Older Adults' Perspectives on HIV/AIDS Prevention Strategies for Rural Kenya

HIV/AIDS is devastating sub-Saharan Africa with great impact in the rural communities. Though prevention is the mainstay of various responses to the epidemic, communication strategies used to influence risk perception and motivate behavior change are culturally inappropriate, hence the lack of success. The bulk of prevention efforts target the 15–49 age group, resulting in limited knowledge and understanding of HIV/AIDS in adults over age 50 who are considered at a lower or no risk of infection. This paper addresses older adults as a key segment of the population in HIV/AIDS prevention given the increasing number that is living with the disease or newly infected. Many older adults are also caregivers of those infected and affected by the disease. As cultural, social, political, and opinion leaders in rural Kenya, older adults are in a position to influence attitudes and behaviors of their community members, but they have not been involved in the current intervention strategies. Through application of a participatory and culture-centered approach, the study sought views of older adults on the factors contributing to the epidemic in rural Kenya and their opinions on effective prevention strategies that are culturally appropriate. Several recommendations are made for a culture-specific HIV/AIDS prevention intervention for rural Kenya.     

Older adults' perspectives on HIV/AIDS prevention strategies for rural Kenya

HIV/AIDS is devastating sub-Saharan Africa with great impact in the rural communities. Though prevention is the mainstay of various responses to the epidemic, communication strategies used to influence risk perception and motivate behavior change are culturally inappropriate, hence the lack of success. The bulk of prevention efforts target the 15-49 age group, resulting in limited knowledge and understanding of HIV/AIDS in adults over age 50 who are considered at a lower or no risk of infection. This paper addresses older adults as a key segment of the population in HIV/AIDS prevention given the increasing number that is living with the disease or newly infected. Many older adults are also caregivers of those infected and affected by the disease. As cultural, social, political, and opinion leaders in rural Kenya, older adults are in a position to influence attitudes and behaviors of their community members, but they have not been involved in the current intervention strategies. Through application of a participatory and culture-centered approach, the study sought views of older adults on the factors contributing to the epidemic in rural Kenya and their opinions on effective prevention strategies that are culturally appropriate. Several recommendations are made for a culture-specific HIV/AIDS prevention intervention for rural Kenya.     

A descriptive analysis of older adults with HIV/AIDS in California.

Between 10 percent and 15 percent of all AIDS cases throughout the United States have been reported in people ages 50 and over. However, older adults often have been overlooked in research on HIV/AIDS. The study discussed in this article examined 571 individuals ages 30 to 81 who had been diagnosed with symptomatic HIV or AIDS. A cross-sectional analysisfound that those in older age groups were more likely to befemale, to live alone, to have private health insurance, and to have died during the study. The results of the study suggest that social workers need to be aware of and sensitive to the role of sociodemographic factors in the lives of older HIV-infected individuals.     

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey

Background  

The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums.     

绍兴、嘉兴两市农村居民艾滋病认知情况调查

目的:通过对绍兴、嘉兴两市农村居民艾滋病认知情况的调查,探讨对农民进行艾滋病宣传教育的有效途径和方法,为相关部门有针对性地开展防制艾滋病的健康教育工作提供理论依据。方法:采用分层整群抽样的方法,对2市15岁及以上农村人口共5 296人进行了问卷调查,调查数据用SPSS 11.5软件进行数据统计分析。结果:绍兴、嘉兴两市农村居民艾滋病知晓率为69.6%,不同年龄、婚姻、受教育程度、职业的农村居民间差异有统计学意义。结论:浙江省部分地区农村居民对艾滋病认知水平偏低,因此,对农村居民应有针对性地深入开展艾滋病宣传教育工作,提高其认知水平,以更有利于开展艾滋病防制工作。     

Growing Older With HIV/AIDS: New Public Health Challenges

At present, the health care infrastructure is ill-equipped to handle the unique treatment and care needs of HIV-positive older adults.The long-term effects of antiretroviral use are still being discovered and have been associated with a number of comorbidities. Stigma presents challenges for those in need of services and health care, and can significantly affect mental health and treatment adherence.The training of elder service providers and health care providers in meeting the needs of HIV-positive older adults, including gay and transgender people, is needed as the population ages. HIV-related and antigay stigma should be challenged by social marketing campaigns. Continued research and key policy changes could greatly improve health outcomes for HIV-positive elderly persons by increasing access to treatment and support.THE ADVENT OF ANTIRETROVIral medications (ARVs) has enabled HIV-positive people to live increasingly longer lives. Those in the developed world who begin highly active antiretroviral treatment (HAART) at an initial CD4 count above 200 can expect to live well into their 70s.1Worldwide the leading cause of death among people living with HIV/AIDS is tuberculosis.2 In the United States tuberculosis is very rare. Less than one third of deaths among people with HIV/AIDS in the United States are now attributed to diseases traditionally associated with HIV infection, such as Kaposi’s sarcoma.3 Liver disease and cardiovascular disease, both associated with long-term use of ARVs, are leading causes of mortality among older people living with HIV.Longer life expectancy is already evident; by 2015 more than half of the HIV-positive population in the United States will be aged 50 years and older.4 Most older adults living with HIV/AIDS were infected in youth or middle age; only 1 in 9 new HIV infections in the United States occurs among people aged 50 years and older.5Aging with HIV/AIDS presents biomedical complexities only now beginning to reveal themselves. Higher rates of comorbidities are among the more severe biomedical issues facing older adults with HIV/AIDS.6 Widespread cognitive impairment among people on treatment of a long time could be caused by “chronic HIV-driven inflammation in an aging brain.”7^(p1) Answers to critical research questions regarding how HIV medications interact with medications to treat other conditions are still in the nascent stages. In this article, we examine what we know about growing older with HIV/AIDS, identify gaps in knowledge, and provide recommendations to enable public health professionals to better treat and care for the burgeoning population of HIV-positive older adults, and reduce infections among older adults.     

Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

Stigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14–22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.     

An Extended Model of Reasoned Action to Understand the Influence of Individual- and Network-Level Factors on African Americans’ Participation in HIV Vaccine Research

In the United States, the number and proportion of HIV/AIDS cases among black/African Americans continue to highlight the need for new biomedical prevention interventions, including an HIV vaccine, microbicide, or new antiretroviral (ARV) prevention strategies such as pre-exposure prophylaxis (PrEP) to complement existing condom usage, harm reduction methods, and behavioral change strategies to stem the HIV epidemic. Although black/African Americans are disproportionately impacted by HIV/AIDS, their participation in HIV clinical research continues to have unique challenges. We theorize that interaction among multilevel factors creates ideal alignment for minority participation in HIV clinical studies. Thus, we initially set out to test an extended model of reasoned action with 362 participants to understand the interplay of sociopsychological and network-level considerations influencing minority participation in HIV prevention research efforts. In this study, we linked the intrapersonal dimensions of attitudes, beliefs, and normative concerns to community-level components, appraisal of involvement with the clinical research organization, an entity which operates within a networked structure of community partner agencies, and identification with coalition advocacy aims. Various participatory outcomes were explored including involvement in future HIV vaccine community functions, participation in community promotion of HIV vaccine research, and community mobilization. Three-stage least squares estimates indicated similar findings across three models. Significant effects demonstrate the importance of positive attitudes toward HIV vaccine research, favorable health research beliefs, perceived social support for participation, HIV/AIDS issue engagement, and perceived relevance of the clinical research site’s mission and values. Identification of these nuanced pathway effects provides implications for tailored community program development.     

深圳市中学生预防艾滋病干预措施评价

目的 探索在中学开展预防艾滋病（AIDS）有效干预模式及其效果评价。方法 对深圳市10所中学初一、高一学生进行预防艾滋病健康教育干预前后相关知识、态度及行为的变化进行比较。结果 （1）知识方面：干预后,学生预防AIDS基本知识平均得分初一男生由7.47提高到10.21（满分为15）;初一妇生从7.17提高互10.21;高一男生从10.30提高到11.09;高一妇生从9.58提高到10.55。（2）态度方面:对待HIV/AIDS患采取正向态度明显提高,男生由22.6％上升到34.9%;女生由24.4%上升到41.5%。（3）行为方面：同学可以运用更多的信息来源获取有关知识。结论 学校预防AIDS教育干预措施以帮助学生增强抵御HIV／AIDS的能力,树立正向的态度,但要由知识转变行为还需要一定的时间、综合的干预和社会的多方支持。     

HIV/AIDS case profile of African Americans: guidelines for ethnic-specific health promotion, education, and risk reduction activities for African Americans

There are discrepancies in health care services for the poor and ethnic minorities in the United States. Within the past decade widespread concerns regarding the need to reform the nation's health care services, including the problem of human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) among African Americans has continued. These inequalities have been the cornerstone of the U.S. Healthy People 2010 national priority objectives. The objectives focus on health and social outcomes such as low quality of life and mortality rates, poverty, lack of accessibility to and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. The dearth of preventive health services for the high-risk groups, particularly children, adolescents, young adults, and older African American adults undermines early intervention efforts, including prompt HIV/AIDS identification and diagnosis, prevention education, health promotion, effective substance abuse treatment, and counseling services. This work reviews the magnitude of HIV/AIDS among African Americans between 1996 and 1999 by race/ethnicity, gender, and age groups. It also addresses the major factors responsible for the continued upward trend in the distribution and rate of infectiousness of HIV/AIDS among African Americans. The study recommends and discusses culturally sensitive and ethnic-specific intervention strategies for the prevention and control of HIV/AIDS among African Americans.     

HIV / AIDS in South-East Asia: an update

As of July 1, 1996, 1,393,649 cumulative AIDS cases in adults and children had been reported to the World Health Organization (WHO) from 193 countries since the beginning of the pandemic. HIV infection is a serious public health and developmental problem in southeast Asia, with the WHO estimating more than 3.7 million people to be infected with HIV in the region. This infection extends into the general population and is not confined among people who practice high risk behaviors. As of July 1, 1996, Thailand, India, and Myanmar had reported the largest number of AIDS cases: 41,230, 2940, and 1093, respectively. However, WHO estimates that 2.5 million people are actually infected in India, 800,000 in Thailand, 350,000 in Myanmar, and 95,000 in Indonesia. While Bhutan and North Korea have not yet reported AIDS cases, people in Bhutan have been diagnosed with HIV infection. The health and socioeconomic impact of HIV/AIDS, national plans and programs, the 100% condom use program in Thailand, peer education among sex workers in Calcutta, WHO support for country responses, advocacy and support, promoting appropriate HIV prevention strategies and interventions, HIV/AIDS care as part of primary health care, HIV/AIDS and STD surveillance, and the future role of WHO are discussed.     

农村妇女艾滋病防治知识及态度调查

目的:探讨农村妇女的艾滋病知识知晓率及相关态度,为后续工作提供参考依据。方法:2008年3月采用自制的结构式调查问卷,对503名农村妇女进行了一对一、面对面询问式调查。内容涉及调查对象的基本情况、艾滋病的传播途径和非传播途径、对艾滋病病毒感染者/病人的看法和态度等内容。结果:电视、宣传材料和广播是获得知识的主要途径,97.02%的人听说过艾滋病,87.08%的人知道艾滋病可以预防,74.95%的人知道外表健康的人也可能是感染者,63.42%的调查对象知道目前已有治疗方法可以延长患者生命,59.84%的调查对象知道艾滋病尚不能完全治好。除了PMTCT的知晓率较低(48.91%)之外,其他5项有关艾滋病传播及预防知识条目知晓率均超过了70%。知晓握手和吃饭不会传播的比例都较高,但是有关共用马桶和蚊虫叮咬不传播的知晓率较低。超过70%的调查对象表示不会歧视感染者并且愿意帮助感染者,但是只有58.25%的调查对象表示会同他们继续交往。与低年龄组相比,50岁以上年龄组在14项知识条目中有10项知晓率都较高。结论:迁西县农村妇女对艾滋病处于全面听说、了解不够深入的状态。对艾滋病传播途径和预防知识了解较多但非传播途径知晓率较低,歧视现象较严重,应强化艾滋病知识的健康教育。     

HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation.

There are now a number of HIV/AIDS prevention programmes for migrant and ethnic minority communities throughout the world, both 'top down' programmes organised, for example, by governments and large NGOs, and 'bottom up' programmes, organised by migrant groups themselves. Evaluation of such programmes, however, is in most cases sorely lacking. The Swiss 'Migrants Project' is, to the authors' knowledge, the only such programme to have been systematically accompanied by evaluation throughout. This paper describes three phases of evaluation of the Migrants Project (exploratory studies, process, and outcome evaluations). The evaluations have highlighted the need for culturally and linguistically appropriate prevention efforts which use already-existing community structures, as well as the need to identify and train people from within communities to carry out local prevention efforts. Outcome evaluation has shown that: a government sponsored HIV/AIDS prevention programme can meet with acceptance by migrant communities; considerable engagement in prevention activities can be mobilised; and AIDS prevention among such communities can be effective. Such efforts can create levels of sensitivity to HIV issues and of protective behaviour that are equal to those of the host country population. The strategy adopted by the programme is thus supported. Key elements are to avoid potential for stigmatising by: (1) placing HIV/AIDS prevention efforts for migrant populations within an overall national HIV/AIDS prevention strategy; (2) informing and sensitising general populations within migrant communities before initiating more targeted prevention with migrant IDUs, MSM, and CSWs; (3) encouraging, facilitating and guiding health promotion efforts which emerge from within migrant communities themselves.     

Innate Health Threat Among a Visibly Hidden Immigrant Group: A Formative Field Data Analysis for HIV/AIDS Prevention Among Zimbabwean Workers in Botswana

As a result of the collapse of the national economy and political instability, Zimbabwe has experienced a diaspora in recent years. Although Zimbabweans are now the largest immigrant group in most sub-Saharan countries, Zimbabwean immigrants are a mostly illegal and socioeconomically marginalized population. This study explores the lives of Zimbabwean workers in Botswana from a health communication perspective and provides suggestions for accelerating the diffusion of HIV/AIDS prevention information and practices among the target population. In particular, this ethnographic report portrays how the Zimbabwean workers in Botswana make sense of their surroundings and perceive information on HIV/AIDS prevention and other public health risks. Field data analysis highlights several communication features among the immigrants, including reliance on interpersonal communication, high rate of mobile phone adoption, inaccurate public awareness on HIV/AIDS and prevention messages, and stagnated communication with health care services. By connecting Dervin's sensemaking theory to Roger's diffusion of innovations theory, the suggestions from this study can be applied to design HIV/AIDS prevention interventions for the immigrants and socioeconomically marginalized groups.     

市场营销在社区吸毒人群艾滋病行为干预中的应用

目的：目前国内艾滋病高危人群的行为干预均在探索阶段。该研究旨在探索社区吸毒人群预防艾滋病的行为干预模式。方法：干预方法主要是以同伴为基础的社区健康教育、建立医学咨询服务点、避孕套及注射器市场营销。结果：1998－1999年四川省性病艾滋病防治协会在冰山州西昌市3个术开展了社区吸毒人群艾滋病干预项目。社区人群及吸毒人员干预后艾滋病知识均有明显提高（P＜0．01）。吸毒人员均放弃了共用注射器行为,但避孕套的推广使用不理想。结论：以同伴为基础的社区健康教育和避孕套及注射器营销在预防控制艾滋病方面是有效的手段,但避孕套的推广工作有待进一步改进。     

HIV and AIDS surveillance among inmates in Maryland prisons

The prevalence of those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is higher among inmates of correctional facilities than among the general population. This raises the need to identify inmates living with or at risk of HIV/AIDS and to provide counseling and appropriate survices for HIV treatment and prevention. The Maryland Division of Corrections (DOC) offers voluntary testing to all inmates on entry and tests inmates when clinically indicated. We reviewed all 1998 HIV antibody tests and confirmed AIDS cases in the Maryland DOC. Inmate demographics, testing acceptance, rates of seropositivity, and AIDS cases and comparisons based on gender, racelethnicity, and age were examined. Comparisons were also made to HIV testing and AIDS cases from the nonincarcerated Maryland population. Trends in DOC AIDS diagnoses and AIDS-related deaths over time were also examined. Of the inmates, 39% were voluntarily tested for HIV on entry to the Maryland DOC in 1998 (38% of males and 49% of females). Overall, HIV seropositivity was 33% (5% for females and 3% for males). The 888 cumulative AIDS cases diagnosed in the DOC inmate population were concentrated among males (90% vs. 77% statewide), African Americans (91% vs. 75% statevide), and among IDUs (84% vs. 39% statewide). Due to high rates of HIV and AIDS, inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts, especially women. Prison-based programs can identify significant numbers of HIV and AIDS cases and bring HIV prevention interventions to a population characterized by frequent high-risk behavior.     

Effectiveness of an HIV prevention intervention in prison among African Americans, Hispanics, and Caucasians.

Prisons and prison inmates present important targets for HIV/AIDS prevention interventions. Inmates often have histories of high-risk behavior that place them in danger of contracting HIV/AIDS, and rates of HIV/AIDS tend to be much higher in this population. The goal of this study was to assess the effectiveness of a prison-based HIV/AIDS intervention to change attitudes toward HIV prevention, norms supporting HIV prevention, perceived behavioral control (i.e., self-efficacy) for HIV prevention behaviors, and intentions to engage in HIV prevention behaviors postrelease. The intervention also had the goal of encouraging inmates to become HIV/AIDS peer educators. The intervention appeared most successful at influencing beliefs and behaviors related to peer education and somewhat successful at influencing beliefs and intentions related to condom use. Analyses also showed some significant differences in effectiveness by race/ethnicity. Results are discussed from the perspectives of both research and practice with regard to prison-based HIV prevention efforts.     

医护人员对HIV感染者接受态度调查

目的 了解某艾滋病高流行地区从事临床工作的医护人员对人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者(简称PHA)的接受态度及影响因素.方法 抽取该市2所市级综合性医院4所乡镇中心卫生院753名医护人员进行自填式问卷调查.结果 绝大多数医护人员对HIV感染者/AIDS患者的接受程度处于中等水平.年龄、知识得分、医院级别、医护人员与HIV/AIDS的接触频率与医护人员的接受程度之间有关联.结论 在对临床医护人员进行有关减少艾滋病偏见与歧视的培训或倡导工作中,应加强医护人员有关艾滋病临床知识、职业暴露和自我防护等方面的专业培训;加强对综合性医院以及青年医生的教育;加强对HIV/AIDS高频率接触的医护人员的心理咨询.     

Communicating surveillance, epidemiologic, and laboratory information on HIV infection and AIDS.

As the epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has evolved over the past 10 years, the Centers for Disease Control (CDC) has been at the forefront of the scientific efforts that have characterized HIV-AIDS research. Because of CDC's central role in these efforts, the medical and public health communities have come to depend on the agency for prompt reporting of new developments related to the epidemiology of HIV infection and AIDS and for advice on risk management, prevention, and control. CDC disseminates this information through epidemiologic updates and prevention guidelines published in the periodical, Morbidity and Mortality Weekly Report, through articles in scientific journals and summary tabulations of AIDS case data and HIV seroprevalence data, and through interviews and presentations at scientific meetings. These formal information dissemination activities are supplemented with training and support efforts directed at health care providers, health department and laboratory personnel, educators, and centralized HIV-AIDS information resources. As questions are answered, controversies resolved, and new research applications explored, CDC will continue to provide the medical and public health communities with the most recent epidemiologic information and recommendations developed to help direct efforts in HIV prevention and risk reduction.