HIV/AIDS. Some organizational and managerial issues

Discusses factors emerging from research into the management and organizational processes involved in developing services for HIV/AIDS which affected the speed and character of the response made by health authorities. An early response was promoted by perceived high local prevalence, an existing service infrastructure, and high status individuals "championing" the issue and helping to foster a mobilizing sense of crisis. Responses were shaped by the diverse interests and perspectives of those developing services; the lack of established guidelines for treatment and service delivery; and ring-fenced funding. The idiosyncratic nature of initial service development has sometimes made later strategic choices difficult. Argues that if the momentum of service development is to be sustained, HIV/AIDS needs to be integrated into mainstream service provision and managers need improved information about local prevalence and the evaluation of service initiatives.     

Future issues in HIV/AIDS surveillance.

Public health surveillance for human immunodeficiency virus (HIV) seeks to define and quantity the spectrum of HIV risk, infection, and disease at the local, state, and national levels. Reporting of cases of acquired immunodeficiency syndrome (AIDS) or HIV and seroepidemiologic surveys are the primary methods. In selected areas, this infrastructure supports supplemental systems that address issues of risk or infection beyond the scope of routine surveillance. Future concerns include maintaining the basic HIV/AIDS surveillance infrastructure, maintaining flexibility to meet emerging needs, improving surveillance for incident infections and risk behaviors, and enhancing the capacity of community-based groups to use surveillance data in setting priorities for prevention and care.     

AIDS, older people, and social work.

The acquired immune deficiency syndrome (AIDS) epidemic is significantly affecting older people. Older people themselves may be HIV positive, or they may be the caregiving spouse, partner, parent, or grandparent of a person with AIDS. In addition, older people may share housing or institutional space with people with AIDS. Concerns about the allocation of long-term care resources may create conflict between the needs of older people and people with AIDS. Social workers are particularly suited to lead the discussion of the impact of AIDS on older people, a role the profession has not yet embraced. Four areas of social work leadership are discussed: education, direct service, research, and advocacy.     

Econometric issues in modeling the costs of AIDS.

The goals of AIDS or HIV econometric modeling efforts are: (i) to evaluate or project the costs-of-illness to the individual and to society; and (ii) to examine the efficiency and cost-effectiveness of medical and social services provided to patients. Most of the standard theoretical and statistical approaches are not applicable because of the scarcity, incompleteness and non-representative nature of available data. This paper discusses specific methodological approaches concerning AIDS and HIV epidemiology, medical cost estimation techniques, evaluation of the cost-effectiveness of social support programs and valuation of human life. The epidemiologic projection approach--a simplified 'back calculation' method--suggests that the number of Americans infected with the AIDS virus in 1987-88 was likely to be between 500,000 and 800,000. This estimate is between 2 and 3 times lower than the U.S. Centers for Disease Control estimates. Methods for estimating both the direct and indirect costs of illness are described.     

Sex workers and the issues surrounding registration in Turkey

Awareness of the activities of commercial sex workers can be an important step toward understanding the transmission of sexually transmitted infections (STIs) in developing countries. This study discusses how sex workers are viewed in Turkey and the process of mandatory registration. To support the information provided and the conclusions drawn, a sample of 150 sex workers who made regular visits to a STI hospital was interviewed. Information on socio-demographic characteristics, family and support information and certain risk behaviors were solicited. Recommendations for increasing preventive education are made, with considerations for increased attention and support for this group of individuals.     

Measurement issues in research on social support and health.

STUDY OBJECTIVE--The aims were: (1) to identify methodological problems that may explain the inconsistencies and contradictions in the research evidence on social support and health, and (2) to validate a frequently used measure of social support in order to determine whether or not it could be used in multivariate analyses of population data in research on social support and health. DESIGN AND METHODS--Secondary analysis of data collected in a cross sectional survey of a multistage cluster sample of the population of the United States, designed to study relationships in behavioural, social support and health variables. Statistical models based on item response theory and graph theory were used to validate the measure of social support to be used in subsequent analyses. PARTICIPANTS--Data on 1755 men and women aged 20 to 64 years were available for the scale validation. RESULTS--Massive evidence of item bias was found for all items of a group membership subscale. The most serious problems were found in relationship to an item measuring membership in work related groups. Using that item in the social network scale in multivariate analyses would distort findings on the statistical effects of education, employment status, and household income. Evidence of item bias was also found for a sociability subscale. When marital status was included to create what is called an intimate contacts subscale, the confounding grew worse. CONCLUSIONS--The composite measure of social network is not valid and would seriously distort the findings of analyses attempting to study relationships between the index and other variables. The findings show that valid measurement is a methodological issue that must be addressed in scientific research on population health.     

Methodological issues in social support and social network research

With the plethora of articles describing a relationship between social support and/or social network and health status, it was considered useful to take stock of the current status of research in this area, focusing on two critical methodological issues: clarity of definition, and validity and reliability of the measurement instruments. Of the 33 instruments reviewed only modest agreement was found in conceptual definition, and frequently the concepts were not defined or ill-defined. Of particular concern is the definitional confusion between social support and social network. Variables used to operationalize these concepts confirm this lack of specificity and ambiguity in definition. As for validity and reliability, many of the investigators reported no data on these issues; others provided information that only modestly supported the validity or reliability of their instrument. The conclusion of this assessment suggests the need to clarify the essential elements of social support and social networks in order to better distinguish between the behavioral (support) and structural (network) variables that may be affecting health status. A question is also raised as to the likelihood of a single questionnaire being designed that would accurately measure the perceptions of support or supportive behaviors in the variety of supportive research that will continue to be studied. Finally, more rigorous standards need to be used by investigators in establishing the validity and reliability of the instruments in order to improve their predictive utility.     

AIDS, risk and social governance

This paper considers the discursive properties of public health literature produced around AIDS in the 1980s and early 1990s. Attention is focused upon the role of health promotion in the UK government's response to the epidemic and on the language used in the educational campaigns conducted by the Health Education Council and its replacement the Health Education Authority. Using an analytical approach influenced by the work of Michel Foucault, the paper argues that the knowledges of AIDS produced by these various public health institutions constructed discursive boundaries between the idea of 'normal' and 'abnormal' behavioural practices. The notion of risk, produced as it is from epidemiological knowledge, is a central mechanism in this process. It is through the production, articulation and normalisation of 'at risk' groups that society is fragmented and hence subject to the governance strategies of late-modern liberal economies.     

Methodological issues involved in the study of young people and HIV/AIDS: a social psychological view

This paper explores methodological issues associated with researchon sexual behaviour and the risk of contracting HIV. Drawingon our own research we discuss the ways in which multiple modesof assessment can contribute to our understanding of HIV/AIDS.We demonstrate that different approaches (questionnaires andopen-ended interviews) can provide complementary data. Our examplesillustrate that apparent contradictions between responses toquestionnaires and to interviews can be integrated, leadingto a greater understanding of the relationship between knowledgeabout HIV/AIDS and sexual behaviour.