AIDS as a social phenomenon

Stigma and rejection: living with AIDS in villages in southern Thailand

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

Pain in human immunodeficiency virus disease

OBJECTIVES

To review the prevalence and etiology of pain in persons with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and issues and considerations for pain management in this patient population.

DATA SOURCES

Research studies, review articles, and books related to pain in persons with HIV/AIDS.

CONCLUSIONS

Pain is a common problem for individuals with HIV/AIDS that is often poorly managed and net well documented. Many of these patients have multiple, coexisting illnesses that are painful. Adequate assessment of the underlying cause will help in the treatment or eradication of pain.

IMPLICATIONS FOR NURSING PRACTICE

The management of pain in persons with HIV/AIDS is an important responsibility for oncology nurses because increasing numbers of persons with HIV/AIDS are being treated for neoplastic complications, cytopenias, or being referred to hospice care.

Anthropology, HIV and contingent identities

The paper explores the relationship between social identity and HIV/AIDS, with special reference to gay men in Britain. This relationship was first seen as significant since it might have a bearing on the spread of HIV in the population. Three major forms of commentary have emerged on the issue: (i) basic research into the relationship between sexual identities and behaviours; (ii) applied research on how to convert the findings from (i) into health promotional materials, and (iii) discourse from within the politically gay community on what HIV/AIDS means for gay people. These different forms of commentary arise from a diverse range of voices, within and outside academia. The paper draws comparison between different disciplinary approaches to questions of identity and HIV/AIDS, in terms of their relative strengths and weaknesses (for example, contrasting psychology with anthropology). An ethnography of a day centre for people living with HIV/AIDS is used to illustrate the need to understand identity from a processual perspective, so that both individual and collective identities are seen as emerging from specific historical circumstances and struggles. A dialogic approach to understanding identity, tied to qualitative empirical research, is suggested as necessary to understanding how different forms of identity engage with HIV/AIDS (gender, ethnicity, age, sexual orientation), and how the identities of individuals and groups are always complex, shifting mosaics.

Acquired immunodeficiency syndrome in forensic autopsies

From May 1985 to May 1989, 126 necropsies were performed at the São Paulo City Morgue on cadavers of individuals AIDS victims whose unnatural deaths had prompted police investigations. One hundred and nineteen males and 17 females were included. Ages were most commonly in the 20-to-30 year range. Fifty four deaths occurred in penal institutions, 29 deaths resulted from suicides, 17 deaths from manslaughter, 17 deaths were considered suspicious, 5 willful murders and 4 others also considered suspicious because corpses were found in advanced stages of putrefaction. Inmates, except one man who was strangled, died as a consequence of the disease. During all autopsies, special attention was paid to the high rate of extrapulmonary Mycobacterial infections. Suicides were committed in different ways and the majority of the victims were documented to be still in the initial stages of the disease. Suspicious deaths and deteriorated corpses were the result of negligence of the subject's families. Homicidal deaths occurred in subjects in the terminal stages of the disease inside the hospital where these subjects were assisted and the immunodeficiency certainly contributed to aggravate the injuries leading to death. Attention is drawn to both legal and social issues affecting AIDS victims. The authors believe these issues may pose a hindrance for efficient control of the AIDS epidemic.

The perception of AIDS in the Bété and Baoulé of the Ivory Coast

The purpose of this study was to gain a better understanding of the socio-cultural aspects of transmissible diseases, in particular AIDS perceptions, among the two major Ivorian ethnic groups, the Bété and Baoulé, in order to implement more suitable educational programmes. The methods used consist of structured interviews to obtain quantitative findings on knowledge and practices, and 'focus groups' and semi-structured interviews with key-informants for the collection of qualitative data. Interpretations according to traditional ways of thinking are widespread among both the Bété and Baoulé. Urinating where an AIDS patient has urinated and sorcery attacks are considered possible ways of transmitting AIDS according to traditional categories of pure-impure and supernatural powers intervention. Educational level is the factor which most influences a person's knowledge of AIDS and prevention methods through western categories. Education as well as a better knowledge of the disease appear to be associated with an attitude that favours isolating the patient. The content of health education messages on AIDS, in the rural environment, cannot be separated from the Bétés or Baoulés conceptions of transmissible diseases.

Sociocultural aspects of AIDS in an urban peripheral area of Abidjan (Côte d'Ivoire)

This study aimed to gain a better understanding of the social dynamics--migration, urbanization, the status of women, education--related to AIDS in an urban peripheral area of Abidjan. Structured interviews were administered to 420 people, selected through cluster random sampling. Focus groups and semi-structured interviews were performed with key-informants. The results show that 26.9% of the interviewees are foreigners and 40% of all people interviewed participate in ethnic associations. Knowledge of AIDS is associated with age, gender, educational level and purchasing power. Those who are generally better informed about AIDS are: younger people; people with a higher education; and wealthier people. Men respond correctly to questions more frequently than women. French, the chosen language of the education campaigns, is not understood by 18% of the immigrants, and when considering only immigrant women, the figure increases to 38%. Particular attention should be paid to the design of health education messages and strategies for specific groups, such as non-educated people, women and immigrants. Care must also be taken to match the language used to the target population. Ethnic associations constitute an important starting point, particularly in relation to their use by immigrants, and these should be involved in educational programmes.

From illness to symbol and symbol to illness

This paper explores two aspects of the relationship between illness and social symbols: one in which illnesses become symbols; the other, in which symbols become implicated in processes that eventuate in illness. Illness is first discussed as a symbol of social beliefs, attitudes, norms, values, and other social phenomena conceptualized in relation to them. This symbolization is analyzed as it relates to various dimensions of illness that lend themselves to figurative thinking. The paper then turns to processes through which social symbols may generate illness. In this regard, ways in which social symbols may attract people to behavior that puts their health at risk are discussed. The paper concludes with an analysis of how the development of illness may be affected by the relationship between social symbols and somatization.

Going public as an AIDS family caregiver

Images of AIDS invoke fears of contagion, disability and formidable death, and moral overtones directed toward drug use, sexuality and sexual identity and freedom. Responses to these images are both private and public, and have profound consequences for individuals whose lives have been touched by the disease, both the person with AIDS and the family caregiver. The purpose of this paper is to analyze in detail 'going public,' one category of a substantive theory of AIDS family caregiving. This category was developed from a grounded theory study of 53 AIDS family members who were asked to describe their experiences as an AIDS family caregiver during an indepth interview. Data were content analyzed using constant comparative analysis. Going public referred to how AIDS family caregivers let others known that they were caring for a PWA. Specifically, going public entailed selecting appropriate persons and audiences to tell, formulating approaches to communicating information, and considering the risks and benefits of the possible choices. The description of going public as an AIDS family caregiver details the assertiveness involved in political action and social change, contrasted with the isolation and secrecy involved in maintaining relationships with others under the condition of a stigmatizing illness. Data revealed a particular emphasis on the phenomenon of 'guilt by association'. Because of their close relationship to a person with AIDS, caregivers were obligated to share the stigma of AIDS and were likewise discredited. Findings from our study emphasize the tremendous personal suffering experienced by caregivers which was associated with AIDS stigma in the form of rejection, loss of friends and harassment. Data also revealed the strong commitment of many caregivers to social activism which ranged from participating in educational efforts to marching in demonstrations. The rationale for the apparent increased activism among AIDS family caregivers compared to other groups of caregivers is explored. Going public highlights both the personal suffering and social manifestations of AIDS, significant issues to consider in planning health services for the second decade of the AIDS epidemic.

Sex, drugs and HIV: an ethnographic approach

This is an ethnographic study of the sexual relationship that exists between a group of heroin addicted prostitutes and a Latino/Hispanic group of migrant undocumented workers from Mexico in Orange County, California. Some of the sexual practices elicited and observed by the ethnographer have implications for the transmission and prevention of the HIV. Of particular interest is a form of sexual behavior which is known to the participants as 'becoming milk brothers'. In this sexual practice several men have sexual intercourse with a single woman in rapid succession, allowing the possibility of HIV transmission to take place from male to female, from female to male, and from male to male.

The evolution of antihypertensive therapy

The goal of antihypertensive therapy has changed dramatically over the past 40 years. What was once a treatment for a life-threatening disease has gradually evolved to become just one of the many ways of modifying a symptomless risk factor. The development of safer drugs throughout the 1970s resulted in treatment being offered at successively lower levels of blood pressure elevation, and consequently to an ever increasing proportion of the population. Based on new evidence from clinical trials, however, recent policy guidelines for the treatment of hypertension--especially mild hypertension--have become more conservative. Yet, there are a number of reasons for doubting that this policy reversal will be transmitted into actual clinical practice, unless major changes are made to the arrangement of structural interests--professional, industrial and third-party funders--which currently support and maintain antihypertensive therapy on a mass scale. Meanwhile, 'control' of blood pressure, 'quality of life', and 'compliance' with therapy have become ends in themselves, often to the exclusion of much-needed discussion on the real therapeutic goal of antihypertensive medication, i.e., the prevention of cardiovascular and cerebrovascular morbidity and mortality and the question of whether drugs are always the best way to achieve this.

Community and individual considerations in legislation and test policy regarding HIV-infection in the Nordic countries--a cross national comparative study

The purpose of the study is to facilitate international co-operation and national development on AIDS-policy by describing and comparing the programmes on the control of AIDS in the five Nordic countries. This article is focusing especially on community and individual considerations in legislation and test policy regarding HIV-infection in relation to general testing, testing of special groups, registration, voluntariness and confidentiality. The data were collected in the period of April-December 1987 by a review of existing documental material, mailed questionnaires to key persons in the health agencies in each country and personal interviews with 60 representatives of relevant organisations and institutions. The analysis of the data demonstrate that all the Nordic countries are seeking compromises which try to satisfy individual as well as community needs, although with different weight attached to the elements involved. Compared with international recommendations, national AIDS-policies in the Nordic countries in some instances do not fully respect voluntariness and confidentiality. It is concluded that AIDS-policy should be studied in the context of national traditions concerning general health policy, individual rights and community protection.