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The Politics of Prevention
AIDS kills over two million people every year and nearly 33 million people are infected with HIV worldwide. However, HIV prevention has slipped down the international agenda and meaningful attempts to tackle it are hampered by religious ideology and power struggles.
This book brings together stories from around the world that explore and expose the underlying 'politics of prevention' which deny millions of people life-saving education. The larger issues and trends in the global fight against AIDS are also studied, including the rise of the controversial abstinence-only movement in the US, which is now being exported to Africa.
In response to the unfavourable political climate, those worst affected by the crisis are becoming politicised in order to overcome the inertia in the international community and take truly effective action against AIDS.
eBook
HIV/AIDS Counseling Skills and Strategies: Can Testing and Counseling Curb the Epidemic?
The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic is in its third decade and has reached to alarming proportions worldwide. According to the Centers for Disease Control and Prevention, more than one million people are living with HIV with an estimated 56,300 infections happening each year in the United States. Diagnosis of HIV/AIDS via early testing along with pretest and post-test counseling is important for psychosocial stabilization and destigmatization. Risk reduction counseling as a preventive counseling method is equally important in high-risk individuals such as adolescents, substance abusers and in gay and bisexual population. The purpose of this review is to address a number of counseling strategies used for education and counseling of individuals at risk of getting HIV/AIDS and also among those who are HIV-infected.
In order to collect materials for this review, a detailed search of CINAHL, MEDLINE, ERIC, Academic Search Premier, Scopus, Web of Science and Social Sciences Citation Index databases was carried out for the time period 1995-2010.
Some of the various dimensions of counseling are negative approach counseling, assessing readiness to change, and motivational enhancement therapy.
Multiple approaches are used by counselors in providing education and prevention counseling to 'at risk' individuals and also individuals who have been infected with the virus. No one method is superior to another and some gamut of techniques are practiced by HIV/AIDS counselors.
Journal Article
Association of HIV Education with HIV Testing and Sexual Risk Behaviors Among US Youth, 2009–2017: Disparities Between Sexual Minority and Sexual Majority Youth
HIV remains a serious concern among youth, particularly among sexual minority youth (SMY). Risk behaviors including low rates of HIV testing and inconsistent condom use as well as use of substances before sex contribute to these disparities. Therefore, HIV education in schools may be a valuable tool for reducing HIV-related risk behaviors. Using a large, pooled sample of youth (N = 169,468) from the 2009–2017 Youth Risk Behavior Survey (YRBS), we conducted the first population-level assessment of associations between HIV education and risk behavior prevalence among high school–aged youth by sexual behavior (i.e., sex of sexual partner [s]) in the USA. Results demonstrated that racial/ethnic minority youth and SMY were less likely to have received HIV education than White or heterosexual peers. HIV education was associated with less substance use at last sex. Among males, HIV education was associated with increased condom use and HIV testing, emphasizing its promise as a potential intervention for risk behavior reduction. Results are discussed in light of current literature with future recommendations.
Journal Article
AIDS Clinical Research in Spain—Large HIV Population, Geniality of Doctors, and Missing Opportunities
The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.
Journal Article
Internationalisation of African higher education : towards achieving the MDGs
In today's globalised world, which prioritises economic growth through liberalised trade and competitive market strategies, much emphasis has been placed on higher education's ability to produce graduates to serve the labour market and produce new knowledge for the knowledge economy. While these are important contributions, the book argues that international higher education and new knowledge must go beyond economic purposes and serve the human and social development needs of the continent.
eBook
Age and regional disparity in HIV education among migrants in China: migrants population dynamic monitoring survey, 2014–2015
Objective
A lack of education among migrants remains an important but overlooked issue that indirectly contributes to HIV transmission. It is necessary to know who has received HIV education and who has a lower probability of being educated among migrants across different regions and age groups in China.
Methods
We used pooled data from the 2014 and 2015 Migrants Population Dynamic Monitoring Survey. The study population included 406,937 Chinese migrants. Participants were asked whether they had received any HIV education after migrating to the destination city. Regions were categorized into east-coast, central, northwest, southwest, west-Tibet, west-Uyghur, and northeast regions. Hierarchical logistic regression modeling was conducted to investigate the relationships between the independent variables and HIV education.
Results
Of 406,937 participants, half (50.6%) had reported receiving HIV education. Individuals in the west-Uyghur region had the highest proportion of receiving HIV education (73.0%), followed by the southwest region (67.9%) and the west-Tibet region (54.8%). Methods of receiving HIV education varied among different age groups. Individuals who were in a region with a higher prevalence of HIV, a lower density of medical professionals, and a higher density of migrants were more likely to receive HIV education.
Conclusions
The study showed significant regional disparities among migrants in China. More HIV resources need to be allocated to regions with large-scale floating populations, such as the east-coast region. Providing multiple options, including both new and traditional media, for both young and elderly migrants is essential. HIV education should be tailored to the age of migrants with low educational and income levels.
Journal Article
Linking Criminal Justice-Involved Individuals to HIV Preexposure Prophylaxis: A Qualitative Analysis of Multiple Stakeholder Perspectives
Objective
Although incarcerated individuals are at disproportionately higher HIV risk compared to the general US population, few jails offer linkage to preexposure prophylaxis (PrEP). We explored stakeholder perspectives about barriers and facilitators to PrEP for justice-involved individuals.
Methods
Semi-structured interviews were conducted with three stakeholder groups in Dallas County, Texas: justice-involved individuals (n = 8), County Jail staff (n = 9), and employees of local community organizations that provide PrEP services (n = 9). Transcripts were analyzed using a combined deductive and inductive approach.
Results
Barriers to PrEP linkage included: limited provider knowledge of and capacity for PrEP care, stigma around incarceration and PrEP, and mistrust in healthcare and criminal justice systems among justice-involved individuals. Perceived facilitators included addressing competing priorities, partnering with community organizations, and providers' cultural competency training.
Conclusion
Future research should focus on adapting successful implementation strategies to the needs of justice-involved populations to improve HIV prevention and health outcomes in high-burden regions like the Southern USA.
Journal Article
Promotion of couples’ voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia
Background
Many African adults do not know that partners in steady or cohabiting relationships can have different HIV test results. Despite WHO recommendations for couples’ voluntary counseling and testing (CVCT), fewer than 10 % of couples have been jointly tested and counseled. We examine the roles and interactions of influential network leaders (INLs) and influential network agents (INAs) in promoting CVCT in Kigali, Rwanda and Lusaka, Zambia.
Methods
INLs were identified in the faith-based, non-governmental, private, and health sectors. Each INL recruited and mentored several INAs who promoted CVCT. INLs and INAs were interviewed about demographic characteristics, promotional efforts, and working relationships. We also surveyed CVCT clients about sources of CVCT information.
Results
In Zambia, 53 INAs and 31 INLs were surveyed. In Rwanda, 33 INAs and 27 INLs were surveyed. Most (75 %–90 %) INAs believed that INL support was necessary for their promotional work. Zambian INLs reported being more engaged with their INAs than Rwandan INLs, with 58 % of Zambian INLs reporting that they gave a lot of support to their INAs versus 39 % in Rwanda. INAs in both Rwanda and Zambia reported promoting CVCT via group forums (77 %–97 %) and speaking to a community leader about CVCT (79 %–88 %) in the past month. More Rwandan INAs and INLs reported previous joint or individual HIV testing compared with their Zambian counterparts, of which more than half had not been tested. In Zambia and Rwanda, 1271 and 3895 CVCT clients were surveyed, respectively. Hearing about CVCT from INAs during one-on-one promotions was the most frequent source of information reported by clients in Zambia (71 %). In contrast, Rwandan couples who tested were more likely to have heard about CVCT from a previously tested couple (59 %).
Conclusions
CVCT has long been endorsed for HIV prevention but few couples have been reached. Influential social networks can successfully promote evidence-based HIV prevention in Africa. Support from more senior INLs and group presentations leveraged INAs’ one-on-one promotions. The INL/INA model was effective in promoting couples to seek joint HIV testing and counseling and may have broader application to other sub-Saharan African countries to sustainably increase CVCT uptake.
Journal Article
Conflicting HIV/AIDS Sex Education Policies and Mixed Messaging among Educators and Students in the Lower Manya Krobo Municipality, Ghana
While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10–24 years, Ghana’s national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health’s HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15–24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people’s risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.
Journal Article