Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC).

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.     

South African teachers' reflections on the impact of culture on their teaching of sexuality and HIV/AIDS

This paper aims to explore South African Life Orientation teachers' perception and practice of teaching HIV/AIDS and sexuality in a cultural perspective. We aim to investigate how teachers respond to perceived cultural differences between the local community and the content of their teaching. Data were collected through interviews with teachers who taught students in grades 8 or 9 in public high schools. The teachers expressed differing viewpoints regarding the rationale for teaching about HIV/AIDS and sexuality. Many teachers saw teaching these topics as a response to declining moral standards, while others suggested that they were teaching issues that parents failed to address. The teachers were more concerned about young people's sexual behaviour than about preventing HIV/AIDS. They perceived that cultural contradictions between what was taught and local cultural values were an issue to which they needed to respond, although they differed in terms of how to respond. Some took an adaptive approach to try to avoid conflicts, while others claimed the moral neutrality of their teaching. Teaching about sexuality was perceived to be challenging in terms of language and communication norms. Teaching about HIV/AIDS was perceived as challenging because teachers often needed to convince students about the reality of AIDS.     

Country watch: Zimbabwe

Tsungirirai is a counseling and information service developed during 1994 in response to the growing problem of HIV/AIDS in the small town of Norton, southwest of Harare, Zimbabwe. The objectives of the project include identification of key leaders in the area, determination of the setting in which HIV was spreading, and community consultation in program design and implementation. Tsungirirai's initial activities included a series of workshops on participatory techniques particularly the LADA (Listening-Appraisal-Dialogue-Action) method for key leaders, community men, women, and adolescents. Workshop participants demonstrated different views concerning HIV/AIDS problems. Key leaders viewed the HIV/AIDS problem within the context of existing laws that contradict traditional mores, while the youth linked the problem of HIV to the issue of unemployment and lack of recreation. Lessons learned include the following: 1) stop talking and listen; 2) start where people are at instead of telling them what they already know; 3) let the people decide; 4) turn a dream into reality; and 5) facilitate awareness process instead of leading it.     

Narratives of Ugandan Women Adhering to HIV/AIDS Medication

Adherence to highly active antiretroviral therapy (HAART) is essential to improving the quality of life of people living with HIV/AIDS; however, it still remains a challenge especially for young African women. The purpose of the study was to explore how young women with HIV/AIDS in Uganda experience the influence of their everyday life occupations on adherence to HAART after more than 1 year on the medication. Narratives of six participants were elicited using two semistructured interviews within a period of 1 month. Narrative analysis was used to develop themes reflecting the participants' stories of coping with everyday activities. The participants described their adherence to HAART in relation to everyday life occupations as a “tug of war”, which describes the struggles they had taking medication because they were afraid of being discriminated by peers and the general society. They also expressed fear of not being included in many activities if people knew they have HIV/AIDS because there are many beliefs associated with the illness especially for young women in which they are branded promiscuous. However, in the Ugandan culture, women are considered to be home makers, which restricted their activities mostly around domestic work making it hard for them to prioritize their medication, and when they young women prioritized, it was all about fun activities that seemed to consume much time, hence contributing to the poor adherence. It is therefore important to assess the everyday occupations of young women before they start taking medication, so that HAART is scheduled in accordance with their everyday life occupation to reduce poor adherence. The implications of the study on practice is that it will enable occupational therapists working with persons with HIV/AIDS develop age‐specific activities taking into consideration HAART as an everyday life activity rather than one that needs to be incorporated into their already existing activities, hence improving their adherence and reducing on stigma associated to the medication. Copyright © 2012 John Wiley & Sons, Ltd.     

Living positively: the experiences of Thai women living with HIV/AIDS in central Thailand

Living with an incurable illness such as HIV/AIDS is a stressful experience. However, many HIV-positive individuals are able to maintain their emotional well-being. This begs the question of what strategies these individuals employ to allow them to do so. In this article, we examine how Thai women living with HIV/AIDS learned about their health status, what feelings they had, and how they dealt with the illness. In-depth interviews were conducted with 26 women in central Thailand. The women adopted several strategies to deal with their HIV status, including taking care of themselves, accepting their own faith, disclosing their HIV status to family, and joining AIDS support groups. These strategies can be situated within the "living positively" discourse, which helped to create a sense of optimism to combat the HIV epidemic among the women. Additionally, the acceptance of their HIV status played an essential role in the meaning-making process because it assisted the women in sustaining the equilibrium of their emotional well-being.     

Childhood sexuality and rights in the context of HIV/AIDS

The primary objective in this study was to explore what HIV and AIDS mean to seven- and eight-year-old children in South Africa and how sexual and gender dynamics are embedded within these meanings. Against representations that associate young children with innocence, the paper argues for a more capacious view of young children as sexual and gendered agents with the ability to exercise their rights. In contrast to research that addresses children as relatively passive desexualised beings, focusing on their dependence on adults, their innocence and their need for protection, this paper examines how HIV and AIDS are constructed and negotiated by young people. It views children not simply in terms of their need for sexual rights but as potentially active participants in the negotiation of their rights. Viewing children's rights as highly contested, the notion that young children have sexual rights opens up possibilities for children (including those from marginalised groups) to talk about their concerns and pleasures, fears and hopes, as well as issues relating to sexual rights and resistances. By working creatively with teachers, it may be possible to broaden young children's knowledge of HIV and AIDS and sexuality within a more supportive environment.     

Country watch: Malawi

The Drought Network for information sharing eventually led to the establishment of the more formal Southern Region AIDS Network (SORAN) where representatives from government and nongovernmental organizations (NGOs) focused on awareness raising, lobbying, and advocacy. As an initial step towards networking on HIV/AIDS issues, a festival was organized in Blantyre on December 4, 1993, by NGOs, private companies, church groups, school children, and volunteers to bring about behavior change. About 2000 people gathered to listen to music, learn about HIV transmission through drama group presentations, watch videos with HIV/STD prevention messages, and learn about proper condom use. The participants officially established SORAN in February 1994 to act as a coordinating body for organizations working in prevention and care for HIV/STD-infected persons and their families. Network activities endeavored: to assist organizations interested in developing HIV/AIDS programs and activities; to encourage the business communities to participate in multisectoral coordination and to help channel funds from them to HIV/AIDS programs; to act as a resource center for information about HIV/AIDS; and to lobby among politicians as well as traditional local and religious leaders. When the first multi-party parliamentary election approached in May 1994, SORAN challenged representatives of 7 political parties and a women's organization to speak out publicly on what they envisioned doing about HIV/AIDS. The Grand Walk was also organized by SORAN members representing the Catholic Episcopal Conference of Malawi, the Protestant Blantyre Synod, a local brewery, and UNICEF. About 500 walkers received support from passersby. 70% were school children 10-18 years old who sang AIDS awareness songs and passed out flyers. Three months later the National AIDS Program's Big Walk for AIDS, following a National AIDS Crisis Conference, signaled the government's public recognition of the need for a multisectoral approach to combatting HIV/AIDS.     

Revisiting the concept of 'vulnerability'

The terms 'vulnerable' and 'vulnerability' are used more and more frequently in the areas of both social science research into and prevention of HIV/AIDS, but certain difficulties arise when it comes to applying this concept to actual situations at the heart of which individuals or groups are more exposed to HIV. The concept of vulnerability must thus be clarified to reinforce its heuristic capacity and political and practical relevancy. The first part of this paper is devoted to presenting a heuristic matrix of vulnerability, used in previous research among people living with HIV/AIDS (PWHAs) and to extracting three levels of intelligibility, that is to say, first the social trajectory level, then the level on which two or more trajectories intersect, and finally that of the social context. Each of the elements belonging to these three levels must be described both objectively and subjectively. The identity construction processes are then proposed as particular observation and 'gelling' points for these various levels taken as a whole. In the second part of the paper, we have reviewed how the concept of 'vulnerability' has been defined and used in other fields, notably disaster, famine, and mental health, paying special attention to the crucial points in the debates that are raging in these fields. We have also shed light on a few concepts that are frequently associated with vulnerability, such as victimization, insecurity, and risk. In the third part, we have summarized our approach to vulnerability as a relevant concept for elucidating risk-taking processes and designing intervention programmes. The importance of analysing the inter-individual differences, the variability in time and the relational dimension of all social vulnerability has been stressed.     

Childhood sexuality and rights in the context of HIV/AIDS

The primary objective in this study was to explore what HIV and AIDS mean to seven‐ and eight‐year‐old children in South Africa and how sexual and gender dynamics are embedded within these meanings. Against representations that associate young children with innocence, the paper argues for a more capacious view of young children as sexual and gendered agents with the ability to exercise their rights. In contrast to research that addresses children as relatively passive desexualised beings, focusing on their dependence on adults, their innocence and their need for protection, this paper examines how HIV and AIDS are constructed and negotiated by young people. It views children not simply in terms of their need for sexual rights but as potentially active participants in the negotiation of their rights. Viewing children's rights as highly contested, the notion that young children have sexual rights opens up possibilities for children (including those from marginalised groups) to talk about their concerns and pleasures, fears and hopes, as well as issues relating to sexual rights and resistances. By working creatively with teachers, it may be possible to broaden young children's knowledge of HIV and AIDS and sexuality within a more supportive environment.     

AIDS-talk in everyday life: the presence of HIV/AIDS in men's informal conversation in Southern Malawi

Malawi is one of the world's most AIDS-afflicted countries. In order to cope with the AIDS pandemic, we must know what the people most at risk think about it, how they evaluate their situation and that of their community, and what actions they would consider adopting to lower their risk. However, the main research methods in studying attitudes-surveys and questionnaires-have only a limited ability to capture what people think about AIDS. In order to get a more naturalistic perspective on attitudes towards AIDS from 1999 to 2001 six Malawian research assistants who lived in rural villages were asked to keep journals in which they wrote down information about all the conversations they participated in or witnessed in which the topic of AIDS surfaced in any way. The conversations ranged from graveside condolences following a funeral to stories told during men-only beer-drinking sessions, to women chatting on the bus. In this paper, I analyse these journals in order to see how men talk about AIDS in naturalistic settings, what they perceive as the impact of the AIDS epidemic, and how they understand AIDS risk.     

Experiences and Perceptions of Sexuality and HIV/AIDS among Young People with Physical Disabilities in a South African Township: a Case Study

This study explored the experiences and perceptions of sexuality and HIV/AIDS among 15–24 year-old young people with physical disabilities in a South African Township characterised by high unemployment rates and lack of social services. Ten young people and ten parents participated in multiple individual interviews as well as in focus group discussions. The analysis of audio taped and transcribed responses identified common experiences and perceptions among participants. The results indicate that disabled young people have limited factual knowledge about sexuality and HIV/AIDS. The decisions and choices they make about sexual behaviour are not informed by what they know; rather, they are part of the whole life situation in Nyanga. Their need to be loved and accepted, need for job security and family life, were more important than practicing ‘safe sex’. Therefore, there is need for HIV/AIDS programme developers to take into account the experiences and perceptions of the target population.In this paper the phrases ‘young people with physical disabilities’ and disabled young people’ are used interchangeably.     

Archetypes of Infection: People with HIV/AIDS in the Australian Press in the Mid 1990s

This article presents the findings of an interpretive analysis of the representation of people with HIV/AIDS in the Australian press in a three-year period between 1994 and 1996. Three major archetypes of people with HIV/AIDS dominating reports – the 'AIDS victim', the 'AIDS survivor' and the 'AIDS carrier'– are discussed for what they reveal not only about contemporary approaches to HIV/AIDS but also about more general notions of morality and self-control related to the body, medicine, health and illness. It is argued that these dominant archetypes inevitably draw from previous representations of HIV/AIDS, but at the same time demonstrate evidence of changing discourses and meanings. One feature of particular interest is that moral judgements related to people with HIV/AIDS presented in these news texts appear to be based less on how they acquired the virus than the manner in which they deport themselves once infected.     

Paradoxes and asymmetries of transnational networks: a comparative case study of Mexico's community-based AIDS organizations

This article examines whether transnational networks reconfigure state-civil society relationships in ways that lead to civil society empowerment and increased organizational capacity to address the HIV/AIDS epidemic in Mexico. Using a comparative case study, I identify the types of transnational networks and exchanges that both help and hinder community-based HIV/AIDS organizations (CBOs) that provide AIDS prevention and treatment services in Tijuana and Mexico City. Data derive from over 50 formal interviews, organizational documents and archival records, and observation. I argue that the form and function of transnational networks is shaped by the geo-political context of local organizational fields and that, in turn, transnational networks provide innovative opportunities for civil society-state partnerships that favor some local organizations over others. Ultimately, I take apart the prevailing assumption that transnational networks are inherently good, and show how they can (re)produce inter-organizational stratification at the local level. The conclusions of this research are helpful to international health practitioners and social scientists seeking to understand how civil society's participation in transnational networks can both challenge and reproduce existing community-state power regimes and health inequities.     

Unprotected Tajik Male Migrant Workers in Moscow at Risk for HIV/AIDS

This paper focuses on Tajik male migrant workers in Moscow and seeks to address the global public health problem of HIV prevention amongst male migrant workers. To develop feasible and effective preventive interventions for reducing HIV risk behaviors amongst Tajik male migrant workers in Moscow, this study aimed to characterize their HIV/AIDS risk and protective knowledge, attitudes, and behaviors, as well as key contextual factors that would likely impede or facilitate a preventive intervention. This was a collaborative multi-sited ethnography in Moscow that included minimally structured interviews with 16 participants and focus group discussions with an additional 14 participants. The results suggest that many Tajik male migrant workers in Moscow are having unprotected sex with commercial sex workers. Although some of the migrants have basic knowledge about HIV, the migrants' ability to protect themselves from acquiring HIV is compromised by harsh living and working conditions as a consequence of being unprotected by law in Russia. To respond to HIV/AIDS risks amongst Tajik male migrant workers in Moscow, preventive interventions must be developed that respond to their sense of being unprotected in the midst of harsh living and working conditions and that draw upon existing sources of religious, community, and family support.     

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents.

PURPOSE: To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents. METHODS: The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups. RESULTS: In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex." CONCLUSIONS: To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.     

Variations in Rural AIDS Epidemiology and Service Delivery Models in the United States

This article reviews AIDS surveillance data and the rural health literature to summarize what is known about the rural AIDS epidemic, characteristics of rural environments that affect HIV service delivery, and approaches that rural areas are using to address the health and support service needs of HIV-positive residents. During 1999, nonmetropolitan (non-MSA) adult/adolescent AIDS rates were highest in the South (11 per 100,000) and Northeast (9 per 100,000). The South had the highest non-MSA proportion of adult/adolescent AIDS cases (12%), followed by the North Central region (9%), the West (4%), and the Northeast (3%). Variations in rural HIV/AIDS epidemiologic patterns and the demographic, socio-economic, and cultural characteristics of rural environments are likely to require different levels of resource investment and different methods of organizing and delivering HIV services. Currently, many HIV-positive rural residents are traveling to metropolitan areas for medical care because of concerns about confidentiality or a lack of confidence in the HIV management capabilities of local physicians. Rural communities are attempting to address these problems by developing the HIV care capacity of existing clinics, building local networks of physicians with HIV management experience, and cultivating "shared care" arrangements with urban-based specialists.     

Ecologies of security: On the everyday security tactics of female sex workers in Nairobi,Kenya

ABSTRACT

This paper highlights important environmental dimensions of HIV vulnerability by describing how the sex trade operates in Nairobi, Kenya. Although sex workers there encounter various forms of violence and harassment, as do sex workers globally, we highlight how they do not merely fall victim to a set of environmental risks but also act upon their social environment, thereby remaking it, as they strive to protect their health and financial interests. In so doing, we illustrate the mutual constitution of ‘agency’ and ‘structure’ in social network formations that take shape in everyday lived spaces. Our findings point to the need to expand the focus of interventions to consider local ecologies of security in order to place the local knowledges, tactics, and capacities that communities might already possess on centre stage in interventions. Planning, implementing, and monitoring interventions with a consideration of these ecologies would tie interventions not only to the risk reduction goals of global public health policy, but also to the very real and grounded financial priorities of what it means to try to safely earn a living through sex work.     

Context, Culture, and Collaboration in AIDS Interventions: Ecological Ideas for Enhancing Community Impact

The paper describes developments in preventive interventions in AIDS/HIV that signal the emergence of a new perspective focusing on community-level intervention and community-level impact. These developments are reviewed, and a ecological framework from community psychology is offered as an integrating and guiding mind-set for future community impact interventions. Key ingredients are community assessment, the ecology of lives lived in different sociocultural communities, the development of collaborative relationships, and enhancing community empowerment through the development of local community resources. The perspective is outlined using existing examples of AIDS/HIV preventive interventions, which focus on such community-level issues as norms regarding sexual risk behavior. The paper concludes with a call to explore more fully the wisdom found in existing community-level work in the AIDS/HIV area and to develop an ecological mind-set when engaging in preventive community interventions.