongst inmates in Scottish prisons

The intravenous drug use behaviour and HIV risk reduction strategies used by a group of Scottish inmates prior to prison, during imprisonment and as expected after release was investigated. From a sample of 559 inmates (480 males and 79 females) 27.5% were involved in IVDU prior to imprisonment, 7.7% on at least one occasion during a period of imprisonment and 14.7% expected to do so after release. Prior to imprisonment 17,3% had shared needles, 5.7% at some time during imprisonment and 4.3% expected to do so after release. Some form of HIV risk reduction strategies were practised by the majority of IVDU inmates prior to imprisonment, during imprisonment and were expected to continue after release. The most at risk inmates were those who continued to share injecting equipment without reduction and without sterilizing. The reduction in IVDU and needle sharing during imprisonment in comparison to prior to imprisonment was paralleled by a self-perceived reduction of personal risk from HIV during imprisonment.     

HIV risk behavior history of prison inmates in Hungary.

As part of an intervention in correctional facilities in Hungary, we conducted research on AIDS-related attitudes and the HIV risk behavior history of 551 male and 81 female inmates to assess needs for and to tailor AIDS education programs. Although lifetime injection drug use was uncommon (8% of men, 3% of women), many Hungarian inmates had engaged in unprotected sex and had had high-risk sex partners: a quarter of men had primary partners who sold sex, about half of them had sex with female prostitutes, 13% of women had worked as prostitutes, and 9% of all inmates indicated having had sex in prison. Because many prison inmates may constitute a potential bridge population for the sexual transmission of HIV between the general population and high-risk populations, interventions among prison inmates may provide an opportunity to reach an at-risk population and to prevent the wider spread of sexually transmitted HIV.     

Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in northern Thailand

We assessed the relation between accurate beliefs about HIV transmission and inaccurate beliefs about HIV transmission and emotional reactions to people with AIDS (PWA) and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV. In Chiang Rai, northern Thailand, 219 respondents filled in a structured questionnaire assessing accurate and inaccurate HIV transmission beliefs, emotional reactions towards PWA and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV according to variables from Protection Motivation Theory. Complete accurate beliefs about documented modes of HIV transmission were present in 47% of the respondents, while 26% of the respondents held one or more inaccurate beliefs about HIV transmission. Incomplete beliefs about documented modes of transmission were significantly related to stigmatizing beliefs towards people with AIDS (PWA), to lower vulnerability of HIV infection and lower self-efficacy in protection. Those who held inaccurate beliefs about HIV transmission reported more fear towards PWA and homosexuals and more irritation towards PWA and commercial sex workers. Persons who held inaccurate beliefs about HIV transmission also reported more stigmatizing attitudes, perceived AIDS as less severe, perceived a lower vulnerability and were less motivated to use condoms. Results of this study suggest that inaccurate beliefs about HIV transmission are related to fear and stigmatizing and undermine HIV prevention behaviour.     

HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction, their experiences and expectations, and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre, South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200 male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34, 95%CI: 0.23 – 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50%) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services, ranging from 79% (fair to very good) for ‘the way he/she received you’ to 62% ‘clarified all your concerns’. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctional centres especially with regard to VCT services.     

Tuberculosis in a prison population in Mwanza, Tanzania (1994-1997).

SETTING: Bugando Medical Centre, a referral consultant hospital in the lake zone to which all inmates from Butimba prison are admitted and treated. OBJECTIVE: To determine the extent of open (smear-positive) tuberculosis and other types of tuberculosis among prisoners with tuberculosis. DESIGN: A retrospective cohort study. Case notes of 501 prisoners from January 1994 to December 1997 were retrieved and reviewed. RESULTS: The proportion of open tuberculosis in this study was high, with 204 prisoners (40.7%) having smear-positive tuberculosis. Co-infection was recorded in the majority of patients; HIV/AIDS was recorded in 25.9% of cases. The mean length of imprisonment at the time of diagnosis was 19 months. CONCLUSION: The proportion of open, smear-positive tuberculosis among prisoners admitted with tuberculosis is high. Intervention measures specifically targeting this population are urgently needed in order to contain tuberculosis disease in the prison population.     

The effects of individual- and community-level knowledge, beliefs, and fear on stigmatization of people living with HIV/AIDS in China

This paper assesses the effects of individual- and community-level knowledge of HIV transmission, beliefs and fear of infection on individual attitudes toward and willingness to interact with people living with HIV/AIDS in China. Data are from a sample survey of 12,270 men and women age 15-49 from seven provinces/municipalities. The survey was conducted by the Population and Family Planning Commission in December 2003. Multilevel regression analyses show that stigmatization of people living with HIV/AIDS is strongly associated with community-level HIV knowledge and fear, even after taking into account HIV knowledge and fear at the individual level. The findings suggest that individual attitudes are partially shaped through social learning and social influence. Public-health interventions aimed at eliminating stigmatization of people living with HIV/AIDS will need to pay special attention to social and community influences while continuously working to enhance HIV knowledge and reduce inaccurate beliefs and fear.     

Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men

The study aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or their attitudes to highly active antiretroviral treatments. Any unprotected anal intercourse (UAI) with casual partners was used as the sexual-risk indicator. The study enrolled 261 MSM. There were no significant differences between beliefs, attitudes and perceptions about HIV/AIDS, knowledge of post-exposure prophylaxis (PEP) or exposure to the HIV/AIDS epidemic among those who had had UAI with casual partners and those that had not (P>0.12). Those who considered that low levels of viral load and withdrawing before ejaculation reduced the risk of HIV transmission were significantly more likely to have had UAI with a casual partner (P=0.03). Only a minority of MSM engaging in UAI were optimistic about antiretroviral therapy. The study participants were in general pessimistic about life with HIV/AIDS despite their risk-taking sexual behaviour.     

A pilot study of health beliefs and attitudes concerning measures of antiretroviral adherence among prisoners receiving directly observed antiretroviral therapy

High level adherence to antiretroviral therapy (ART) is required to achieve and maintain suppression of HIV replication. Although directly observed therapy (DOT) has been suggested as an intervention to improve adherence, there is a paucity of data describing the attitudes and beliefs regarding DOT for ART among HIV-infected individuals. This study was designed to evaluate the acceptability and psychometric properties of a survey instrument for use in assessing barriers and facilitators of adherence to ART DOT in prison. From July 1, 1999 to April 1, 2000, we piloted an interviewer-administered questionnaire to assess health beliefs and attitudes regarding HIV treatment among 65 HIV-infected prison inmates receiving one or more of their antiretrovirals via directly observed therapy (DOT). The first 24 participants were administered the questionnaire to determine the feasibility of surveying prisoners in a correctional setting. There were no adherence data collected on these participants. The remaining 41 participants had their adherence measured in addition to receiving the questionnaire. Thirty-one were included in the final analysis because 10 did not complete the study. Multiple antiretroviral adherence measures (electronic device medication monitoring [eDEM] caps, medication administration records [MARs], and pill counts) were assessed among a subset of the participants (n = 31) and correlated to the instrument response items. The median internal consistency reliability coefficient for the multi-item scales was 0.79. The strongest correlation between inmates' beliefs and their adherence was between "positive beliefs about protease inhibitors" and the MAR adherence measure (r = 0.72; p < 0.001). This study provides preliminary support for the psychometric properties of the survey in this correctional setting.     

HIV Seroprevalence among High-Risk Groups in Kohgiloyeh and Boyerahmad Province, Southwest of Iran, a Behavioral Surveillance Survey

We conducted a survey to assess the seroprevalence and risk behaviors for HIV infection in 2,009 individuals in Kohgiloyeh and Boyerahmad province, in Southwest of Iran. Blood samples were drawn from each participant and tested for anti-HIV1/2 antibodies. HIV antibodies were detected in 36 (1.8%) blood samples among a total of 2,009 participants. The rate of infection in inmates was 2.7% while this rate was 9.9% in injection drug users. Correlation between HIV infection and sex, age, marital status, history of imprisonment, injection drug use, and place of residence were significant. Improving of the surveillance in this community through supervision and monitoring of infected people is needed.     

Association between HIV/AIDS knowledge and stigma towards people living with HIV/AIDS in Botswana

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient β (95% CI)] [?0.25 (?0.29, ?0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.