AIDS and the social side of health

Surface modification of graphene and fullerene with Sulfur (S), Selenium (Se), and Oxygen (O): DFT Simulation for enhanced zidovudine delivery in HIV treatment

HIV is one of the most threatening health conditions with a highly increasing rate, affecting millions of people globally, and from its time of discovery until now, its potential cure cannot be explicitly defined. This challenge of having no/low effective drugs for the subjected virus has called for serious attention in the scientific world of virus disease therapeutics. Most of these drugs yields low effectiveness due to poor delivery; hence, there is a need for novel engineering methods for efficient delivery. In this study, two nanomaterilas (graphene; GP, and fullerene; C60) were modelled and investigated with sulfur (S), selenium (Se), and oxygen (O) atoms, to facilitate the delivery of zidovudine (ZVD). This investigation was computationally investigated using the density functional theory (DFT), calculated at B3LYP functional and Gd3bj/Def2svp level of theory. Results from the frontier molecular orbital (FMO), revealed that the GP/C60_S_ZVD complex calculated the least energy gap of 0.668 eV, thus suggesting a favourable interactions. The study of adsorption energy revealed chemisorption among all the interacting complexes wherein GP/C60_S_ZVD complex (-1.59949 eV) was highlighted as the most interacting system, thereby proving its potential for the delivery of ZVD. The outcome of this research urges that a combination of GP and C60 modified with chalcogen particularly, O, S, and Se can aid in facilitating the delivery of zidovudine.

Whose Epidemic is it? Reviewing the Literature on Women and AIDS

AIDS is widely presented as a critical problem for women, which raises special issues of prevention and care. Although it is suggested that women are particularly vulnerable physiologically to HIV infection, biomedical research into treatment and prevention options specifically for women has been limited. Considerable social science research at both the theoretical and applied level has been documented. While analyses have tended to highlight broad structural factors, interventions have often been at individual/group level. The literature demonstrates the dilemma of AIDS being seen as women's responsibility, although they lack the power and means to implement safe sex. Gender imbalances in depictions of and responses to AIDS need to be attended to if the epidemic is to be effectively addressed.

Respect for Human Vulnerability: The Emergence of a New Principle in Bioethics

Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged (1) distinguishing between different types of vulnerability, (2) criticizing the categorization of populations as vulnerable, and (3) questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously.

Community involvement in health services at Namayumba and Bobi health centres: a case study

BACKGROUND

Community involvement has been employed in the development of both vertical and horizontal health programmes. In Uganda, there is no empirical evidence on whether and how communities are involved in their health services.Aim and Setting: The aim of this study was to establish the existence of community involvement in health services and to identify its support mechanisms in Namayumba and Bobi health centres in Wakiso and Gulu districts, respectively.

METHODS

Participants were selected with the help of a community mobiliser. Key informants were selected purposively depending on their expertise and the roles played in their respective communities. The focus group discussions and key informant interviews were audio-recorded and transcribed verbatim. The transcripts were analysed manually for emerging themes and sub-themes.

RESULTS

Several themes emerged from the transcripts and we categorised them broadly into those that promote community involvement in health services and those that jeopardise it. Easy community mobilisation and several forms of community and health centre efforts promote community involvement, whilst lack of trust for health workers and poor communication downplay community involvement in their health services.

CONCLUSION

Community involvement is low in health services in both Namayumba and Bobi health centres.

Proximate context of gender-unequal norms and women's HIV risk in sub-Saharan Africa

OBJECTIVE

To determine whether the proximate context of gender-unequal norms about violence against women undermines women's ability to negotiate condom use in sexual relationships.

DESIGN

Secondary analysis of cross-sectional data pooled from 22 Demographic and Health Surveys conducted in sub-Saharan Africa.

METHODS

Each of the 22 surveys employed a multistage stratified design with probabilistic sampling and was designed to be nationally representative of reproductive-age women. The outcome was self-reported condom use at last sexual intercourse. The primary explanatory variable of interest was a scale consisting of five questions about whether the respondent agreed with the appropriateness of wife beating under five different scenarios. To measure the proximate context of norms about violence against women, this scale was aggregated to the level of the primary sampling unit. We fit logistic regression models with cluster-correlated robust standard errors and adjustment for country-level fixed effects and sociodemographic characteristics.

RESULTS

Our analysis sample included data from 198,806 sexually active women living in 22 sub-Saharan African countries. The wife-beating scale was internally consistent (Cronbach's α = 0.84), and factor analysis confirmed the presence of a single factor. Condom use was associated with gender-unequal contextual norms about violence against women (adjusted odds ratio = 0.88; 95% confidence interval, 0.85-0.92; P < 0.001). The estimated association was robust to adjustment for sociodemographic characteristics and several sensitivity analyses.

CONCLUSIONS

The proximate context of gender-unequal norms about violence against women is associated with lack of condom use among women in sub-Saharan Africa.

Is food insecurity associated with HIV risk? Cross-sectional evidence from sexually active women in Brazil

BACKGROUND

Understanding how food insecurity among women gives rise to differential patterning in HIV risks is critical for policy and programming in resource-limited settings. This is particularly the case in Brazil, which has undergone successive changes in the gender and socio-geographic composition of its complex epidemic over the past three decades. We used data from a national survey of Brazilian women to estimate the relationship between food insecurity and HIV risk.

METHODS AND FINDINGS

We used data on 12,684 sexually active women from a national survey conducted in Brazil in 2006-2007. Self-reported outcomes were (a) consistent condom use, defined as using a condom at each occasion of sexual intercourse in the previous 12 mo; (b) recent condom use, less stringently defined as using a condom with the most recent sexual partner; and (c) itchy vaginal discharge in the previous 30 d, possibly indicating presence of a sexually transmitted infection. The primary explanatory variable of interest was food insecurity, measured using the culturally adapted and validated Escala Brasiliera de Segurança Alimentar. In multivariable logistic regression models, severe food insecurity with hunger was associated with a reduced odds of consistent condom use in the past 12 mo (adjusted odds ratio [AOR] = 0.67; 95% CI, 0.48-0.92) and condom use at last sexual intercourse (AOR = 0.75; 95% CI, 0.57-0.98). Self-reported itchy vaginal discharge was associated with all categories of food insecurity (with AORs ranging from 1.46 to 1.94). In absolute terms, the effect sizes were large in magnitude across all outcomes. Underweight and/or lack of control in sexual relations did not appear to mediate the observed associations.

CONCLUSIONS

Severe food insecurity with hunger was associated with reduced odds of condom use and increased odds of itchy vaginal discharge, which is potentially indicative of sexually transmitted infection, among sexually active women in Brazil. Interventions targeting food insecurity may have beneficial implications for HIV prevention in resource-limited settings.

Men's multiple sexual partnerships in 15 Sub-Saharan African countries: sociodemographic patterns and implications

Men's multiple sexual partnerships contribute to the spread of HIV in sub-Saharan Africa, but the social determinants of these relationships remain poorly understood. Prevailing wisdom suggests that men's institutionalized authority over women and their control of economic resources are key facilitators of multiple partnerships in this region. Men's exposure to or freedom from social control mechanisms embedded in family and village life may also play a role. This article provides insight into these issues by examining sociodemographic correlates of men's multiple sexual partnerships using data from recent Demographic and Health Surveys in 15 sub-Saharan African countries. The prevalence of self-reported multiple partnerships varies widely among countries. Sociodemographic patterns of such partnerships confirm the importance of men's control of economic resources and suggest that men's freedom from social control mechanisms may be more important than their authority over their wives.

Behavioral mechanisms in HIV epidemiology and prevention: past, present, and future roles

In the 1980s, behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms--especially other sexually transmitted infections, antiretroviral therapy, and male circumcision--predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters.

Mama Jaja: the stresses and strengths of HIV-affected Ugandan grandmothers

This paper reports an exploratory qualitative project in the Entebbe-Kampala area of Uganda with 11 grandmothers who are raising orphans because of a parent's death from HIV infection. In Sub-Saharan Africa, the highest HIV infection and mortality rates are among women, especially in their childbearing years, leading to a tremendous number of orphaned HIV-infected and -affected children. Uganda has the world's highest rate of HIV-affected orphans. In Uganda, extended family members, especially grandmothers, provide general orphan care, AIDS care, and care for HIV-affected orphans. If orphans have places to stay, they are most often with grandparents and other elderly relatives in rudimentary village dwellings. Many of these elders are in poor health, recovering from nursing their adult children as they died of AIDS, and suffering from an extreme lack of financial resources. The burden of HIV-affected orphan care is enormously heavy. Services are not being provided adequately to custodial grandparents who are enormously challenged spiritually, socially, emotionally, financially, physically, and mentally. The following themes emerged from the interviews: experiencing extreme economic deprivation; feeling physically challenged with caregiving; being concerned for the children under their care; and struggling to cope through action, resilience, and relationships. Recommendations for research, practice, and policy are offered.

Notas sobre a solidariedade e o fenômeno da orfandade na sociedade Akan-Agni Morofoé da Costa Do Marfim (África Do Oeste)

Neste artigo propõe-se analisar as possíveis relações existentes entre o código de família marfinense, implantado em 1964, o fenômeno da orfandade e a crise da solidariedade comunitária vivenciada por parte da sociedade Akan-Agni Morofoé da Costa do Marfim. Acontecimentos importantes apontam para o fato de que o conjunto de leis promulgadas em 1964, ao ignorar as instituições tradicionais, ignorou também o fato de que os direitos costumeiros, além de milenares, são fontes de equilíbrio social, econômico e político. A análise, baseada em dados de realidade de duas aldeias, coloca em destaque os conflitos e controvérsias nascidos com a adoção de um código de família de inspiração ocidental, fato duramente sentido com o avanço da epidemia do HIV/AIDS.

Cohabitation, marriage, and 'sexual monogamy' in Nairobi's slums

The current study investigates the extent to which sexual exclusivity--the restriction of one's sexual engagements to a single partner--prevails across various marital status, union type, and co-residence categories among Nairobi's poorest residents, slum dwellers. This question is central to the spread of HIV in the increasingly urban and poor, high prevalence countries of sub-Saharan Africa, where transmission is primarily via heterosexual sex. In many circles, sexual exclusivity is considered a prominent feature of the marriage institution. Yet, marriage and cohabitation are often not easily distinguishable in sub-Saharan Africa, meaning that the frequent use, as a proxy, of the "in union" category, which includes married as well as cohabiting persons can, at best, be considered tenuous. Using the 2000 Nairobi Cross-Sectional Slum Survey (NCSS), this paper confirms that marriage is associated with higher reports of sexual exclusivity even in settings where poverty provokes risky behavior. The finding, here, is of lower risk of HIV infection for married respondents, with a smaller effect observed among non-married cohabiters. Converse to the implied benefits of marriage, though, women with co-wives are more likely to report multiple partners. The implications of these findings are discussed.

Sociodemographic characteristics of HIV-positive mother-child pairs in Ile-Ife, Nigeria

This study was designed to identify sociodemographic characteristics of HIV-positive mother-child pairs in the southwest of Nigeria. The aim was to identify factors that will be helpful in designing initiatives for preventing mother to child transmission (MTCT) of the virus. It was a hospital-based, case-control study carried out at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from August 2000 to July 2002. Eligible mother-child pairs identified at the paediatric department, who consented to participate in the study, were interviewed using semi-structured questionnaires and screened for HIV seropositivity. Ninety-three (46.7%) of 199 mother-child pairs were HIV-positive. When compared with the 106 HIV-negative mothers, the HIV-positive mothers were younger, unemployed, had earlier sexual exposure, lower education and were married to polygynous spouses. It is recommended that initiatives designed to reduce MTCT of the HIV virus in the southwest of Nigeria should include education and improvement of the economic status of female adolescents; promotion of cultural practices such as virginity until marriage while discouraging polygyny and early marriage. Health education on prevention of HIV infection should target potential mothers and their partners.

Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date

BACKGROUND

HIV is contracted most frequently at birth and during early adulthood. The epidemic may thus impact the demographic structure and the household structure of affected populations.

METHODS

This paper reviews earlier evidence of such an impact, uses demographic theory to anticipate its changes over time, and reviews the most recent evidence for indications of these changes.

RESULTS

Modest increases in the male : female ratio are beginning to show within certain age groups only (approximately 15% among 25-34 year olds). Similarly sized increases in the proportion of 15-29 year olds relative to 30-54 year olds are observed in some age pyramids. These 'youth bulges' are expected to fade out, whereas an aging effect phases in with the fertility impact of the epidemic. In the longer run, the size of all age groups will be reduced, but relatively less so for middle-aged adults. Proportions of orphans and widows have increased in the most affected countries. Fewer remarriage probabilities for widows were observed. Resulting increases in the proportion of female-headed households should only be temporary, as female mortality is catching up with male mortality. The number of double orphans is beginning to increase, but overall, orphans continue to live predominantly with a family member, most often the grandparents if not with the surviving parent.

CONCLUSION

To date, the epidemic's impact on the population and household structure has been limited by demographic (aging) and social (adaptive movements of kin across households) processes that contribute to diffuse the epidemic throughout the entire population and all households.

Pregnant or positive: adolescent childbearing and HIV risk in KwaZulu Natal, South Africa

In communities where early age of childbearing is common and HIV prevalence is high, adolescents may place themselves at risk of HIV because positive or ambivalent attitudes towards pregnancy reduce their motivation to abstain from sex, have sex less often or use condoms. In this study, we analyse cross-sectional survey data from KwaZulu Natal, South Africa, to explore whether an association exists between the desire for pregnancy and perceptions of HIV risk among 1,426 adolescents in 110 local communities. Our findings suggest that some adolescents, girls more than boys, were more concerned about a pregnancy if they lived in environments where youth were perceived to be at high risk of HIV infection. The probability that pregnancy was considered a problem by boys was positively correlated with the proportion of adult community members who thought youth were at risk of acquiring HIV, and for girls by the proportion of peers in the community who thought youth were at risk of HIV. We also found that becoming pregnant would be a bigger problem for the African girls than the white and Indian girls. The analysis suggests that for some adolescents, in addition to effects on educational and employment opportunities, the danger of HIV infection is becoming part of the calculus of the desirability of a pregnancy.

Coercive sex in rural Uganda: Prevalence and associated risk factors

Despite growing recognition of the problem, relatively little is known about the issue of coercive sex in developing countries. This study presents findings from a community-based survey of 4279 reproductive-aged women in current partnerships in the Rakai District of Uganda carried out in 1998-99. One in four women in our study report having experienced coercive sex with their current male partner, with most women reporting its occasional occurrence. In a regression analysis of risk factors for coercive sex, conventional socio-demographic characteristics emerged as largely unpredictive of the risk of coercive sex. Behavioral risk factors-most notably, younger age of women at first intercourse and alcohol consumption before sex by the male partner-were strongly and positively related to the risk of coercive sex. Coercive sex was also strongly related to perceptions of the male partner's HIV risk, with women who perceived their partner to be at highest risk experiencing almost three times the risk of coercive sex relative to low risk partnerships. Supplemental analysis of 1-year longitudinal data provides additional support for the hypothesis that coercive sex may frequently be a consequence of women's perceptions of increased HIV risk for their male partner. The findings of this study are discussed in terms of the need for sexual violence prevention programs more generally in settings such as Uganda, and in terms of the possible importance of incorporating issues of sexual and physical violence within current HIV prevention programs.

Virginity testing: managing sexuality in a maturing HIV/AIDS epidemic

KwaZulu-Natal province in South Africa is currently the site of the world's fastest growing HIV/AIDS epidemic, where it is estimated that between 30 and 40 percent of the adult population is seropositive for HIV. With support from local politicians and members of various government ministries, several self-styled guardians of tradition have emerged to form organizations that advocate and conduct regular virginity testing of girls. Reference to the current HIV/AIDS epidemic is central to calls for greater support of this practice. Drawing on original research among Zulu-speaking people in the periurban communities of Durban, this article examines the sociocultural construction of HIV/AIDS and locates the growing popularity of virginity testing within a gendered meaning-making process consistent with commonly held beliefs that the epidemic is the result of women being sexually "out of control." With the social impact of AIDS starting to take its toll in the forms of increasing AIDS-related deaths and a growing population of orphans, I argue that virginity testing is an attempt to manage the epidemic by exerting greater control over women and their sexuality. In addition, virginity testing of girls helps to draw attention away from the role of men in the maturing epidemic, consideration of which has been conspicuously absent in the popular discourse on AIDS at all levels of South African society.

Determinants of perinatal health problems in Kisumu district, Kenya

Perinatal health is a good indicator of both maternal health status and the level of socioeconomic status attained in any community. This article presents part of the findings of a research project conducted in 1997 by the author to look at the determinants of maternal and perinatal health in Kisumu district of Kenya. Data were collected from four health facilities within the district which were selected through purposive sampling to act as sentinel centres. In total, 1,455 obstetric cases were enumerated and those with perinatal complications were isolated. Perinatal health status was measured by the frequency of low birth weights, neonatal deaths, still‐births, and early neonatal morbidity. Cross‐tabulations and multivariate analysis have been used to identify the major risk factors of the perinatal health problems identified in the study area. Among other things, the study reveals that the risk of most perinatal complications is significantly increased by maternal and environmental factors. These include poor pregnancy care, malaria and anaemia during pregnancy, poor socioeconomic conditions of the mother and poor sanitary conditions in the household. Any policy measure aimed at promoting perinatal health should seek to address all these factors.

Participatory diagramming as a means to improve communication about sex in rural Zimbabwe: a pilot study

It is increasingly recognised that unequal gender relations and poor communication between men and women about sexual matters, play a central role in the rapid transmission of HIV in sub-Saharan Africa. Analysis of how communication might practically be improved remains a critical area for investigation however. To this end a pilot study, conducted in January 1998 involving two all-female focus groups in two rural areas of Zimbabwe, explored the possibility of using 'participatory' methods and visual diagramming as a means to facilitate rural people's communication about issues of sexual health. While still provisional, the results hold considerable interest for future HIV/AIDS work in the region. As a research tool, diagramming provides richer, more nuanced data about sexual activity than wholly discursive focus groups. However, the technique also holds considerable potential for action research and positive interventions that seek to facilitate couples' more open communication and safer sexual decision making. The pilot established both that rural women were comfortable utilising the techniques and that they were prepared to use them to discuss the detail of their sex lives. The next and vital step, as participants themselves suggested, is to involve men in similar self-analytical activities.

Indigence, marginalization and HIV infection among Brazilian cocaine users

In recent years the HIV/AIDS epidemic in Brazil has increasingly affected younger and more impoverished segments of the population. The rate of infection among drug users has also risen dramatically over the past decade. Despite these alarming trends, epidemiologic studies of indigent drug users in Brazil are virtually nonexistent. In order to fill this void, a research demonstration program was initiated in Rio de Janeiro which targeted drug users from the poorest strata of society, assessed their HIV risk behaviors and serostatus, and provided HIV prevention counseling, hygiene materials, and follow-up. Because participation in the intervention program appeared to impact on drug use and sexual risk behaviors, the implementation of successful prevention programs with this population appears feasible. In that HIV prevalence among this sample of poor injectors was markedly lower than that reported in previous studies of higher socioeconomic status injectors, the timely and widespread implementation of risk reduction strategies assumes great importance for the prevention of HIV infection in the most marginalized segments of Brazilian society.

HIV risk behaviors become survival techniques for aboriginal women

In northern Alberta, the Aboriginal (native) female population appears to be overrepresented in the HIV statistics. A qualitative research study was designed to explore the cultural factors that relate to the high HIV infection rate in these women. Eight HIV-positive women were interviewed for the study, representing about one third of the population. A model was developed to explain the relationships that exist between the women's formative years, their self-esteem, and the survival techniques they used prior to becoming HIV-positive. These survival techniques may have placed them in situations that increased their risk of infection with the HIV virus.

Community participation in HIV prevention: problems and prospects for community-based strategies among female sex workers in Madras

The concept of strengthening community action within the context of HIV prevention is gaining popularity among health circles, with organizations such as gay volunteer groups in the U.S. providing positive evidence of the potential role of community participation in HIV/AIDS prevention and care efforts. Care must be taken, however, in assuming that participation can easily be achieved among all high-risk groups. This paper examines problems and prospects for participation in HIV prevention strategies among commercial sex workers (CSWs) in Madras. Based upon the experiences of a pilot project established by the Tamil Nadu State Government AIDS Cell and WHO, it finds that the organization of the commercial sex trade in Madras is not highly conducive to collective action. Identifying factors that have frustrated attempts to promote community-based strategies in the city, the paper suggests that this approach is unlikely to succeed unless there are significant changes to the institutional arrangements that keep sex workers in a position of subordination and exploitation.

Use of Culture Care Theory with Baganda women as AIDS caregivers

In Uganda, AIDS patients are increasingly cared for at home by women in their traditional role of family caregiver. This transcultural nursing study utilized Leininger's (1991) Culture Care Theory to discover the meanings, patterns, and expressions of AIDS caregiving for Baganda women. Ethnonursing, supported by life history and Leininger's (1988, 1990, 1991, 1993) Sunrise Model, was used to discover care among 12 key and 25 general Baganda informants providing AIDS caregiving to family members at home. In-depth interviews were conducted with informants selected from home-based nursing care programs in the Rakai/Masaka and Kampala areas. Data were analyzed using Leininger's (1990) Phases of Ethnonursing Analysis for Qualitative Data. Six major themes were identified. The findings highlighted the struggle of Baganda women to provide care and love for family members with AIDS, identified intergenerational care as essential for survival and prevention of HIV infection, and offered insight into improving the quality of life for those who are HIV positive. Care knowledge from these findings can be used to provide culturally congruent nursing care to Baganda families who are affected by AIDS through the three modes of action and decision of the theory.

Social roles and physical health: the case of female disadvantage in poor countries

Women's culturally and socially determined roles greatly impair their health and that of their children through a complex web of physiological and behavioural interrelationships and synergies that pervade every aspect of their lives. Women's roles also affect their use of health services since modern health care has been absorbed so successfully into traditional structures that families tend to allocate it, like food, according to characteristics such as sex and age. Change may be occurring through the agency of female education and a redefinition of familial relationships, both of which operate to improve women's position, and hence their health. Health services could perhaps accelerate the process by revising their view of women as the natural guardians of their family's health, and by drawing other family members, and particularly husbands, into their orbit.

Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya

OBJECTIVES

The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya.

METHODS

A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors.

RESULTS

Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic.

CONCLUSIONS

Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

The social impact of HIV/AIDS in developing countries

This paper highlights some of the main areas of social impact of HIV and AIDS in developing countries and suggests that these must constitute priority areas for action among international and national policy makers, as well as others concerned with HIV and AIDS. The areas of impact which are considered are: economic and demographic; labour productivity; agricultural production and development; pressures on the health sector; the role of families and households; children; women; HIV/AIDS discrimination; and the impact of HIV/AIDS on the individual. Some of the responses which have already been developed to the impact of HIV and AIDS are considered, and many of these are seen to be at least partially effective ways of addressing some of the consequences of pandemic. The paper concludes however that the escalating cost of HIV and AIDS, in personal, social and economic terms, demands a greater degree of considered, concerted and coordinated action by international, national and local agencies.

Risking everything? Risk behavior, behavior change, and AIDS

Inquiry into the determinants of risk-related sexual behavior is important for the development of interventions to reduce the incidence of new cases of human immunodeficiency virus infection. Recent social and behavioral research has revealed much about the individual and social factors influencing risk-taking. Findings from these studies have been important in the development of new educational and community-based interventions for communities at risk in the developed and developing worlds.

Knowledge and meaning: the AIDS education campaign in rural northeast Thailand

Nearly 80% of Thailand's population live in the rural sector. To date, these villages have been subject to top-down dissemination of HIV/AIDS education information via the mass media and bureaucratic networks. This report details an ethnographic enquiry into the impact education campaigns are having in one village in Northeast Thailand. It is found that AIDS information is primarily integrated with local conceptions of sexual behaviour and commercial sex. By the early 1990s, heterosexual behaviour is a major mode of HIV transmission in Thailand. Local and international media discourse focuses on the commercial sex industry in describing the spread of the virus. However, the lack of detailed research of sexual practices in Thailand makes accurate projections of HIV transmission difficult and allows unsubstantiated claims to be made concerning typical Thai sexual behaviour. This paper explores the local context in which these practices are found and discusses the meanings villages attached to HIV/AIDS information. Knowledge levels and behaviour change are assessed and it is argued that community based imperatives are essential for effective future campaigning.

AIDS action-research with women in Kinshasa, Zaire

AIDS has assumed epidemic proportions in Central Africa. Knowledge of culturally constructed gender relations and sexual meanings is crucial to developing prevention strategies and reducing the impact of AIDS. CONNAISSIDA, a transdisciplinary medical anthropology research project, developed culturally appropriate community-based empowerment workshops. These used cognitive, emotional and social stimulants to provoke critical reflection and action. Collaborative relationships developed in workshops were used to study sexual relations in many contexts. Significant changes in knowledge and action were observed. Nevertheless, economic necessity and inequality limited the ability of many women to avoid sexual risk. Economic crisis, structural adjustment and debt reimbursement policies have exacerbated poverty, particularly among women. Linking macrolevel political economy to microlevel sociocultural analysis shows how strategies adopted for survival contribute to sexual risk. Therefore broader socioeconomic changes that reduce poverty and gender subordination are necessary to control the HIV/AIDS epidemic. Findings from Zaire are widely applicable in the region.

African women's control over their sexuality in an era of AIDS. A study of the Yoruba of Nigeria

Very limited knowledge is available about African women's control over their sexual relations with husbands or other stable partners in situations where there is a high risk of STDs and HIV/AIDS. Such control must be seen as encompassing women's control over their sexuality and reproduction as well as the broader areas over which they can make decisions. The paper examines other research findings in sub-Saharan Africa, and then reports a study carried out by survey and anthropological methodologies among the Yoruba people in Ado-Ekiti, a town in southwestern Nigeria. Because the AIDS epidemic is still at an early stage in Nigeria and because of the relation of STD infection to HIV-transmission, as well as the probability that the behaviour developed for limiting STD transmission will subsequently be employed to limit HIV transmission, the study focused on STDs. Yoruba women have a considerable ability to refuse sexual relations for a limited time, and they are placed at greater risk of STD infection by their ignorance of whether their partner is infected than by a lack of ability to control the situation when STDs have been identified. This ability may be more limited in the case of AIDS because of its longer duration.

The competing discourses of HIV/AIDS in sub-Saharan Africa: discourses of rights and empowerment vs discourses of control and exclusion

The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.

The impact of HIV/AIDS on the family and other significant relationships: the African clan revisited

Although changing in size, structure and function, the African family has persistently maintained its place as the central human social unit. Beyond the traditional African family--whether in the nuclear or the extended form--is a network of people, most of whom are connected by kin or blood relationships, termed the clanship system. Patterns of family treatment and care are deeply embedded in this wider kinship system. The AIDS epidemic has caused adverse psychosocial and economic consequences leading to change in the family structure, and thus disturbed the capacity of the nuclear and extended family to respond to the needs of members afflicted by HIV and AIDS. Hence, the clanship system could become the locus of AIDS activity designed to ensure the well-being and continuity of the family where its leadership undertakes to sustain, to reorganize, or to create wholly new families or structures among populations being devastated by AIDS. New associations based on common emotional bonds of caring beyond kinship ties will be necessary to support some vulnerable members. However, for such to prove durable in the troubled socio-economic context of Sub-Saharan Africa, these will need strong links to or derive their legitimacy from the resilient traditional social network, the African kinship system.

Women and AIDS in developing countries

It is estimated that 8-10 million people worldwide are infected with HIV, the virus causing AIDS; a large proportion live in developing countries. A review of the recent literature reveals that the impact of HIV/AIDS is particularly great on women in developing countries for four reasons. (1) Stereotypes related to HIV/AIDS have meant that women are either blamed for their spread or not recognized as potential patients with the disease. The consequences can be: delayed diagnosis and treatment, stigmatization, loss of income and violations of human rights. (2) Women are at increased risk of exposure to HIV infection for reasons related indirectly and directly to their gender. (3) The psychological and social burdens are greater for women than men in a similar situation. These include: problems related to pregnancy and motherhood; rejection as marital partners, loss of security and income (if they or their partners are seropositive); and greater demands to cope with the effects of the epidemic, both as lay persons and professionals. (4) Women's frequently low socioeconomic status and lack of power make it difficult for them to undertake prevention measures. Prevention programs targeting sex workers have begun and need to be continued. However, more programs are needed for women in general, including older women, men, traditional health practitioners and opinion leaders, incorporating seropositive women wherever possible. In addition, HIV/AIDS-related research regarding women must be increased as well as their access to adequate health services and income-earning opportunities.