Support among persons infected with HIV for routine health department contact for HIV partner notification

Public health partner notification (PN) services are provided inconsistently to persons diagnosed with HIV/AIDS in the United States, and some community groups representing persons with HIV/AIDS have opposed widespread application of PN. We surveyed persons with HIV recently reported to our health department and a random sample of HIV-infected persons attending an HIV/AIDS clinic. A total of 95 persons, of whom 76 (80%) were men who have sex with men, completed an anonymous self-administered questionnaire. Eighty-four percent of participants believed the health department should routinely offer everyone diagnosed with HIV help in notifying their partners; 79% indicated they would be somewhat or very likely to provide information to a doctor, case worker, or health department employee for purposes of PN; and 20% indicated they wanted help in notifying a recent sex partner. Seventy-eight percent of participants believed the health department should contact all HIV-infected persons after diagnosis to help them access medical care and social services, and 68% wanted the health department to contact them about the availability of medical or social services. In contrast to common public perceptions, these results suggest that most persons with HIV support health departments routinely contacting people after HIV diagnosis and that many want assistance with PN.     

Sensitization and training for health promotion on HIV / AIDS and STDS

Many people are loathe to confront the issues of HIV/AIDS, sexually transmitted diseases, and sexual behavior. Health planners, administrators, and personnel, must, however, courageously confront such issues as they plan and implement programs to help populations in need. The sensitization and training of people who could be or are involved in health promotion/education is an ongoing process. People must consciously confront their values, norms, and attitudes on factors associated with the HIV/AIDS epidemic so that they can learn to teach others in an unbiased and nondiscriminatory manner. On that note, a better understanding is needed of how what is undertaken in health promotion is connected to the larger whole of HIV/AIDS and STD activities. A strategic approach is called for.     

Society for Women and AIDS in Africa (SWAA)

In 1988, a group of African women founded the Society for Women and AIDS in Africa (SWAA) during the Fourth International Conference on AIDS in Stockholm. SWAA founders were concerned that national AIDS programs, professional associations, and donor agencies were not paying enough attention to how HIV/AIDS touches the lives of women in Africa. SWAA provides opportunities for women to be leaders in bringing about positive change. It asserts that if women have appropriate education and problem-solving opportunities, they will use their knowledge to make decisions and to take action, minimizing their risk of HIV infection and the risk behaviors of their partners and family members. SWAA helps women to provide AIDS education appropriate for women and safe, effective home and community-based HIV/AIDS health care and to address the cultural beliefs that foster misinformation about AIDS and the stigmatization of women. SWAA also assists women in changing traditional norms, in reducing prostitution, and in being advocates for persons living with HIV/AIDS, including AIDS orphans, grandparents, and street children. SWAA targets male policy and decision makers at both the national and international level. It cooperates with governmental and nongovernmental organizations to stem the AIDS epidemic in Africa. SWAA News is a permanent link between the SWAA branches in 25 countries and members. It features meetings, conferences, and SWAA activities. SWAA has increased solidarity among African women. It provides a forum for examining the sexual, social, and economic factors affecting the lives of women. It is expanding to include women's support centers and networks, counseling and help for women and HIV/AIDS, and training of media professionals on women and AIDS issues.     

Health economics: potential applications in HIV/AIDS control in Africa

There is growing evidence that HIV/ AIDS has enormous negative impact on health status and economic development of individuals, households, communities and nations in the African region. Thus, there is urgent need for various disciplines to demonstrate how they can contribute in curbing the spread of this deadly disease in the African region. This paper, using an extended version of Professor Alan Williams schema as the conceptual framework, attempts to demonstrate how health economics can be used to inform policy and managerial choices related to HIV/AIDS advocacy, prevention, treatment and management. It argues that the discipline of health economics (and economics generally) is extremely valuable in: measuring health impacts of the disease and interventions; evaluating the relationships between health care-seeking behaviour of individuals and health system specific attributes; the estimation of determinants of compliance of HIV/AIDS patients with treatment regimen; establishing of health institutions efficiency in combating AIDS; guiding choices of HIV/AIDS interventions; assessing the relationships between HIV/AIDS, development, poverty, and trade; programme planning, monitoring and evaluation; and assessing health system's overall performance. The paper is a modest attempt to show how the discipline of health economics can elucidate, and help in resolving practical and conceptual issues in HIV/AIDS control in Africa.     

Social support,distress, and well-being in older men living with HIV infection

Older men with HIV infection/AIDS, having often lived with the condition longer, are more likely to confront the stress of managing more advanced HIV disease than their younger counterparts. Meanwhile, they also are more likely to have less social support and experience more distress than younger persons with HIV infection. The moderating effect of social support on health functioning and distress is unknown for persons with HIV infection, particularly those who are older. Study objectives were to assess whether the association between perceived health functioning and psychological distress and well-being is moderated (or influenced) by social support and age and if the impact of social support on distress and well-being is more pronounced for older than for younger men living with HIV infection/AIDS. In this cross-sectional study of HIV-positive adult men (n = 199) who have sex with men, participants completed self-report assessments of perceived health functioning, social support, and psychological distress and well-being. Measures of health functioning and overall social support were significantly associated with outcome measures of distress and positive affect (all p < .05). However, the main effect for social support was qualified by a significant age-by-social support interaction for both outcomes (beta = -.190, p < .01 for distress; beta = .172, p < .05 for positive affect), indicating that the impact of social support on decreasing distress and increasing well-being was more pronounced in older men. The relationships between perceived health functioning and distress and well-being were not moderated by social support or age. The influence of social support on negative and positive moods in this population of HIV-infected men who have sex with men was significantly greater among older than among younger participants. With an increasing number of older people with HIV infection/AIDS, special efforts to create effective and sustainable social support interventions may be particularly beneficial to older persons living with HIV infection.     

HIV感染者/AIDS病人生存质量现状及相关因素研究

目的了解HIV感染者/AIDS病人生存质量的现状并分析其相关因素。方法应用世界卫生组织生存质量量表（WHOQOL-BREFF）中文版评价HIV感染者及AIDS病人的生存质量,同时调查可能影响生存质量的人口学特征、HIV感染有关情况和社会支持等。采用t检验、方差分析进行单因素分析,多元线性回归模型分析生理、心理、社会关系及环境4大领域的影响因素。结果 112例HIV感染者/AIDS病人生存质量4大领域平均得分分别为：生理领域（60.5±16.2）分、心理领域（51.8±17.5）分、社会关系领域（58.1±19.3）分,环境领域（47.5±15.6）分。各维度得分均低于全国常模,差异有统计学意义（P〈0.05）。主观支持得分越高,HIV感染者/AIDS病人生存质量4个领域得分就越高;静脉吸毒途径感染的HIV感染者/AIDS病人生理领域总分低于性途径感染者;有工作/学习的HIV感染者/AIDS病人生理和心理领域得分高于无业者;对支持利用度高者,其心理领域得分也高;在环境领域得分中,患者文化程度越高,其得分越高。结论应加强失业、文化程度低、抗病毒治疗患者、静脉注射感染者以及社会支持差者的心理健康辅导,以提高其生存质量。     

Ethical and legal issues

At the 9th International Conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA), issues concerning the legal and ethical aspects of HIV/AIDS are brought to the fore. Throughout the world, people living with HIV/AIDS are experiencing various forms of human rights abuses including testing abuses, lack of confidentiality, refusal to treat patients, dismissal of HIV-positive employees without sufficient reason, invasion of privacy, and placement of infected subjects in quarantine. This discrimination and stigmatization is not justified and gravely compromises the considerable efforts already made in fighting the epidemic. Participants suggested that the law should be used to support the authority of individuals infected with HIV/AIDS. Legislation should follow a double objective: it should know that victims of AIDS should be protected and supported, and it should clearly indicate what the responsibility of seropositive persons vis a vis society could be. The controversy of whether it is necessary to enact a legislation concerning HIV/AIDS, however, remained. While some people believed that the existing legal framework could be exploited to develop the necessary protocol concerning the responsibilities and rights of patients, an opposing viewpoint is that current legislation should not be applied in solving the problems associated with HIV/AIDS. But the important interest is that numerous recommendations of the ICASA will not remain simple declarations of intention, but translated into correct actions.     

Social Stigma,HIV/AIDS Knowledge,and Sexual Risk: A Cross‐Cultural Analysis1

The main aim of this study is to evaluate relationships linking social stigma, HIV/AIDS knowledge, and sexual risk among African American (AA) and South African (SA) college students. One major barrier to HIV prevention efforts is the social stigma associated with HIV/AIDS. Based on the Burkholder et al. (1999) findings, persons who engage in greater stigmatization of persons with AIDS (PWA) and gay people are associated with greater sexual behavior risk for HIV/AIDS. The present study attempted to replicate the Burkholder et al. study using African American and South African college students, but the findings were inconsistent with the aforementioned study. AA respondents had higher social stigma of PWA and gays and higher condom self‐efficacy. While SA respondents were less likely to stigmatize PWA and gay persons and had high‐perceived risk of being infected, they reported engaging in high‐risk sexual behavior. The authors discuss the differences that may account for the dissimilar findings.     

Reflections on Geneva

The 12th World AIDS Conference in Geneva revealed two very different HIV epidemics in the world, marked by vast differences in wealth and technology availability. Ninety-five percent of people living with AIDS reside in Africa and Asia where funds are scarce. India has 4 million people infected with HIV, and HIV is now present in every province in China. Drug companies need to take the initiative, and help the Third World battle the epidemic. Another message delivered at Geneva was the idea of rebuilding the immune system to help control the virus. HIV is now being seen more as a chronic and difficult disease that is manageable, especially since simpler HIV regimens are appearing. Vaccines are being pursued, but an effective vaccine is believed to still be more than 10 years away.     

Report from Capetown: GNP+ and ICW hold annual meetings

Capetown, South Africa, has recently hosted the Third Annual Gathering of the International Community of Women Living with HIV/AIDS (ICW) and the Seventh Annual International Conference of the Global Network of People Living with HIV/AIDS (GNP+). The National Council for International Health's AIDS Program sent two participants to the conferences: ICW's key contact in the Caribbean, who is from Trinidad and Tobago, and a US activist from the AIDS Project, Los Angeles. About 200 women from 70 countries attended the ICW conference. Topics included overcoming isolation, caring for others and themselves, sexual abuse, harassment and violence against women, loss/bereavement, situation of women in Africa and the impact of HIV, sexual health, treatments, access to medical care, pregnancy and motherhood, and the impact of HIV on children. More than 400 persons attended the GNP+ conference. The major program tracks were the dichotomy between the importance of holistic health strategies in many parts of the developing world and treatment of opportunistic infections and antiviral treatment in the developed world, travel restrictions, skills building, and communication. Priorities identified during the business sessions were expansion of the network's communication capabilities and enhancement of the autonomy of each of the regions. The GNP+ conference was a significant opportunity for South African PWAs (persons with AIDS) to meet people from around the world. The South African Ministry of Health is committed to a national PWA conference and an affirmative action plan to include more HIV-seropositive staff members in the National AIDS Control Program and the Ministry. Ongoing activities of ICW and GNP+ are preparation of proposals for support from major donors and planning a global survey of the living conditions of persons living with HIV/AIDS and another survey focusing on human rights.     

Health Literacy: Impact on the Health of HIV-Infected Individuals

Health literacy is known to affect vulnerable communities such as persons living with HIV/AIDS. The purpose of this review was to provide a current summary of research on the impact of health literacy on the health of persons living with HIV/AIDS and to address future areas of need. Contemporary studies focused on expanding the reach of health literacy in HIV/AIDS to retention in HIV care, use of technology for assessing and intervening to improve health literacy, and health literacy across the globe, for example. A number of studies did not find health literacy to explain health behaviors whereas other studies supported such a relationship. Future issues relevant to health literacy in HIV/AIDS include the aging of the HIV population and associated comorbidities, studies to understand the role of health literacy in specific populations affected by HIV/AIDS, and the continued need to refine the definition and measurement of health literacy.     

Mandela calls for greater commitment and leadership in fighting AIDS. The World Economic Forum -- Policy and business in a world of HIV / AIDS

The 27th annual meeting of the World Economic Forum in Davos, Switzerland, on February 3, 1997, was attended by 2000 political and financial leaders of countries and businesses around the world. The forum is the world's largest annual gathering of economic and political dignitaries. In his address to the forum, Nelson Mandela, president of South Africa, called for a global effort against AIDS and a strengthening of the world's political and business leaders' commitment against HIV/AIDS. The disease is creating global economic problems by affecting people in their prime productive and reproductive years. Mandela criticized political leaders for their limited actions in addressing the AIDS pandemic and called upon the world's business community to support government AIDS programs and help people affected by AIDS. All sectors and all spheres of society must be involved as equal partners in the war against HIV/AIDS, for neither the health sector nor government can meet the challenge on its own. If current HIV/AIDS trends continue in South Africa, AIDS will cost the country 1% of its domestic gross product by the year 2005, and up to 75% of the country's budget will be consumed by direct health costs related to HIV/AIDS. At a panel discussion preceding President Mandela's address, Dr. Peter Piot, executive director of UNAIDS, argued that the AIDS pandemic could have a devastating effect upon the global economy and urged business leaders to take strong action against the disease.     

Issues of human rights and HIV. Guest commentary

The AIDS pandemic has not spread in a social and economic vacuum. Indeed, HIV and AIDS have spread in the context of widespread poverty, sexism, racism, homophobia, and heterosexism throughout most nations of the world. Globally, communities have been allowed to reject or ignore that the spread of HIV/AIDS is symptomatic of underlying social injustices. It is, however, extremely difficult to combat AIDS in the context of poverty, gay bashing, low women's status, and overt violence against HIV-seropositive individuals, notably in Russia, Mexico, and the US. It is clear even at the policy level that countries around the world are still ignorant about HIV/AIDS and violate the human rights of infected individuals. US immigration and entry restrictions against HIV-seropositive individuals is but one example of such policy. Discrimination also extends down to the fundamental need for and provision of health care to people with AIDS. These individuals are stigmatized by health care workers, discriminated against when receiving treatment, or simply denied health care services. Shapiro et al's study found that 23% of young American medical residents would not care for AIDS patients if they had a choice. The study also found that 39% of surgeons or other medical specialists have refused care to at least one of the HIV-infected patients in the respondent physicians' care. Governments must act to ensure that such discrimination is eradicated. Each country must reassess its laws which directly affect the lives of people who are most at risk, eschewing anti-gay rights initiatives and the criminalization of prostitution.     

Maximizing the existing health potential of people with HIV / AIDS: have we succeeded?

The author considers health to be an essential element of the quality of life which should always be maximized through active promotion. A review of the impact of efforts made at the global, institutional, and individual levels, however, reveals the health potential of persons living with HIV and AIDS to not be maximized. Efforts must be made to create and develop the potentials of healing and health for these people and their supporters. Effective, viable strategies will come from cooperation between those living with HIV/AIDS and professionals from other disciplines. Moreover, those living with HIV/AIDS are urged to stand and voice their concerns and desires to be made part of AIDS-related strategies. As such, positive steps may be made in the fight against stigmatism and social disadvantages endured by the community, thereby increasing their capacity to deal with the consequences of HIV and AIDS.     

Coping,social support,and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS

The purpose of this study was to examine psychosocial correlates of adjustment to HIV/AIDS in a sample of 137 HIV-positive persons (78 men and 59 women). Multiple regression analysis was used to examine relationships between perceived quality of general social support, three attachment styles, and three coping styles with total score on Positive States of Mind Scale (PSOMS), our measure of adjustment. The influence of demographic and medical status variables was also accounted for. PSOMS total score was significantly associated with greater satisfaction with social support related to HIV/AIDS, more secure attachment style, and less use of behavioral disengagement in coping with HIV/AIDS. These results indicate that for people with HIV or AIDS, those individuals who are more satisfied with their relationships, securely engaged with others, and more directly engaged with their illness are more likely to experience positive adjustment. Implications for physical health outcome and opportunities for intervention are discussed.     

AIDS/HIV crisis in developing countries: the need for greater understanding and innovative health promotion approaches.

Epidemiologic data on morbidity and mortality have shown that the acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV) epidemic is relatively widespread in the developing countries of the world, especially in the already economically deprived regions of Sub-Saharan Africa. Africa is estimated to have approximately 5 million seropositive individuals, and by the year 2000, this number is expected to include 10 million HIV-infected children. Improved control over this epidemic can only come through a greater understanding of the specifics of the disease and, eventually, the introduction of more effective and innovative health promotion campaigns targeted at medical personnel, traditional healers, families, and persons with AIDS. Comprehensive health promotion campaigns, carefully using mass media strategies in addition to more community-based programs, all operating under "decentralized" AIDS control programs, are reasoned to be the most efficacious approach that African and other developing countries can use to successfully contain the AIDS/HIV epidemic. Given the reality of the following factors: Pattern II (ie, transmission of AIDS via heterosexual sexual activity) is the main mode of HIV transmission in Africa, the traditional dominant roles males have in sexual relations, and the positive relationship between sexually transmitted diseases and AIDS, health promotion campaigns must focus specifically on addressing at-risk culturally related sexual values and behaviors in African communities. Failure to address these and other related factors will certainly lead to an escalation of the AIDS/HIV epidemic in Africa and, therefore, concomitant devastation in the human and societal realms of the region.     

Sexual and family planning practices and needs of people living with HIV/AIDS in Nigeria: a rapid ethnographic assessment

BACKGROUND: This study was conducted among people living with HIV/AIDS (PLWHAs) and it tries to understand their sexual and reproductive lives, with the aim of understanding what they know about reproductive health, social challenges of life they face daily and what are their needs. METHOD: The study was conducted in the Northern state of Kaduna, Nigeria; a qualitative approach was employed using group interviews, in-depth interviews and focus group discussions. Individual PLWHAs, their associations and officials of the associations were interviewed. RESULTS: People living with HIV/AIDS (PLWHAs) are a group of people whose life has not been studied very well, they have a lot of pressing social issues such as their circumstances of diagnosis, bad experiences following the diagnosis, and lack of adequate provisions for their healthcare. They wish to see their welfare addressed with provision of drugs and social support. CONCLUSION: PLWHAs and their associations expressed concerns about how they are treated by both medical workers and the society. There is need to address these issues in the way of research aimed at changing the views of policy makers favourably.     

Algae -- a poor man's HAART?

Drawing inferences from epidemiologic studies of HIV/AIDS and in vivo and in vitro HIV inhibition by algae, we propose algal consumption as one unifying characteristic of countries with anomalously low rates. HIV/AIDS incidence and prevalence in Eastern Asia ( approximately 1/10000 adults in Japan and Korea), compared to Africa ( approximately 1/10 adults), strongly suggest that differences in IV drug use and sexual behavior are insufficient to explain the 1000-fold variation. Even in Africa, AIDS/HIV rates vary. Chad has consistently reported low rates of HIV/AIDS (2-4/100). Possibly not coincidentally, most people in Japan and Korea eat seaweed daily and the Kanemba, one of the major tribal groups in Chad, eat a blue green alga (Spirulina) daily. Average daily algae consumption in Asia and Africa ranges between 1 and 2 tablespoons (3-13 g). Regular consumption of dietary algae might help prevent HIV infection and suppress viral load among those infected.     

Country watch. Chile

"A life...a story" is a quilt project for people affected by HIV/AIDS supported by the Chilean Corporation for the Prevention of AIDS. Unlike the quilts displayed at public events to commemorate people who have died, these quilts are also made by people who are still living with HIV/AIDS (PHIV) and their families. The project was conceived as a way to develop an organizing tool with two aims: to break through the barriers created by HIV infection between PHIV and their own families and to humanize the epidemic, which is often presented only in terms of statistics and "risk groups." Most of the quilt-makers are recruited through personal contacts, including family members of deceased persons. Through their artwork, the participants tell something about their lives and the way they are dealing with HIV/AIDS. A primary aim is to show the dignity of human beings who are confronting a challenge which is emotional, physical, familial and social. Some quilts relate stories of discrimination and subsequent solidarity; others are testimonies to courage and the process of going from ignorance through transformation to resistance. So far about half the quilts have been made by PHIV and half by friends and relatives of persons who died. They have been shown in nine exhibitions in various institutions and been used in two demonstrations. On occasion, the quilt-makers accompany their own quilts and speak at these events.     

'Dying twice': a multi-level model of the roots of AIDS stigma in two South African communities

We highlight the complex interplay of psychological and social factors driving AIDS stigma, drawing on a study of community responses to HIV/AIDS in two communities in KwaZulu-Natal, South Africa. We draw on 120 semi-structured interviews and focus groups, in which open-ended topic guides were used to explore community responses to HIV/AIDS. Drivers of stigma included fear; the availability and relevance of AIDS-related information; the lack of social spaces to engage in dialogue about HIV/AIDS; the link between HIV/AIDS, sexual moralities and the control of women and young people; the lack of adequate HIV/AIDS management services; and the way in which poverty shaped people's reactions to HIV/AIDS. We discuss the implications of our findings for stigma-reduction programmes.