Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives

Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39 % of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.     

Fertility intentions among HIV-infected,sero-concordant couples in Nyanza province,Kenya

Research in sub-Saharan Africa has shown significant diversity in how HIV influences infected couples' fertility intentions. Supporting HIV-infected, sero-concordant couples in sub-Saharan Africa to make informed choices about their fertility options has not received sufficient attention. In-depth interviews were conducted among 23 HIV-positive, sero-concordant married couples in Kenya, to better understand how HIV impacted fertility intentions. HIV compelled many to reconsider fertility plans, sometimes promoting childbearing intentions in some individuals but reducing fertility plans among most, largely due to fears of early death, health concerns, stigma, perinatal HIV transmission and financial difficulties (particularly in men). Preferences for sons and large families influenced some couples' intentions to continue childbearing, although none had discussed their intentions with healthcare providers. Additional support and services for HIV-infected, sero-concordant couples are needed. Family planning counselling should be tailored to the unique concerns of HIV-infected couples, addressing perinatal transmission but also individual, couple-level and socio-cultural fertility expectations. Community-level programmes are needed to reduce stigma and make HIV-infected couples more comfortable in discussing fertility intentions with healthcare providers.     

Internalized HIV/AIDS-related stigma in a sample of HIV-positive people in Bangladesh

Internalized stigma among people living with HIV/AIDS (PLHA) is prevalent in Bangladesh. A better understanding of the effects of stigma on PLHA is required to reduce this and to minimize its harmful effects. This study employed a quantitative approach by conducting a survey with an aim to know the prevalence of internalized stigma and to identify the factors associated with internalized stigma among a sample of 238 PLHA (male=152 and female=86) in Bangladesh. The findings suggest that there is a significant difference between groups with the low- and the high-internalized HIV/AIDS stigma in terms of both age and gender. The prevalence of internalized stigma varied according to the poverty status of PLHA. An exploratory factor analysis (EFA) found 10 of 15 items loaded highly on the three factors labelled self-acceptance, self-exclusion, and social withdrawal. About 68% of the PLHA felt ashamed, and 54% felt guilty because of their HIV status. More than half (87.5% male and 19.8% female) of the PLHA blamed themselves for their HIV status while many of them (38.2% male and 8.1% female) felt that they should be punished. The male PLHA more frequently chose to withdraw themselves from family and social gatherings compared to the female PLHA. They also experienced a higher level of internalized stigma compared to the female PLHA. The results suggest that the prevalence of internalized stigma is high in Bangladesh, and much needs to be done by different organizations working for and with the PLHA to reduce internalized stigma among this vulnerable group.     

AIDS stigma in health services in the Eastern Caribbean

Stigma obstructs HIV/AIDS prevention and care worldwide, including in the Caribbean, where the prevalence of AIDS is second only to sub-Saharan Africa. To contextualise the experience of AIDS stigma in health services in Grenada and Trinidad and Tobago, we conducted eight focus groups with 51 people living with HIV/AIDS (PLHA), families, and service providers. Quasi-deductive content analysis revealed consonance with Western and Northern conceptualisations of AIDS stigma wherein stigma is enacted upon marginalised populations and reinforced through psycho-sociological processes comparing 'in' and 'out' groups. Socially constructed to be physically contagious and socially deviant, PLHA are scorned by some service providers, especially when they are perceived to be gay or bisexual. PLHA and providers identified passive neglect and active refusal by hospital and clinic staff to provide care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as marginally enforced. Interventions are needed to reduce provider stigma so the public will access HIV testing and PLHA will seek treatment.     

A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS

HIV/AIDS-related stigma and discrimination have a substantial impact on people living with HIV/AIDS (PLHA). The objectives of this study were: (1) to determine the associations of two constructs of HIV/AIDS-related stigma and discrimination (negative attitudes towards PLHA and perceived acts of discrimination towards PLHA) with previous history of HIV testing, knowledge of antiretroviral therapies (ARVs) and communication regarding HIV/AIDS and (2) to compare these two constructs across the five research sites with respect to differing levels of HIV prevalence and ARV coverage, using data presented from the baseline survey of U.S. National Institute of Mental Health (NIMH) Project Accept, a four-country HIV prevention trial in Sub-Saharan Africa (Tanzania, Zimbabwe and South Africa) and northern Thailand. A household probability sample of 14,203 participants completed a survey including a scale measuring HIV/AIDS-related stigma and discrimination. Logistic regression models determined the associations between negative attitudes and perceived discrimination with individual history of HIV testing, knowledge of ARVs and communication regarding HIV/AIDS. Spearman's correlation coefficients determined the relationships between negative attitudes and perceived discrimination and HIV prevalence and ARV coverage at the site-level. Negative attitudes were related to never having tested for HIV, lacking knowledge of ARVs, and never having discussed HIV/AIDS. More negative attitudes were found in sites with the lowest HIV prevalence (i.e., Tanzania and Thailand) and more perceived discrimination against PLHA was found in sites with the lowest ARV coverage (i.e., Tanzania and Zimbabwe). Programs that promote widespread HIV testing and discussion of HIV/AIDS, as well as education regarding and universal access to ARVs, may reduce HIV/AIDS-related stigma and discrimination.     

Stigmatization among drug-using sex workers accessing support services in Dublin

Findings from 35 qualitative interviews with drug users who were engaging in or who had engaged in sex work in Dublin, Ireland, illuminated how, because of a result of felt stigma and internalized shame, they tried to hide their drug use, thus endangering their own lives. This group carried multiple layers of stigma because of sex work, drug use (including injecting drug use), and having contracted human immunodeficiency virus (HIV) or hepatitis C virus (HCV). This stigma was powerfully reinforced by the language routinely used by health professionals. To improve the effectiveness of harm-reduction interventions, it is recommended that service providers change their language, in particular in recognition of the human dignity of these clients, but also to help attract and retain drug users in services, and to help reduce the unacceptable mortality levels among drug users.     

An evaluation of a mass media campaign to encourage parents of adolescents to talk to their children about sex

PurposeWe evaluated a mass media campaign in North Carolina that used television (TV) public service announcements (PSAs), radio PSAs, and billboards to encourage parents of adolescents to talk to their children about sex. The primary message of the campaign was “Talk to your kids about sex. Everyone else is.”MethodsThirty-two of the 100 counties in North Carolina were chosen to evaluate the mass media campaign. Paid TV PSAs were aired in 22 of these counties, radio PSAs were aired in 21 counties, and billboards were displayed in 6 counties over a period of 9 months. The counties in our sample varied from no exposure to exposure to all 3 types of media. To assess the impact of the campaign, a sample of 1,132 parents of adolescents living in the 32 counties was administered a postexposure survey via a telephone interview. Questions about exposure to the media campaign were embedded among questions concerning media exposure to other health-related messages. The parent survey assessed the frequency the parents reported exposure to each type of media message, correct knowledge of the message, and multiple item scales that assessed how often they had talked to their child about various issues related to sex during the previous 6 months, intentions to talk to their child about these issues during the next month, and attitudes about discussing sexual issues with their child.ResultsIn bivariate analyses the levels of parental exposure to the 3 types of media messages were associated with both having talked to their children and intentions to talk to their children about sex (p < .0001). When analyzed with multiple regression, female gender, minority ethnicity, frequency of seeing a billboard on teenage pregnancy, frequency of seeing a TV PSA about sex, and frequency of hearing a radio PSA about sex and teenage pregnancy accounted for 12.8% (p < .0001) of the variance in having talked to their child about sex. Female gender, minority ethnicity, and previously talking to their child about sex accounted for 9.9% of the variation in positive communication attitudes about sex. Positive communication attitudes, female parent, minority ethnicity, frequency of seeing a billboard about sex, frequency of seeing a TV PSA about sex, and frequency of hearing radio PSAs about sex accounted for 12.3% of the variation in parental intentions to talk to their child about sex during the next month.ConclusionsExposure to each component of this mass media campaign was associated with parents recently having talked to their adolescent children about sex and intentions to talk to their children during the next month.     

Societal and individual drivers of fertility desires and intentions among people living with HIV: a cross sectional study of HIV clinic attendees in Soweto,South Africa

BackgroundHigh proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors.MethodsThis was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data.ResultsThe participants'' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81).ConclusionIndividual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.     

Communicating in Complex Situations: A Normative Approach to HIV-Related Talk Among Parents Who Are HIV+

Parents with HIV/AIDS are confronted with unique challenges when discussing HIV-related information with their children. Strategies for navigating these challenges effectively have not been systematically examined. In this study, we conducted in-depth interviews with 76 parents with HIV/AIDS who had children ages 10–18 years. Guided by O'Keefe and Delia's definition of a complex communication situation and Goldsmith's normative approach to interpersonal communication, we examined parents’ goals for discussing HIV-related information, factors that made conversations challenging, and instances where these conversational purposes conflicted with one another. Our data reveal the following parent–adolescent communication predicaments: relaying safety information about HIV while minimizing child anxiety, modeling open family communication without damaging one's parental identity, and balancing parent–child relational needs amid living with an unpredictable health condition. Parents also described a variety of strategies for mitigating challenges when discussing HIV-related topics. Strategies parents perceived as effective included reframing HIV as a chronic, manageable illness; keeping talk educational; and embedding HIV-related topics within more general conversations. The theoretical and practical applications of these findings are discussed with regard to their relevance to health communication scholars and HIV care professionals.     

"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities

CONTEXT: Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased. A better understanding of the interaction between HIV and family planning is needed, especially as antiretroviral medications allow HIV-positive women to live longer, healthier lives. METHODS: Qualitative methods were used to examine pregnancy decision-making among 56 HIV-positive women in four U.S. cities. Biomedical, individual and sociocultural themes were analyzed in groups of women, categorized by their pregnancy experiences and intentions. RESULTS: Regardless of women's pregnancy experiences or intentions, reproductive decision-making themes included the perceived risk of vertical transmission, which was often overestimated; beliefs about vertical transmission risk reduction strategies; desire for motherhood; stigma; religious values; attitudes of partners and health care providers; and the impact of the mother's health and longevity on the child. Most women who did not want children after their diagnosis cited vertical transmission risk as the reason, and most of these women already had children. Those who became pregnant or desired children after their diagnosis seemed more confident in the efficacy of risk reduction strategies and often did not already have children. CONCLUSIONS: Future studies may help clarify the relationship between factors that influence pregnancy decision-making among HIV-positive women. HIV-positive and at-risk women of childbearing age may benefit from counseling interventions sensitive to factors that influence infected women's pregnancy decisions.     

Attitudes towards and perceptions of reproductive health needs of persons living with HIV/AIDS in rural Kilimanjaro,Tanzania

The introduction of antiretroviral treatment has resulted in the resumption of socially productive and sexually active lives of people living with HIV/AIDS, together with the desire for children. However, factors affecting the reproductive health needs of people living with HIV/AIDS are not well understood. With this in mind, the aim of this paper was to investigate factors associated with these health needs using a qualitative approach. Findings indicate that attitudes and perceptions about reproductive health needs are influenced by fertility beliefs, the central role of family, procreation and the perceived social and clinical consequences of pregnancies among people living with HIV/AIDS. While there was mixed opinion about acceptability of people living with HIV/AIDS, having children, marriage and family were institutions important for partnerships maintenance and procreation. These findings suggest that living with HIV in a community with strong pro-life attitudes is challenging for people living with HIV/AIDS who do not have children. Apart from having to grapple with potential stigma of not having children, people living with HIV/AIDS also face social challenges in realising their reproductive choices. Interventions to address stigma, societal changes and the integration of reproductive-health education into HIV care and treatment are needed.     

某地既往有偿供血人群艾滋病歧视状况研究

目的 了解因既往有偿供血造成艾滋病流行地区艾滋病歧视现象及其产生原因和影响因素.方法 在安徽省某地利用目的抽样法从人类免疫缺陷病毒(HIV)感染者、家庭成员、村民及卫生工作者中各选择20名共80名作为调查对象.采用一对一深入访谈的方法,了解艾滋病歧视现象,分析产生原因与影响因素.结果 80名调查对象中,1名未完成调查,在完成调查的79名中,歧视的主要表现形式是扩大的歧视[81.0%(64/79)],嫌弃、回避及抛弁,看病时受到歧视[47.4%(28/59)],失去社会支持[33.3%(13/39)]等.艾滋病流行严重的村庄歧视相对较轻,艾滋病流行较轻的村庄歧视较严重.对艾滋病存在错误认识[57.5%(23/40)]、恐惧[32.5%(13/40)]及道德判断是歧视产生的主要原因.为了避免家人和孩子的正常生活受到影响,多数HIV感染者不愿暴露身份.结论 由于对艾滋病的错误认识等,导致歧视现象严重,亟须开展减少歧视相关工作.     

Stigma by association: the effects of caring for HIV/AIDS patients in South Africa

The shortage of healthcare workers caring for South Africa's 5-6 million persons living with HIV/AIDS (PLHA) calls for inquiry into workers' challenges and experiences. This exploratory study examines one little-studied challenge: stigmatisation of HIV/AIDS healthcare workers based on their association with PLHA. The authors tested the hypotheses that HIV/AIDS healthcare workers experience stigmatisation due to their association with PLHA, and that such association stigma is correlated with thoughts of leaving the HIV/AIDS field. A sample of 100 participants who provided direct care to PLHA was recruited from a variety of public and private HIV/AIDS care centres in Eastern Cape province, South Africa. Participants attended one of 12 focus groups held between June and August, 2008. They completed a 17-item questionnaire and discussed each item. Findings exhibit the presence of an adverse differentiation and labelling of HIV/AIDS healthcare workers, leading to status loss and discrimination, creating an impetus for HIV/AIDS healthcare workers to leave AIDS work altogether. A significant relationship (χ(2) (TREND) = 3.86, df = 1, P = 0.049) was found between contemplation of leaving AIDS work and perception of others' responses to their work with PLHA. In addition, associations emerged between type of AIDS worker and contemplation of working in AIDS care outside of South Africa (Kruskal-Wallis χ(2) = 6.96, df = 2, P = 0.031), with doctors and nurses reporting higher frequency of contemplating leaving South Africa to work with PLHA elsewhere (Mann-Whitney z = -2.53, P = 0.011). The study lays the foundation for additional research on the effects of association stigma. In turn, increased efforts to retain and recruit new HIV/AIDS healthcare workers will expand the pool of healthcare personnel to PLHA.     

Engaging HIV Care Providers in Conversations With Their Reproductive-Age Patients About Fertility Desires and Intentions: A Historical Review of the HIV Epidemic in the United States

Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients’ reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic’s impact on reproductive health. We used a historical review of the US epidemic to describe the problem’s scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient–provider communication about reproductive intentions.We reviewed the literature on childbearing desires among people living with HIV to understand to what extent and why such desires have not been appropriately addressed in the public health response to HIV. We briefly explain why appropriate attention to fertility desires among people living with HIV should be a public health priority. We then present the results of a historical review of the HIV epidemic in the United States focused on reproductive desires for biological children. From the early epidemic up to the current context, we document a critical unmet need for reproductive planning, including research on this topic. We present evidence that (1) reproductive desires among people living with HIV have been largely ignored historically, (2) HIV-positive women and men desire to have biological children, and (3) despite recent attention to fertility intentions in research, patient–provider communication about safer childbearing remains limited according to the few published studies available.Drawing on this history, we discuss 3 key reasons for the lack of attention spanning across the 3 decades of the epidemic: (1) the initial focus on men who have sex with men (MSM) because of the early epidemiology of the epidemic, (2) subsequent focus on infants and sexual partners because of legitimate concerns about vertical and horizontal transmission before the development of antiretroviral therapy (ART) and HIV preconception strategies, and (3) a legacy of stigma that persists despite medical advances that make childbearing among people living with HIV much safer. We recommend a series of strategies for addressing this unmet need.Roughly three quarters of more than 1 million people living with HIV in the United States are of reproductive age.1,2 Similar to persons who are not infected with HIV, research suggests that people living with HIV have desires and intentions to have biological children that warrant adequate attention and available high-quality reproductive health care from HIV providers. In a seminal study published in 2001, Chen et al. reported that among 1421 HIV-positive women and men from a nationally representative sample of adults in the United States receiving medical care, 29% of women and 28% of men desired children in the future.3 More recently, a study of HIV-positive women in a Baltimore, Maryland, clinic (mean age = 32 years) documented that 59% desired to bear future children.4 Despite these desires, a few recent studies suggest that reproductive counseling has yet to become a standard component of routine HIV clinical care in the United States.5–7Why is this a concern? For one, providers must know whether their HIV-positive patients want to bear children to tailor treatment options and refer patients for HIV preconception counseling to meet their childbearing desires while preventing HIV transmission to partners (horizontal transmission) and children (vertical transmission). In addition, there is the need to ensure that services adequately respond to the sexual and reproductive rights of people living with HIV.8,9Although there has been recent recognition that the reproductive intentions of people living with HIV have been largely neglected with consequences for public health and human rights, there has not been a historical review to explore the past and current scope of this problem or discuss why this need remains unmet in the United States. To enhance provider communication with HIV-positive patients of reproductive age about their reproductive desires and intentions, these gaps must be addressed. Therefore, we explored 3 aims. First, we turned to the history of the epidemic in the United States to understand the scope of the need for reproductive planning for people living with HIV. Second, using this historical context, we explored the reasons underlying the current challenge. Third, we considered strategies for meeting this need.Our analysis focuses specifically on desires to have biological children among people living with HIV. However, nearly half of all pregnancies in the United States in 2006 were unintended,10 indicating that the need for routine reproductive planning certainly extends beyond people living with HIV. Several of the concluding recommendations can apply to the general population more broadly. The review and recommendations also focus on women and men who have sex with women as having biological children is a more relevant reproductive health concern for these populations than for MSM. Much of this article presents data on HIV-positive women because of the very limited research on childbearing desires among HIV-positive men and HIV-negative women in relationships with HIV-positive men. We recognize, however, the importance of this issue for these populations and highlight the need for future research. Finally, to ensure focus, we have limited the review to the desire for biological children and childbearing; thus, pregnancy prevention is not discussed. It is likely, however, that many of the conclusions and recommendations will apply to pregnancy prevention or spacing—the more commonly emphasized dimensions of family planning.We also focused on the US epidemic for several reasons. Increasingly, research on the fertility intentions of people living with HIV occurs in low-resource country contexts and rightfully so because of the magnitude of the epidemics in these settings.11,12 Much of the historical literature, however, discusses the epidemic in the United States, and even in this high-resource setting, HIV persists as a public health challenge. According to the Centers for Disease Control and Prevention (CDC), there were an estimated 47 500 new HIV infections in 2010. Of these, 63% stemmed from male-to-male sex and 25% occurred via heterosexual transmission.13 Women constituted an estimated 20% of the newly infected persons in 2010, 64% of whom were Black women13 who must not only contend with HIV-related stigma but also with marginalization in the form of sexism and racism.14 With this epidemiology and its implications, the lack of attention to the epidemic’s impact on women, men who have sex with women, and reproduction must be addressed.     

Prevalence and Factors Affecting Discrimination Towards People Living With HIV/AIDS in Indonesia

ObjectivesThis study aimed to identify the behaviors associated with discrimination towards people living with HIV/AIDS (PLHA) in Indonesia and to determine the factors affecting discrimination.MethodsSecondary data from the 2017 Indonesia Demographic and Health Survey were analyzed using a cross-sectional design. Discrimination was assessed based on the questions (1) “Should children infected with HIV/AIDS be allowed to attend school with non-infected children?” and (2) “Would you buy fresh vegetables from a farmer or shopkeeper known to be infected with HIV/AIDS?” Multivariable logistic regression was used to determine the factors affecting discrimination, with adjusted odds ratio (aOR) and 95% confidence interval (CIs) used to show the strength, direction, and significance of the associations among factors.ResultsIn total, 68.9% of 21 838 individuals showed discrimination towards PLHA. The odds of discrimination were lower among women (aOR, 0.63; 95% CI, 0.55 to 0.71), rural dwellers (aOR, 0.81; 95% CI, 0.75 to 0.89), those who understood how HIV is transmitted from mother to child (aOR, 0.81; 95% CI, 0.73 to 0.89), and those who felt ashamed of their own family’s HIV status (aOR, 0.56; 95% CI, 0.52 to 0.61). The odds were higher among individuals who knew how to reduce the risk of getting HIV/AIDS (aOR, 1.27; 95% CI, 1.15 to 1.39), how HIV/AIDS is transmitted (aOR, 3.49; 95% CI, 3.09 to 3.95), and were willing to care for an infected relative (aOR, 2.78; 95% CI, 2.47 to 3.13). A model consisting of those variables explained 69% of the variance in discrimination.ConclusionsGender, residence, knowledge, and attitudes related to HIV/AIDS were explanatory factors for discrimination against PLHA. Improvements in HIV/AIDS education programs are needed to prevent discrimination.     

Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo,Brazil

The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35–49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.     

HIV-related stigma: adapting a theoretical framework for use in India

Stigma complicates the treatment of HIV worldwide. We examined whether a multi-component framework, initially consisting of enacted, felt normative, and internalized forms of individual stigma experiences, could be used to understand HIV-related stigma in Southern India. In Study 1, qualitative interviews with a convenience sample of 16 people living with HIV revealed instances of all three types of stigma. Experiences of discrimination (enacted stigma) were reported relatively infrequently. Rather, perceptions of high levels of stigma (felt normative stigma) motivated people to avoid disclosing their HIV status. These perceptions often were shaped by stories of discrimination against other HIV-infected individuals, which we adapted as an additional component of our framework (vicarious stigma). Participants also varied in their acceptance of HIV stigma as legitimate (internalized stigma). In Study 2, newly developed measures of the stigma components were administered in a survey to 229 people living with HIV. Findings suggested that enacted and vicarious stigma influenced felt normative stigma; that enacted, felt normative, and internalized stigma were associated with higher levels of depression; and that the associations of depression with felt normative and internalized forms of stigma were mediated by the use of coping strategies designed to avoid disclosure of one's HIV serostatus.     

Disclosure of parental HIV/AIDS to children in rural China

Abstract

The purpose of this study is to examine the complex issue of disclosure of parental HIV/AIDS to children in rural China. Semi-structured interviews were conducted with children affected by HIV/AIDS aged 8–17 (n?=?16), their caregivers (n?=?16) and key informants in the community (n?=?5). Findings showed that most children were shielded from knowing the HIV/AIDS status of their parents, although many children may have drawn their own conclusions through observation or sources outside the family. Caregivers felt discouraged and hesitated to discuss parental HIV/AIDS with children due to societal stigma and lack of knowledge and skills. Interventions are needed to improve caregivers' skills to communicate about HIV/AIDS with children. Interventions are also needed to reduce the stigma and discrimination towards people living with HIV/AIDS and their families.     

Fertility desires and family planning demand among HIV-positive clients in follow-up care at antiretroviral treatment unit in Gondar university hospital,Ethiopia

Despite the growing importance of fertility issues for HIV-infected persons, little is known about their actual fertility desires and intentions. This study was, therefore, aimed at assessing fertility desires and demand for family planning in HIV-positive clients in follow-up care at antiretroviral treatment (ART) unit in Gondar University Hospital, Ethiopia. A cross sectional quantitative study on 389 study subjects (56% females and 44% males living with HIV/AIDS in follow-up care) supplemented by in-depth interview was conducted between November 2007 and January 2008. Eighty-five (49.71%) of the male and seventy-nine (36.3%) of the female participants expressed the desire for children, giving a total of 164 (42.16%) of all participants. Study subjects who had no children and whose partners wants children were more likely to have children desire. During the survey period, 100 (25.7%) of the clients were using different forms of family planning devices and 124 (42.9%) wants to use family planning in the future. The extent of fertility desire and family planning needs of these people has implication for vertical and heterosexual transmission of HIV, the needs for fertility-related counselling, and/or contraception, and advice regarding childbirth.