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HIV/AIDS: Social Perspectives

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 January 2015) | Viewed by 47231

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Prof. Dr. Janet Seeley

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Guest Editor

Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), 15-17, Tavistock Place London, London WC1H 9SH, UK
Interests: social aspects of health (with a particular focus on HIV); poverty; inequality; migration and mobility and the study of diversity

Special Issue Information

Dear Colleague,

In recent years the success of antiretroviral therapy through which many people living with HIV have maintained or regained their health, and/or continued to work and support their families with the expectation of living into their old age, have prompted some to herald the “end of AIDS”. Yet, while access to treatment may indeed aid prevention efforts while saving the lives of those infected, public health challenges remain. Co-infection with tuberculosis poses serious health risks for people living with HIV while co-morbidities with diabetes and hypertension, for example, may seriously affect the quality of life of HIV-positive people as they age.

Yet, young and older people are still becoming infected with the virus. A woman, for example, may become infected as the result of sex that was an isolated violent incident or part of collective violence, or she may become infected in the context of a caring relationship. The consequences of that infection will vary according to context. Support may be lacking, stigma and prejudice may cause delays in seeking treatment or sustaining a disciplined treatment regime may prove challenging because of relationships, work and location. The environments in which people manage HIV infection and access to treatment and care over time vary enormously within countries and across regions.

This Special Issue is open to papers which examine the public health challenges posed by environments (both physical and social) where the risk of HIV infection is high and/or access to treatment and care may be difficult because of location or scarce resources.

Prof. Dr. Janet Seeley
Guest Editor

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Keywords

HIV and AIDS
public health
risk factors
stigma
intolerance
barriers to treatment
inequality/inequity

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Published Papers (6 papers)

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Research

707 KiB

Open AccessArticle

Drug Use and HIV Infection Status of Detainees in Re-Education through Labour Camps in Guangxi Province, China

by Lei Zhang, Lorraine Yap, Joanne Reekie, Wei Liu, Yi Chen, Zunyou Wu, Handan Wand and Tony Butler

Int. J. Environ. Res. Public Health 2015, 12(5), 4502-4519; https://doi.org/10.3390/ijerph120504502 - 23 Apr 2015

Cited by 9 | Viewed by 7149

Abstract

This study describes HIV disease burden and patterns of drug use before and during incarceration among detainees in Re-education-Through-Labour-Camps (RTLCs) in China. A cross-sectional survey of 576 men and 179 women from three RTLCs was conducted in Guangxi Province, China. Over three-quarters of study participants were detained due to drug-related offences. Over half of the women (n = 313, 54.3%) and two-thirds of men (n = 119, 66.5%) had been previously been incarcerated in a compulsory detoxification treatment centre (CDTC), and around one-third (men n = 159, 27.6%; women n = 50, 27.9%) in a RTLC. Of those surveyed, 49 men (8.5%) and one (0.6%) woman reported ever using drugs while in a CDTC and/or RTLC. Previous incarceration in CDTCs and RTLCs were associated with HIV infection among both male (OR = 2.15 [1.11–4.15]) and female (OR = 3.87 [1.86–9.04]) detainees. Being married/cohabiting with a partner (OR = 0.53, [0.30–0.93]) and being employed (OR = 0.46, [0.22–0.95]) were associated with a reduced odds of HIV infection among male detainees. A significant proportion of RTLC detainees had a history of drug use and a limited number of inmates had used illegal substances whilst in custody. Repeat incarcerations in CDTCs/RTLCs were associated with higher risks of HIV infection. Full article

(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)

708 KiB

Open AccessArticle

Traditional Healing, Biomedicine and the Treatment of HIV/AIDS: Contrasting South African and Native American Experiences

by Adrian Flint

Int. J. Environ. Res. Public Health 2015, 12(4), 4321-4339; https://doi.org/10.3390/ijerph120404321 - 20 Apr 2015

Cited by 9 | Viewed by 8555

Abstract

Traditional healing remains an important aspect of many people’s engagement with healthcare and, in this, responses to the treatment of HIV/AIDS are no different. However, given the gravity of the global HIV/AIDS pandemic, there has been much debate as to the value of traditional healing in this respect. Accordingly, this paper explores the extent to which meaningful accommodation between the biomedical and traditional sectors is possible (and/or even desirable). It does this through a consideration of Native American and South African experiences, looking at how the respective groups, in which medical pluralism is common, have addressed the issue of HIV/AIDS. The paper points to the importance of developing “culturally appropriate” forms of treatment that emphasise complementary rather than adversarial engagement between the traditional and biomedical systems and how policymakers can best facilitate this. Full article

(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)

865 KiB

Open AccessArticle

On the Road to HIV/AIDS Competence in the Household: Building a Health-Enabling Environment for People Living with HIV/AIDS

by Caroline Masquillier, Edwin Wouters, Dimitri Mortelmans and Brian Van Wyk

Int. J. Environ. Res. Public Health 2015, 12(3), 3264-3292; https://doi.org/10.3390/ijerph120303264 - 18 Mar 2015

Cited by 22 | Viewed by 8287

Abstract

When aiming to provide chronic disease care within the context of human resource shortages, we should not only consider the responsibility of the individual person living with HIV/AIDS (PLWHA) but also the capacity of the social environment to actively encourage a lifestyle that fosters health. In this social environment, extensive efforts are thus required to increase HIV/AIDS knowledge, reduce stigma, stimulate HIV testing, improve health care-seeking behavior, and encourage safe sexual practices—described in the literature as the need for AIDS competence. In accordance with socio-ecological theory, one cannot restrict the research focus to communities, as AIDS competence studies should also incorporate the intermediate household level. In responding to this research need, the aim of this article is to conceptualize an “HIV/AIDS competent household” based on qualitative interviews and focus group discussions conducted in a township on the outskirts of Cape Town, South Africa. Our results show that a household’s supportive response to disclosure allows a patient to live openly as HIV positive in the household concerned. This may mark the start of the road to HIV/AIDS competence in the household, meaning the PLWHA receives sustainable support throughout the care continuum and positive living becomes the norm for the PLWHA and his or her household. A feedback loop might also be created in which other household members are encouraged to be tested and to disclose their status, which is an important step towards a sustainable response to HIV/AIDS-related challenges. Despite the fact that this road to HIV/AIDS competence at the household level is fragile and prone to various barriers, this article shows that the household has the potential to be a health-enabling environment for PLWHA. Full article

(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)

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660 KiB

Open AccessArticle

Exploring the Care Relationship between Grandparents/Older Carers and Children Infected with HIV in South-Western Uganda: Implications for Care for Both the Children and Their Older Carers

by Rwamahe Rutakumwa, Flavia Zalwango, Esther Richards and Janet Seeley

Int. J. Environ. Res. Public Health 2015, 12(2), 2120-2134; https://doi.org/10.3390/ijerph120202120 - 13 Feb 2015

Cited by 39 | Viewed by 7745

Abstract

The care of children orphaned by HIV/AIDS in sub-Saharan Africa is often undertaken by grandparents, yet little is known about the care relationship between grandparent and grandchild. Our aim was to examine this relationship to understand the needs and responsibilities of both the HIV positive child and older carer and the nature of the relationship, and to assess the implications for care for the children and the older carers. A qualitative study was conducted with 40 purposively sampled children (13–17 years) and their older carers (50 years and above). Participants were recruited from two clinics in south-western Uganda. Up to three semi-structured interviews were held with each participant. Data were analysed using a thematic framework approach. We found that the care relationship was mostly reciprocal: HIV positive children depended on carers for basic and health needs and carers counted on the children for performing tedious household tasks. The relationship was also characterised by challenges, sometimes causing tension between child and carer. We conclude that: (1) interventions targeting HIV positive children need to also address the needs of older carers, and (2) carers and children would benefit from psychosocial support and social protection. Full article

(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)

700 KiB

Open AccessArticle

Impact of HIV Testing and Counseling (HTC) Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria

by Alice Osuji, Jennifer R. Pharr, Uche Nwokoro, Anulika Ike, Christiana Ali, Ogheneaga Ejiro, John Osuyali, Michael Obiefune, Kevin Fiscella and Echezona E. Ezeanolue

Int. J. Environ. Res. Public Health 2015, 12(2), 1969-1982; https://doi.org/10.3390/ijerph120201969 - 10 Feb 2015

Cited by 4 | Viewed by 7032

Abstract

Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC) knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p < 0.01), sterilization of delivery equipment (p < 0.01), participation in blood safety training (p < 0.01), and disposal of sharps (p < 0.01). As long as a high percent of births occur outside health care facilities in Nigeria, there will be a need for TBAs. Providing TBAs with HTC training increases HIV prevention practices and can be a key to improve maternal and child health. Full article

(This article belongs to the Special Issue HIV/AIDS: Social Perspectives)

299 KiB

Open AccessArticle

Exploring HIV Prevention Strategies among Street-Based Female Sex Workers in Chongqing, China

by Huan Zeng, Yong Zhao, Siying Meng, Xiaojun Tang, Hang Guo, Yang Wang and Lei Zhang

Int. J. Environ. Res. Public Health 2015, 12(1), 855-870; https://doi.org/10.3390/ijerph120100855 - 16 Jan 2015

Cited by 10 | Viewed by 7386

Abstract

Background: Commercial sex plays an increasingly important role in China’s growing HIV and sexually transmitted infection (STI) epidemics. In China, street-based sex workers (SSWs) are a subgroup of female sex workers with a particularly high risk of HIV/STI infections but are neglected in responses to HIV. This study assesses changes in HIV voluntary counseling and testing (VCT) utilization and high-risk sexual behaviors following a three-month HIV preventive intervention among SSWs in Chongqing, China. Methods: A three-month intervention was conducted by a team of peer educators, outreach workers from community-based organizations and health professionals. It mainly included distribution of free pamphlets and condoms and delivery of onsite and clinic-based VCT. Cross-sectional surveys were conducted prior to (n = 100) and immediately following (n = 112) the intervention to assess its impact. In-depth interviews were conducted among 12 SSWs after the intervention to further explore potential barriers to HIV prevention. Results: The intervention significantly increased SSWs’ participation in VCT (from 2.0%–15.2%, P < 0.001). Despite participants’ improved HIV-related knowledge level (from 24.0%–73.2%, P < 0.001), there were minimal changes in the levels of condom use with clients. Qualitative research revealed that fear of police arrest and stigma were the main barriers to VCT utilization. Low condom use was associated with family financial constraints, inadequate power in condom negotiation, low awareness and misconceptions of HIV infection risks. Conclusion: HIV intervention improved VCT utilization and knowledge but we did not observe an increase in condom use after this short intervention. SSWs faced substantial economic, social and environmental barriers to VCT utilization and condom use. Full article

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