Women and AIDS: agenda for action

The Fourth World Conference on Women will be held in Beijing, China, September 1995, during a period when women are increasingly and disproportionately being affected by HIV and AIDS. Relatively few women were touched by AIDS during the 1980s. Now, however, more than six million women are infected with HIV and another million will become infected in 1994. By the year 2000, more than 13 million women will have been infected and four million will have died. The sexual and economic subordination of women fuels the HIV/AIDS pandemic. Measures must be taken to allow women to make informed choices and improve the quality of their lives. Women must empower themselves by networking, forming alliances, and advocating for change. Furthermore, top-level political commitment is needed to reduce the social vulnerability of women to HIV infection by improving their health, education, and legal and economic prospects. Effective HIV/AIDS prevention and care efforts along with sound policies and programs targeting women affected by HIV/AIDS need to be developed and integrated into existing national structures, particularly at the community and family levels. Recommendations are made in the interest of reducing the vulnerability of women to HIV/AIDS.     

Family and community support of urban pregnant students: Support person,function, and parity

Family and community support resources available to 200 primiparous and 44 multiparous pregnant students were examined. All pregnant students included in the study were unmarried, African American, and enrolled in urban public high schools of a large midwestern city from 1986 to 1989. Results showed that (a) support persons in the family system were mentioned more frequently than those in the community system in all support functions and by all pregnant students; (b) at least two thirds of all available support involved the baby's father and the student's mother, but their support functions differed; and (c) parity tended to be related to the interplay between the support person and the support function. Health professionals must identify appropriate support persons for the pregnant student and include them in the care process.     

Sense of community: Community resilient responses to oppression and change

Resilience refers to the positive ways in which people respond to adversity and stressful life events. Much of the research and writing in resilience has focused on how children respond to adversity. Community resilience, however, represents an extension of this focus. Often oppressed communities are represented as lacking in resilience and competence. Models that characterize group responses to intergroup and intercultural contact often simplify the responses of communities. Drawing on these concepts, it is argued that oppressed groups do not always capitulate or assimilate to oppressive systems, but in alternative settings these groups find ways to resist oppression and experience a sense of community. In settings such as church groups, sporting clubs, extended family networks and other organizations, groups find ways to protect and propagate what is valued and central for their survival. This has implications for how we interpret and understand the ways in which groups adapt to oppressive and changed contexts and alerts us to the dangers in underemphasizing and overlooking the positive functions of alternative settings. © 1998 John Wiley & Sons, Inc.     

Using mutual information to measure the impact of multiple genetic factors on AIDS

Since the discovery of the 32-base-pair deletion in the CCR5 chemokine receptor gene (CCR5-Delta32) and its effect on HIV-1 infection and AIDS progression, many genetic factors affecting AIDS have been identified. Here we quantify the impact of 13 of these factors on AIDS progression using a new statistic based on the mutual information between causal factors and disease, the explained fraction. The influence of causal factors on disease is commonly measured by the attributable fraction statistic, but the attributable fraction is a poor measure of the extent to which a factor explains disease because it considers only whether a factor is necessary, not whether it is sufficient. The definition of the explained fraction, which is analogous to R or the explained variation for regression models, extends naturally to multiple factor levels. Because the explained fraction is approximately additive, it can be used to estimate how much of epidemiological data is explained by known genetic or environmental factors, and conversely how much is yet to be explained by unknown factors. We show that 13 genetic factors can cumulatively explain 9% of slow progression to AIDS, an effect comparable to the effect of smoking on lung cancer.     

Women in community psychology: the trailblazer story

This article is an archival document which chronicles a herstory project organized and directed by the Society for Community Research and Action (Division 27 of the American Psychological Association) Women's Committee. The experiences of 55 trailblazing women in the field of community psychology are examined, and the authors' journey in collecting, documenting, and presenting the information is also included. © 2008 Wiley Periodicals, Inc. © 2008 Wiley Periodicals, Inc.     

AIDS in the black community: public health implications

As of the end of September 1988, 16,600 cases of acquired immunodeficiency syndrome (AIDS) have been reported in New York City, including 5,248 cases among blacks, 32 percent of the total. Of these, 4,220 (80 percent of adults) are men, 1,028 (19 percent of adults) are women, and 195 are children.     

Women with HIV/AIDS: treating the fastest-growing population

AIDS is essentially the same disease in men and women, but a combination of social, psychological, and physiologic factors appear to define HIV disease and AIDS in women and suggest that different approaches may be needed for female patients. The likelihood that a woman will receive, adhere to, and respond to antiretroviral therapy differs from that among men. Specific psychosocial issues serve as barriers to treatment and adherence in women. Gender differences in CD4+ counts and viral load may warrant revisions of standard treatment guidelines, which were originally developed for men. Physicians need to understand gender differences in the course of AIDS, treatment responses, and the efficacy of newer antiretroviral drugs. Earlier diagnosis of HIV infection and AIDS in women may hinge on recognition of gender-specific AIDS-defining illnesses. Development of once-daily, tolerable, safer pharmacologic agents with distinct resistance profiles might improve adherence and efficacy of treatment in both men and women.     

Progression to AIDS: the effects of stress, depressive symptoms, and social support.

OBJECTIVE: We examined the effects of stress, depressive symptoms, and social support on the progression of HIV infection. METHODS: Eighty-two HIV-infected gay men without symptoms or AIDS at baseline were followed up every 6 months for up to 5.5 years. Men were recruited from rural and urban areas in North Carolina as part of the Coping in Health and Illness Project. Disease progression was defined using criteria for AIDS (CD4+ lymphocyte count of <200/microl and/or an AIDS-indicator condition). RESULTS: We used Cox regression models with time-dependent covariates, adjusting for age, education, race, baseline CD4+ count, tobacco use, and number of antiretroviral medications. Faster progression to AIDS was associated with more cumulative stressful life events (p = .002), more cumulative depressive symptoms (p = .008), and less cumulative social support (p = .0002). When all three variables were analyzed together, stress and social support remained significant in the model. At 5.5 years, the probability of getting AIDS was about two to three times as high among those above the median on stress or below the median on social support compared with those below the median on stress or above the median on support, respectively. CONCLUSIONS: These data are among the first to demonstrate that more stress and less social support may accelerate the course of HIV disease progression. Additional study will be necessary to elucidate the mechanisms that underlie these relationships and to determine whether interventions that address stress and social support can alter the course of HIV infection.     

Women empower women: volunteers and their clients in community service

The study is aimed at examining the relationship between psychological empowerment of women volunteers and their clients in community volunteer projects in Israel. Based on an ecological approach, the study also aimed at examining whether the variables that explain empowerment of women who volunteer also explain empowerment of their clients. The sample included 148 women, who were divided into 74 volunteer‐client pairs. Psychological empowerment of volunteers did not correlate significantly with psychological empowerment of clients. However, the volunteer women's motives for volunteering and the quality of the volunteer–client interaction correlated positively with psychological empowerment of the clients. Empowerment of volunteers was explained primarily by social motives, by the quality of interactions with their clients, and by the quality of the volunteer's interaction with the coordinator of volunteer activity. In light of the findings, practical recommendations are offered for empowering women volunteers and their clients in community settings. © 2011 Wiley Periodicals, Inc.     

孕妇的依恋类型与社会支持

目的:探讨孕妇的依恋类型、社会支持及两者之间的关系。方法:采用关系问卷(RQ)和亲密关系经历量表(ECR)中文版,以及社会支持量表,对1070名孕妇进行问卷调查。结果:①孕妇的依恋类型分布:安全型64.0%、轻视型17.8%、倾注型14.2%、害怕型4.1%;②四种依恋类型的孕妇在"主观支持"得分上没有显著性差异,但在"客观支持"得分上,安全型(10.39±3.47)显著高于轻视型(9.21±3.11)、倾注型(9.20±3.08)和害怕型(9.17±3.73,F(3,1030)=9.83,P<0.01)。在"支持利用度"得分上,安全型(8.32±1.92)显著高于轻视型(7.64±1.86)、倾注型(7.57±1.70)和害怕型(7.60±1.95,F(3,1030)=11.51,P<0.05)。③依恋回避与"支持利用度"(r=-0.205,P<0.01)和"总的社会支持"(r=-0.230,P<0.01)呈显著负相关。④依恋焦虑与"客观支持"(r=-0.111,P<0.01)、"总的社会支持"(r=-0.123,P<0.01)均呈显著负相关。     

Suicide ideation and community support: an evaluation of two programs

Thirty-one suicidal French-Canadian men and women participated in a study of the differential effect of two community-based support programs on levels of self-esteem, stress, and suicide ideation. Results indicate that subjects in both programs reported an increase in self-esteem and a decrease in life stress and suicide ideation. The two social support approaches reflected in the respective programs did not result in relative differences in suicide ideation.     

HIV/AIDS and the African-American community: a state of emergency

HIV and AIDS disproportionately affect African Americans more than any other racial or ethnic group in the United States. Representing only 13% of the U.S. population, African-American adults and adolescents comprise more than half of all HIV/AIDS cases reported to the Centers for Disease Control and Prevention. The present incidence and prevalence of HIV/AIDS in the black community in the United States is of crisis proportions. The situation as it stands today is tantamount to a state of emergency for African Americans.     

Looking for change in response to the AIDS epidemic: trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998

This study investigates trends in AIDS knowledge and sexual behavior among men and women in urban Lusaka 1990 to 1998, and in all of Zambia, 1992 to 1998. Using data from representative surveys of urban Lusaka and of the country as a whole, population proportions were estimated to examine trends in knowledge and sexual risk behaviors. Differences in the estimated proportions between 1990 and 1998 were tested in Lusaka. In all Zambia, tests of difference were conducted between the earliest and latest years for which data were available for each indicator. A decline in premarital sexual activity was observed in urban Lusaka. In 1990, 50% of never married women reported no sexual experience, compared with 60% in 1998 (p =. 003); among men, the figures were 38% and 53%, respectively (p <. 001). Fewer women (1990, 8%; 1998, 2%; p <.001) and men (1990, 31%; 1998, 19%; p =.07) had extramarital partners. The bulk of change observed in urban Lusaka took place from 1990 to 1996; the changes in men's behavior observed between 1996 and 1998 were also observed in the national estimates for those years. National figures for other indicators from 1992 to 1998 were less encouraging. Apart from an increase in having ever used condoms, no change in women's sexual behavior was observed. Fewer men had premarital sex from 1996 to 1998 (1996, 64%; 1998, 46%; p <.001), but condom use with nonregular partners decreased among men (1996, 38%; 1998, 29%; p =.02). Prevention campaigns focused on education about AIDS and promoting safer sexual behavior appear to have made a difference in the early 1990s in Zambia. Findings from more recent years indicate that further change has stagnated. Renewed efforts are needed, particularly targeting condom use with nonregular partners.     

Professional and paraprofessional group treatments for depression: a comparison of cognitive-behavioral and mutual support interventions.

The relative efficacy of professional and paraprofessional therapists in providing group cognitive-behavioral therapy (CBT) and mutual support group therapy (MSG) was examined. Depressed outpatients (N = 98) were randomly assigned to CBT or MSG led by either 2 professional or 2 paraprofessional therapists. Results suggest that nonprofessionals were as effective as professionals in reducing depressive symptoms and that clients in the CBT and MSG conditions improved equally. Clinically significant improvement was demonstrated for both conditions. However, following treatment, more patients in the professionally led CBT groups were classified as nondepressed and alleviated than in the paraprofessionally led CBT groups. Additionally, therapist adherence to manual-based treatments was associated with greater improvement in clinician-rated depressive symptoms in both conditions and skills in cognitive restructuring were associated with greater improvement among clients in CBT.