This document summarizes research from the Malawi Diffusion and Ideational Change Project on misconceptions regarding responses to AIDS in rural Malawi. It discusses research showing that contrary to common beliefs, rural Malawians (1) do openly talk about AIDS and sex, (2) are worried about AIDS and take preventative measures rather than being fatalistic, and (3) are willing to get tested for HIV despite concerns about stigma. The document cautions that holding misconceptions about rural populations can undermine prevention efforts and recommends disseminating correct epidemiological information while maintaining skepticism about conventional wisdom.
OU Med School "Screen to Save" PresentationSherry Clark
This document discusses healthcare and screening for domestic violence. It notes that domestic violence affects millions of women each year and often presents physically, with symptoms like headaches, abdominal pain, and depression. Screening questions are suggested to help identify abuse. The role of healthcare providers is to routinely screen female patients, report abuse if requested, refer patients to support services, and document findings. Mandatory reporting is required for suspected child or elder abuse. The goal is to recognize abuse early and help victims access support.
Women are diagnosed with bipolar disorder on average 3.2 years later than men and are more likely to experience a delay in seeking treatment. They are also more likely to have a depressive first episode and experience more rapid cycling of moods. Women tend to have more severe depressive episodes and mixed episodes than men. Improving recognition of gender differences and barriers to recovery such as unemployment, lack of social support and exploitation could help enhance quality of life and management of symptoms for women living with bipolar disorder.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
This document summarizes HIV/AIDS transmission trends in Russia and the United States. In Russia, high rates of intravenous drug use and unprotected sex have led to over 940,000 people living with HIV despite limited treatment availability. Street youth are particularly vulnerable, with 37.4% testing positive. In the US, over 1.1 million people have HIV, primarily spread through sexual behavior. New prevention methods like PrEP drugs and greater access to antiretroviral therapy have helped control the epidemic. Social stigmas and a lack of education continue to hamper prevention efforts in both countries.
OU Med School "Screen to Save" PresentationSherry Clark
This document discusses healthcare and screening for domestic violence. It notes that domestic violence affects millions of women each year and often presents physically, with symptoms like headaches, abdominal pain, and depression. Screening questions are suggested to help identify abuse. The role of healthcare providers is to routinely screen female patients, report abuse if requested, refer patients to support services, and document findings. Mandatory reporting is required for suspected child or elder abuse. The goal is to recognize abuse early and help victims access support.
Women are diagnosed with bipolar disorder on average 3.2 years later than men and are more likely to experience a delay in seeking treatment. They are also more likely to have a depressive first episode and experience more rapid cycling of moods. Women tend to have more severe depressive episodes and mixed episodes than men. Improving recognition of gender differences and barriers to recovery such as unemployment, lack of social support and exploitation could help enhance quality of life and management of symptoms for women living with bipolar disorder.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
This document summarizes HIV/AIDS transmission trends in Russia and the United States. In Russia, high rates of intravenous drug use and unprotected sex have led to over 940,000 people living with HIV despite limited treatment availability. Street youth are particularly vulnerable, with 37.4% testing positive. In the US, over 1.1 million people have HIV, primarily spread through sexual behavior. New prevention methods like PrEP drugs and greater access to antiretroviral therapy have helped control the epidemic. Social stigmas and a lack of education continue to hamper prevention efforts in both countries.
This study examined the prevalence of coercive sex among adolescents in Uganda. The findings were:
1) Over half (51%) of sexually active youth reported experiencing sexual victimization, and more than one third (37%) reported perpetrating sexual coercion.
2) Girls were more likely than boys to be victims, while boys were more likely than girls to be perpetrators. However, high rates of both victimization and perpetration were reported among boys and girls.
3) The average reported age of first sex was 15, but over 40% reported first having sex at age 12 or younger. Over half of adolescents also reported not being willing during their first sexual experience.
This document summarizes research on mortality and psychiatric outcomes for young offenders in Finland. It finds that juvenile delinquents have significantly higher rates of both natural and unnatural mortality compared to controls. Specifically, those with a history of violent offenses had higher mortality. It also found that adolescent delinquents have a high risk of later being diagnosed with schizophrenia. While Finland emphasizes rehabilitation over criminal sanctions, intervention efforts have not fully reduced health inequities for offenders. Earlier identification and treatment of conduct disorders, including those with callous-unemotional traits, may help improve long-term outcomes.
The document discusses personality disorders and eating disorders, including prevalence found in epidemiological studies. Some key findings are that 11.9% of people meet criteria for a personality disorder, with 6.8% for Cluster C disorders. Eating disorder lifetime prevalence includes 0.9% for anorexia in women, 1.5% for bulimia, and 3.5% for binge eating disorder. Eating disorders are associated with other conditions like mood and anxiety disorders.
The Effect of Psychological Conditions on Sexuality: A Review_Crimson PublishersCrimsonpublishersPPrs
Depression and anxiety are frequently associated with sexual dysfunction in both men and women. Epidemiological studies have found that 12-month prevalence of at least one sexual dysfunction is between 30-70% in sexually active adults in high-income countries. Most research has shown that depression is correlated with reduced libido and sexual interest, though a minority of depressed individuals report increased interest. Schizophrenia has also been shown to impact sexuality, with schizophrenic individuals reporting sexual hallucinations and being at high risk for unsafe sex and sexually transmitted diseases. Counseling can help address underlying causes of sexual dysfunctions not related to medical issues.
This document discusses disparities in HIV among men who have sex with men (MSM) and the role of social determinants. It notes that addressing social conditions and drivers of HIV vulnerability through structural approaches is a key part of moving from an emergency response to a long-term response for AIDS. Several findings are highlighted: MSM have much higher HIV prevalence than general populations in many countries; criminalization of homosexuality and lack of funding targeting MSM undermine HIV prevention efforts; and experiences of discrimination, financial hardship and lack of social support are associated with higher risk sexual behaviors among MSM. Overall, the document emphasizes that effectively addressing the social drivers of the HIV epidemic among MSM through structural interventions is important for reducing disparities.
This study examined the relationship between trauma and alcoholism using data from 167 adults. Childhood physical and sexual abuse were associated with increased risk of earlier alcoholism onset. Those who experienced trauma also had higher odds of alcoholism, with odds ratios increasing with the number of trauma types. Both childhood abuse traits predicted earlier onset in multivariate models adjusting for covariates. A family history of alcoholism also increased risk and may interact genetically with trauma to influence age of onset. The results suggest trauma is an important risk factor for alcoholism and should be considered in prevention and treatment. However, the study had limitations like sample size and additional work is needed to further examine genetic and complex risk factor interactions.
Dr. Richard Lane, MD, MPH, Director of the Master of Public Health Program at Liberty University, addresses religious objections to immunization and how the church can be a vehicle to encourage vaccination for the protection of children.
This document summarizes the key points from a presentation on health implications of transitions between the criminal justice system and community. It finds that 3% of US adults are involved in the criminal justice system annually. Former inmates face high mortality rates, especially from drug overdose, in the first 2 weeks after release. Qualitative interviews found that access to healthcare and risks of overdose are primary concerns for those released. The transitions between incarceration and community have significant impacts on individual and public health.
This presentation offers stats, trends, and factors associated with higher HIV-infection risk and how clinicians can attend to it.This was my presentation for Bayless Bahavioral Health- Didactic training on 12.10.13, it explores the HIV problem in the US and AZ and
This report summarizes findings on HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM) in Canada. Key findings include: rates of HIV are highest among MSM, who represent over 40% of new HIV infections; factors like homophobia, lack of social support, and barriers to healthcare contribute to higher vulnerability; and more research is needed on resilience, subpopulations of MSM, and culturally-competent healthcare services. The report aims to inform future research, policy, and programming to address HIV/AIDS in these communities.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
FSD is increasing and needs a scientific and an empathic approach . its a condition not only affecting the conjugal relationships but also is a major cause of infertility. This talk was delivered at the ISAR 2019 as a recent update on this very important issue
PrEP, or Pre-Exposure Prophylaxis, is a once a day pill that can be taken by an HIV negative individual to prevent HIV infection. This presentation reviews current statistics, research and policy regarding PrEP.
A formative study of drug-using women in Georgia: Setting the Stage for an RCTIrma Kirtadze M.D.
The study is assessing of development of an efficacious comprehensive women-centered drug treatment model. Thus, the proposed study will proceed by meeting four sequential aims.
Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among IDU Georgian women.
Aim 2. Identify from treatment providers their practices and perceptions regarding IDU women in the current Georgian drug treatment system.
Aim 3. Adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence-based Women’s Co-Op HIV prevention, and a case management approach for IDU Georgian women.
Aim 4. In a small-scale randomized trial, determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up.
This study examined the influence of gender roles on adherence to antiretroviral therapy (ART) among people living with HIV in Belgrade, Serbia. A survey of 68 men and 23 women found that the most common reasons for skipping doses were fear of stigma if their HIV status or sexual practices became known. Gender roles and fear of gender-based violence appeared to negatively impact ART adherence by promoting secrecy. The researchers recommend training healthcare workers and HIV service providers on gender issues to help overcome barriers to adherence related to perceptions of gender and stigma.
HIV Remains a Key Killer in Zambia: Results of Community-Based Mortality Surv...MEASURE Evaluation
1) HIV/AIDS remains the leading cause of death in Zambia, accounting for 28.4% of adult deaths and over 7% of child deaths based on community mortality surveillance data from 2010-2012.
2) Other major causes of death included malaria (19.3% of deaths), tuberculosis (9.8%), diseases of the circulatory system (10.9%), and injuries/accidents (9.8%).
3) The study highlights the ongoing burden of HIV/AIDS in Zambia and the need for continued support of antiretroviral and palliative care programs.
smAlbany 2013 People hacking with social media 07 17 2013Liberteks
This document discusses social media security challenges for businesses and provides recommendations for addressing those challenges. It begins with introductions of the presenters and an overview of social media security issues. It then provides examples of how employees have misused social media to the detriment of their employers. Recommendations include developing social media policies, training employees, testing security measures, and planning for potential issues. The document emphasizes the importance of communication and supervision for addressing social media risks. It concludes with a discussion of supporting technology and social media policies in the workplace.
Ryoji Noyori was born in 1938 in Japan and won the Nobel Prize in Chemistry in 2001 for his work developing chiral catalysts for asymmetric hydrogenation reactions. Some of his key accomplishments include developing ruthenium and rhodium complexes with BINAP ligands that allow for the asymmetric hydrogenation of alkenes. This has enabled the commercial production of drugs like naproxen. He has also developed catalyst systems for other asymmetric reactions and his methods are used industrially, such as for the production of menthol.
This study examined the prevalence of coercive sex among adolescents in Uganda. The findings were:
1) Over half (51%) of sexually active youth reported experiencing sexual victimization, and more than one third (37%) reported perpetrating sexual coercion.
2) Girls were more likely than boys to be victims, while boys were more likely than girls to be perpetrators. However, high rates of both victimization and perpetration were reported among boys and girls.
3) The average reported age of first sex was 15, but over 40% reported first having sex at age 12 or younger. Over half of adolescents also reported not being willing during their first sexual experience.
This document summarizes research on mortality and psychiatric outcomes for young offenders in Finland. It finds that juvenile delinquents have significantly higher rates of both natural and unnatural mortality compared to controls. Specifically, those with a history of violent offenses had higher mortality. It also found that adolescent delinquents have a high risk of later being diagnosed with schizophrenia. While Finland emphasizes rehabilitation over criminal sanctions, intervention efforts have not fully reduced health inequities for offenders. Earlier identification and treatment of conduct disorders, including those with callous-unemotional traits, may help improve long-term outcomes.
The document discusses personality disorders and eating disorders, including prevalence found in epidemiological studies. Some key findings are that 11.9% of people meet criteria for a personality disorder, with 6.8% for Cluster C disorders. Eating disorder lifetime prevalence includes 0.9% for anorexia in women, 1.5% for bulimia, and 3.5% for binge eating disorder. Eating disorders are associated with other conditions like mood and anxiety disorders.
The Effect of Psychological Conditions on Sexuality: A Review_Crimson PublishersCrimsonpublishersPPrs
Depression and anxiety are frequently associated with sexual dysfunction in both men and women. Epidemiological studies have found that 12-month prevalence of at least one sexual dysfunction is between 30-70% in sexually active adults in high-income countries. Most research has shown that depression is correlated with reduced libido and sexual interest, though a minority of depressed individuals report increased interest. Schizophrenia has also been shown to impact sexuality, with schizophrenic individuals reporting sexual hallucinations and being at high risk for unsafe sex and sexually transmitted diseases. Counseling can help address underlying causes of sexual dysfunctions not related to medical issues.
This document discusses disparities in HIV among men who have sex with men (MSM) and the role of social determinants. It notes that addressing social conditions and drivers of HIV vulnerability through structural approaches is a key part of moving from an emergency response to a long-term response for AIDS. Several findings are highlighted: MSM have much higher HIV prevalence than general populations in many countries; criminalization of homosexuality and lack of funding targeting MSM undermine HIV prevention efforts; and experiences of discrimination, financial hardship and lack of social support are associated with higher risk sexual behaviors among MSM. Overall, the document emphasizes that effectively addressing the social drivers of the HIV epidemic among MSM through structural interventions is important for reducing disparities.
This study examined the relationship between trauma and alcoholism using data from 167 adults. Childhood physical and sexual abuse were associated with increased risk of earlier alcoholism onset. Those who experienced trauma also had higher odds of alcoholism, with odds ratios increasing with the number of trauma types. Both childhood abuse traits predicted earlier onset in multivariate models adjusting for covariates. A family history of alcoholism also increased risk and may interact genetically with trauma to influence age of onset. The results suggest trauma is an important risk factor for alcoholism and should be considered in prevention and treatment. However, the study had limitations like sample size and additional work is needed to further examine genetic and complex risk factor interactions.
Dr. Richard Lane, MD, MPH, Director of the Master of Public Health Program at Liberty University, addresses religious objections to immunization and how the church can be a vehicle to encourage vaccination for the protection of children.
This document summarizes the key points from a presentation on health implications of transitions between the criminal justice system and community. It finds that 3% of US adults are involved in the criminal justice system annually. Former inmates face high mortality rates, especially from drug overdose, in the first 2 weeks after release. Qualitative interviews found that access to healthcare and risks of overdose are primary concerns for those released. The transitions between incarceration and community have significant impacts on individual and public health.
This presentation offers stats, trends, and factors associated with higher HIV-infection risk and how clinicians can attend to it.This was my presentation for Bayless Bahavioral Health- Didactic training on 12.10.13, it explores the HIV problem in the US and AZ and
This report summarizes findings on HIV/AIDS among gay, bisexual, and other men who have sex with men (MSM) in Canada. Key findings include: rates of HIV are highest among MSM, who represent over 40% of new HIV infections; factors like homophobia, lack of social support, and barriers to healthcare contribute to higher vulnerability; and more research is needed on resilience, subpopulations of MSM, and culturally-competent healthcare services. The report aims to inform future research, policy, and programming to address HIV/AIDS in these communities.
The Effect Race and Income on HIV AIDS infection in African-Americans - Sunil...Sunil Nair
Race and Income has a significant influence on susceptibility to HIV/AIDS infections; Afro-Americans (Blacks) are 1.33 times more likely to be infected than whites. A significant finding is that the income level didn't change race's effect on HIV infections. Race has a significant effect on HIV infections or is an important predictor of incidence of HIV infections independent of the income. In other words, irrespective of the income level being black and poor increases the changes of being infected with HIV/AIDS.
FSD is increasing and needs a scientific and an empathic approach . its a condition not only affecting the conjugal relationships but also is a major cause of infertility. This talk was delivered at the ISAR 2019 as a recent update on this very important issue
PrEP, or Pre-Exposure Prophylaxis, is a once a day pill that can be taken by an HIV negative individual to prevent HIV infection. This presentation reviews current statistics, research and policy regarding PrEP.
A formative study of drug-using women in Georgia: Setting the Stage for an RCTIrma Kirtadze M.D.
The study is assessing of development of an efficacious comprehensive women-centered drug treatment model. Thus, the proposed study will proceed by meeting four sequential aims.
Aim 1. Explore drug use (e.g., types and patterns), HIV and HCV injection and sexual risk behaviors, comorbid conditions (e.g., interpersonal violence, comorbid psychiatric disorders), and treatment barriers and experiences (e.g., gender discrimination) among IDU Georgian women.
Aim 2. Identify from treatment providers their practices and perceptions regarding IDU women in the current Georgian drug treatment system.
Aim 3. Adapt and pretest both a drug abuse treatment approach of Reinforcement-Based Treatment (RBT) that integrates the evidence-based Women’s Co-Op HIV prevention, and a case management approach for IDU Georgian women.
Aim 4. In a small-scale randomized trial, determine the feasibility and initial efficacy of our Georgian RBT model relative to a case management model in terms of their respective impacts on the frequency of unprotected sexual acts and syringe sharing at post-treatment and 3-month post-treatment follow-up.
This study examined the influence of gender roles on adherence to antiretroviral therapy (ART) among people living with HIV in Belgrade, Serbia. A survey of 68 men and 23 women found that the most common reasons for skipping doses were fear of stigma if their HIV status or sexual practices became known. Gender roles and fear of gender-based violence appeared to negatively impact ART adherence by promoting secrecy. The researchers recommend training healthcare workers and HIV service providers on gender issues to help overcome barriers to adherence related to perceptions of gender and stigma.
HIV Remains a Key Killer in Zambia: Results of Community-Based Mortality Surv...MEASURE Evaluation
1) HIV/AIDS remains the leading cause of death in Zambia, accounting for 28.4% of adult deaths and over 7% of child deaths based on community mortality surveillance data from 2010-2012.
2) Other major causes of death included malaria (19.3% of deaths), tuberculosis (9.8%), diseases of the circulatory system (10.9%), and injuries/accidents (9.8%).
3) The study highlights the ongoing burden of HIV/AIDS in Zambia and the need for continued support of antiretroviral and palliative care programs.
smAlbany 2013 People hacking with social media 07 17 2013Liberteks
This document discusses social media security challenges for businesses and provides recommendations for addressing those challenges. It begins with introductions of the presenters and an overview of social media security issues. It then provides examples of how employees have misused social media to the detriment of their employers. Recommendations include developing social media policies, training employees, testing security measures, and planning for potential issues. The document emphasizes the importance of communication and supervision for addressing social media risks. It concludes with a discussion of supporting technology and social media policies in the workplace.
Ryoji Noyori was born in 1938 in Japan and won the Nobel Prize in Chemistry in 2001 for his work developing chiral catalysts for asymmetric hydrogenation reactions. Some of his key accomplishments include developing ruthenium and rhodium complexes with BINAP ligands that allow for the asymmetric hydrogenation of alkenes. This has enabled the commercial production of drugs like naproxen. He has also developed catalyst systems for other asymmetric reactions and his methods are used industrially, such as for the production of menthol.
The document discusses factors that influence asset valuation and how investors determine if an asset is above or below its fair value. It states that investors will pay higher valuations for assets with improving profitability, consistency, or financial situations. It also notes that valuation should not be static and that analyzing trends in areas like margins, earnings, and performance versus peers or history can help decide if an asset is above or below fair value. The document contains additional charts and analyses to support its discussion of valuation metrics and factors.
1) The document summarizes protections for actors in mainstream films versus those in the adult film industry. Mainstream actors receive protections from organizations like the American Humane Association, while adult film actors do not have the same safeguards.
2) It also discusses whether adult film actors should be considered employees or independent contractors. Being classified as employees would entitle them to certain legal protections, while independent contractors do not receive these protections.
3) The "Economic Realities Test" used to determine employment status examines factors like the employer's control over the work and whether the work is integral to the employer's business. Applying this test could help clarify whether adult film actors are legally employees or independent contractors.
SHANE DOUGHTY PERFORMANCE REVIEW - SUPERVISORY AND MANAGERIAL 15(2)Shane Doughty
- Shane Doughty received an overall performance rating of 4 out of 5 in his role as Area Superintendent at CBI, indicating he often exceeds expectations.
- His manager praised Shane for safely closing two large material sites ahead of schedule and without safety incidents, demonstrating inspirational leadership qualities.
- Shane was described as an experienced, effective leader with strong communication, safety, and people skills who reliably delivers high quality work.
This document discusses social determinants of health as they relate to HIV risk and outcomes. It covers topics like stigma, myths, prevalence, transmission, prevention, and treatment of HIV. It also discusses the links between sexual violence and increased HIV risk. Key points include:
- Social factors like income, education, housing, and stigma influence HIV risk.
- Stigma of HIV can lead to worse health outcomes due to isolation, stress, and lack of care.
- Violence limits individuals' ability to negotiate safer sex or end risky relationships, increasing HIV risk.
- Collaboration is needed between HIV and violence support services to address the intersection of these issues.
The document discusses the social determinants of health that influence HIV risk and outcomes, including early childhood development, education, employment, income, food/housing security, health/transportation access, social exclusion, and stigma. It notes that people living with HIV often experience high levels of stigma, leading to negative consequences like reduced testing/treatment, financial/social difficulties, and poorer mental/physical health. Intimate partner violence is also discussed as putting individuals at increased risk for HIV through barriers to condom negotiation, abuse if condoms are used, and health effects that weaken the immune system.
1) Gender issues in health include biological, physical and social differences between males and females that can impact health outcomes.
2) Key statistics provided on population and vital statistics for India show males outnumber females and females have lower sex ratios and higher mortality rates.
3) Many health conditions like heart disease, stroke, malaria and tuberculosis disproportionately impact males and females due to differences in risk factors, social roles and access to care.
Gender issues can impact health in several ways. Biologically, men and women have differences in chromosomes, hormones, physiology and risk factors for certain diseases. Socially, gender roles and inequalities influence access to resources and health outcomes. For many diseases like heart disease, stroke and tuberculosis, prevalence and mortality rates differ between men and women. Gender also affects exposure and vulnerability to conditions like malaria, HIV and road traffic accidents. Addressing gender in health policies, programs and research is crucial to promote equality and improve health for all.
Gender perspectives of reproductive healthvishal soyam
Gender is a social construct that defines the roles and behaviors of men and women within a society. It influences reproductive health through gender differences, inequalities, and inequities in health status and access to care between men and women. Addressing gender is important for designing reproductive health programs and achieving goals like reducing maternal mortality. India has implemented initiatives like the Reproductive and Child Health Program to promote gender mainstreaming and male participation in reproductive health. The program aims to empower women, provide a holistic health approach, and enhance men's responsibilities to help address issues like maternal mortality, family planning, and gender discrimination.
This document summarizes a presentation given to youth leaders on HIV risks and vulnerabilities. It discusses definitions of key terms, facts about HIV and AIDS, how HIV is transmitted, risks faced by out-of-school youth, impacts of HIV/AIDS, epidemiology of HIV in the Philippines, and examples of interventions youth can support like peer education and promoting condom use. The overall goal is to inform youth leaders so they can help prevent the spread of HIV in their communities.
This document provides objectives and information about sexually transmitted infections (STIs) and reproductive tract infections (RTIs). The objectives are to gain knowledge about STIs/RTIs, understand their complications, learn approaches to management, risk assessment, patient referral, education and counseling. It defines STIs and RTIs, discusses common types, symptoms, complications in men, women and babies. It covers prevalence in India, links between STIs/RTIs and HIV, and approaches to prevention, control and case management including the syndromic approach. It discusses important factors to consider when managing men and women with STIs/RTIs.
Young Gay Couples - How they use drugs and sex to stay safeYTH
Data collected from 199 young gay couples (YMSM couples) recruited through Facebook ads found that men were thoughtful about their drug use and HIV risk reduction strategies within their partnerships.
STIs are a major public health problem globally and in Malawi. Over 1 million new STIs occur worldwide each year, including many among young people under 25. STIs can increase the risk of HIV acquisition and transmission from mother to child. The document discusses STIs in Malawi, including data on reported cases and prevalence. It also covers modes of STI transmission, links between HIV and other STIs, factors that affect the spread of STIs, complications of untreated STIs, and challenges to STI prevention and management.
1. The document discusses anal cancer prevention in HIV patients, including the epidemiology of anal cancer, current screening guidelines, and treatment options.
2. Rates of anal cancer are increasing, especially among HIV-positive men who have sex with men, due to higher rates of HPV infection. Screening is recommended for high-risk groups but guidelines are based on expert opinion rather than evidence.
3. Screening involves anal cytology and visual inspection, with follow up such as high resolution anoscopy for abnormal results. Treatment options depend on the grade of anal dysplasia or cancer found. Vaccination and condoms may help reduce HPV transmission and anal cancer risk.
Theodoros F. Katsivas, M.D., M.A.S., of UC San Diego Owen Clinic, presents "San Diego Primary Care Providers' Attitudes to HIV and HIV Testing" at AIDS Clinical Rounds
HIV originated from chimpanzees in West Africa and was transmitted to humans. The earliest known case of HIV in a human was detected in 1959 in the Democratic Republic of Congo. Antiretroviral therapy uses HIV medicines to treat infection and suppress viral load, preventing transmission. Factors like viral load, condom use, and adherence to medication determine likelihood of HIV transmission. Common signs of HIV infection include fever, fatigue, swollen lymph nodes, and skin rashes.
This document discusses gender perspectives on reproductive health. It begins with definitions of key terms like gender, gender equality, and gender discrimination. It then discusses how gender impacts health and reproductive health outcomes. The document outlines international initiatives like ICPD and Beijing that recognized the importance of gender in reproductive health. It discusses reproductive health issues across the lifecycle and barriers to achieving gender equality in reproductive health. Key challenges like maternal health, family planning, and HIV are also summarized.
Planning, implementation and evaluation of education program on HIV/AIDS. .SanjayChaudhary27
1) The document outlines a plan for an education program on HIV/AIDS in Nepal. It includes an introduction to HIV/AIDS, problem statement on prevalence in Nepal, objectives to reduce transmission and stigma through education, and an evaluation plan.
2) A needs assessment identifies risk factors like unsafe sex, lack of access to healthcare, and stigma. The program's goals are to reduce infection rates, increase access to treatment, and coordinate national response.
3) The education program will provide information on transmission, prevention, treatment services, and address stigma through activities like discussion, counseling, and role-playing with targets like key populations and the community.
This document discusses various uses and methods of epidemiology. Descriptive epidemiology characterizes disease distribution, leading to hypotheses about causes. Analytical epidemiology identifies causes by testing hypotheses. Distribution patterns (who, where, when) of disease occurrence can provide clues about risk factors and causation. Medical surveillance aims to identify disease patterns, outbreaks, and changing health needs. Hypotheses about disease causation can be developed by examining correlations between suspected risk factors and disease occurrence across populations, while accounting for potential biases. Age-standardization methods like direct standardization are used to adjust rates to account for differences in population age structures when making comparisons.
Worlds AIDS Day 2016 (Peurto Rican Cultural Center & Vida SIDA) Tahseen Siddiqui
This document provides information about the HIV epidemic in the United States, with a focus on its impact and statistics regarding the Hispanic/Latino community. It discusses that Hispanics/Latinos account for a disproportionate number of HIV diagnoses compared to their population percentage. Specifically, it notes that in 2014 Hispanics/Latinos accounted for 24% of new HIV diagnoses while only representing 17% of the US population. It also summarizes some of the challenges facing the Hispanic/Latino community in terms of HIV, such as lower rates of retention in HIV care and higher rates of other sexually transmitted diseases.
This document discusses sexually transmitted infections (STIs) among adolescents and young people. It notes that adolescents and youth have high rates of STIs due to factors like early sexual debut, lack of condom use, and involvement in sex work. Left untreated, STIs can lead to serious health consequences like pelvic inflammatory disease, infertility, and increased HIV risk. While STIs are common among adolescents, healthcare providers often fail to properly screen and counsel this age group about risk reduction. Effective STI management requires taking a sexual history, clinical examination, timely treatment, and reporting of cases.
Similar to Misconceptions about AIDS in Africa: Ours and Theirs (20)
This document summarizes self-care initiatives for sexual and reproductive health. It discusses the WHO definition of self-care, and examples like the Caya diaphragm introduced in Niger through the EECO project. Over 600 diaphragm kits were sold or distributed there from 2019-2020. The DOT app was marketed in India to help women track their periods and fertility. Looking ahead, more evidence is still needed on specific self-care interventions and how to evaluate them, while building advocacy and addressing regulatory questions. COVID-19 also impacts future self-care work.
- The SASS Project aimed to assess how well California high schools complied with the California Healthy Youth Act (CHYA) standards for comprehensive sex education, from the perspective of students.
- Students at 13 LAUSD high schools completed an anonymous online survey assessing their sex ed classes' coverage of CHYA standards and classroom environment.
- Results showed a range of compliance across schools, with strongest coverage of HIV topics and weakest coverage of gender/sexuality and contraception. Classroom environment also varied, with teachers generally comfortable but time limited.
- The findings could help identify areas of improvement, but LAUSD had not yet decided to formally incorporate the student surveys or provide feedback to schools.
This document discusses the persistence of electronic fetal monitoring (EFM) despite evidence that it does not improve neonatal outcomes for low-risk pregnancies compared to intermittent auscultation. While EFM was introduced to screen for fetal distress and reduce cerebral palsy rates, multiple studies have found it does not achieve these goals. However, EFM continues to be used in 85% of deliveries and has led to increased cesarean rates and costs without clear benefits. The document examines possible explanations for EFM's persistence, including the influence of law and economics, and calls for more randomized trials before new medical technologies are widely adopted.
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Misconceptions about AIDS in Africa: Ours and Theirs
1. The Malawi Diffusion and Ideational Change Project
www.malawi.pop.upenn.edu
Professor Jere Behrman, University of Pennsylvania
Dr. Agnes Chimbiri, University of Malawi
Professor Hans-Peter Kohler, University of Pennsylvania
Professor Susan Watkins, University of Pennsylvania & CCPR, UCLA
Dr. Eliya Zulu, African Population and Health Research Centre, Nairobi, Kenya
The MDICP has been supported by the Rockefeller Foundation and NIH
3. Our Misconceptions About Responses
to AIDS in Rural Malawi
• They don’t talk about AIDS or sex
• They either deny the AIDS epidemic or are
fatalistic about prevention
• They are afraid to be tested because they will be
stigmatized
• Young single women are particularly vulnerable
because they are poor, passionless and
powerless.
4.
5. Malawi Data
Surveys
–Longitudinal panel interviewed in 1998, 2001,
2004 and 2006
–Rural sample in 3 districts
–Includes males and females, adults and
adolescents
–Sample sizes:
• 1998 and 2001, approximately 2500
• 2004 approximately 4000, (added new spouses &
1500 adolescents to rejuvenate the sample)
6. Data Quality
• Reporting: Miller, Zulu & Watkins 2000: systematic
discrepancies in reports of monogamously married
husbands and wives
• Validity--Hewett & Mensch 2007, Pop Council, ACASI,
adolescents;
• Reliability--Bignami 2003 duplicate interviews
• Attrition—Alderman et al 2000, Anglewicz et al
forthcoming
• Sample representativeness—Bignami et al 2003,
Anglewicz et al forthcoming
• Interviewer effects—Onyango 2007
8. Biomarkers
–2004 and 2006 for HIV and other
sexually transmitted infection
–Testing in homes
–Results in tents or at home
9. Consequences of morbidity &
mortality 2008-2012
• 2 more survey rounds
• biomarker-assessed health status (HIV,
CRP, TfR, EBV and glyc. hemoglobin)
• short-run nutritional status (BMI)
• anthropometric indicators of early-life
conditions (height, leg-length,
• Testosterone 2D:4D digit ratios);
10. Qualitative Data
– Interviews
• With randomly selected subsamples of the survey
respondents
• Interviews with clergy
• Ad hoc interviews & participant observation
• Data quality—mobile men
– Ethnographic field journals
Sources: Many of the interviews and field journals (anonymized for
confidentiality) are available on www.malawi.pop.upenn. See also Watkins
and Swidler 2007 for the ethnographic methods.
11. History of Prevention Efforts
• 1980s: blood screening but little else, even in
urban areas
• 1994—2001:
– President leads an AIDS march in 1994
– permits government officials to work with donors on
AIDS policy,
– permits donors to market condoms
– Increasing newspaper coverage
• 2002: Govt finalizes an “integrated behavior
change intervention strategy”
13. Conventional Wisdom
– Malawi Council of Churches 2001: Workshop
with the theme “Break the Silence”
– Muula, A. & Mfutso-Bengo, J. 2004, Nursing
Ethics : "A culture of silence and resistance to
change is prevalent in Malawi.”
– Mtika, Collins, 2005, Daily Times: “That
disease of silence is what is killing us.”
14. • Poster at office of NAC 2001. “It’s Time to Stop being
Shy”: three men, one with his eyes covered and “I don’t
want to see it”, another w/his mouth covered, “I can’t
speak about AIDS”, another with his ears covered, “I
can’t hear it.” Then “Why don’t we talk about AIDS [AIDS
in red]. We all know someone who has died of AIDS.
It’s time we began talking about AIDS. Because we
can save lives that way.”
• At the bottom, “It’s time to change–Let’s talk about
AIDS”.
20. Talking about AIDS
• After we greeted each other, Mrs. Bruce
said to me that I did well to come and
mourn for Miss Baidon because she would
have killed all the people of V___ and
other men from the outside areas. Miss
Baidon has died of AIDS as a salary or gift
for what she was doing.
21. • Her friend who [wore] a traditional suit,
green in colour and the white sandals
answered. She said that the death of Miss
Baidon has concerned her very much
because she was sleeping with her
husband. She had been quarreling with
her husband for a long time because of
her and her marriage was near to an end.
Her husband was challenging her that he
could divorce her and marry Miss Baidon.
22. • About the AIDS disease, the woman said that
her husband was advised at the church by the
church elders and the Nkhoswes [traditional
marriage counselors] that these days life is
difficult because there is no time for enjoyment
since there is the AIDS disease. Having one
woman and depend on her is a very good thing
because you can save your life and your
children’s life….Though her husband changed
his behaviour but the woman was still
worrying….
23. • Now if [Miss Baidon] was infected during
that time that she was moving with her
husband, it is openly that her husband
was also infected and if he was infected it
also means that she is also infected with
that AIDS therefore she will just die for
nothing.
24. • Her husband will kill an innocent woman
like her. The woman was very worried a
lot because she has children and she was
saying that her children will suffer a lot if
their parents will die because they are
very young…. She began crying and I told
her that she must stop crying because
[she] had no evidence that she was also
infected or not.
29. Worried about getting AIDS
Source: Table 1, K.P. Smith, S.C. Watkins. Perceptions of
risk and strategies for prevention: responses to
HIV/AIDS in rural Malawi. Social Science & Medicine 60
(2005) 652 649–660
Women 1998
(N = 878)
Men 1998
(N = 675)
Very Worried 61% 52%
Moderately worried 22% 21%
Not at all worried 17% 27%
32. Increase in justification for divorce
Women 1998
(N = 878)
Women 2001
(N = 878)
Divorce justified
if think
husband has
AIDS
16% 28%
Table 2
K.P. Smith, S.C. Watkins. Perceptions of risk and strategies
for prevention: responses to HIV/AIDS in rural Malawi.
Social Science & Medicine 60 (2005) 652 649–660
33. ** = p<.05, * = p<.1 (robust: adjusted for clustering on respondent)Reniers, Georges. “Marital strategies for managing exposure to HIV in
rural Malawi.” Forthcoming, Demography
0.01.02.03.04
0 10 20 30
marriage duration
<= 1990 >1990
by year of marriage (adj.for marriage order)
Smoothed divorce hazard
34. • Note that although the local strategies do
not provide complete protection for all
individuals, they will help some to avoid
infection. Thus, they have the potential to
reduce HIV transmission in the aggregate
and thereby to slow and perhaps reverse
the epidemic.
36. • Yoder & Matinga, 2004
– Interviewed VCT counselors
– Interviewed 200 individuals asking would they
like to be tested (hypothetical)
– Concluded that Malawians not ready for
testing
• Afraid of stigma
• Afraid because expected to be found positive and
would die from the shock
37. MDICP 2004
• Testing in homes by nurses trained by the
UNC lab
• Tests for
– HIV
– Chlamydia, gonorrhea, trich
Sources: Obare-Onyango 2007; Thornton et al 2005;
Thornton 2006; compare with Yoder and Matinga
40. Receiving results
• Receiving results:
– Social event
– Two-thirds received their results
• Lab delays
– Great happiness among 93%, esp. those who
thought they were infected but found they
were not
– Sources: Thornton 2006, Obare-Onyango
2007
41. Talking about AIDS revisited
• Disclosing HIV test result to a spouse:
• In 2006, 86% of women and 92% of men reported disclosing
their 2004 result to their spouse
• Women: There are significant differences in disclosing HIV
test result by actual HIV status for women. : 67% of HIV+
women told their test result to their spouse, compared with
86% of HIV negative women.
• There are no significant differences by HIV status for men-
over 90% of both HIV positive and HIV negative men
reported disclosing their test result to their spouse.
42. Confirmation from spouse
• Among husbands men who state that they
disclosed their HIV status to their wife, only 4.4%
of the wives disagree. Among women only 2.3%
of husbands disagree.
• By HIV status: A larger percentage of HIV
positive respondents disagree with their
spouse’s claim of disclosure.
– Perhaps due to small sample sizes, these differences
are not statistically significant.
43. Vulnerability of women
• HIV + in 2004:
– Men: 5.6%
– Women: 7.9%
Non-response analysis: Onyango 2007
44. Are young women more
vulnerable?
• Adolescents 15-19 HIV+
– Males=0.4%
– Females=1.0%
45. Young single women?
• HIV+, Women 15-24
– Unmarried Married
• 1.50 % 6.17%
• See also microsimulations of infection at lst
marriage, Bracher, Santow and Watkins 2003
47. Disease of women’s poverty-- or
disease of men’s wealth?
• “Poor, passionless, powerless women”
• Men with money
Sources: Tawfik & Watkins 2007; Swidler and Watkins,
2007; Poulin 2006 (for adolescents)
48. Their misconceptions –a short
list
• Probabilities of HIV transmission
• Duration from infection to AIDS symptoms
49.
50. Overestimating subjective
likelihood of infection
• Survey question: How likely do you think it
is that you are currently HIV+?
– Only about 10% of respondents who say it is
highly likely that they are infected are correct
Source: Anglewicz 2007; Anglewicz & Kohler 2007
51. Overestimating transmission
probabilities
• Survey question: If you have unprotected
intercourse once with an HIV+ person,
how likely are you to become HIV+?
– Over 90% said “certain” or “highly likely”
52. Consequences of “our
misconceptions”
• IEC programs: if begin by believing that people don’t talk about
AIDS, won’t ask them what they say
• Misdirect efforts to what they already know
• Don’t provide information on what don’t know
• Behavior change programs: if don’t know what they are actually
doing
• Misdirect efforts to what they are already trying to do
• Can’t learn where programs might actually help (e.g. re divorce)
• Agency: if believe that uneducated rural people can’t do anything on
their own, miss opportunities to support them in their efforts
• Testing: if use hypothetical questions, can’t know what people will
actually do
53. Discussion: “Our” misconceptions
about “Their” Misconceptions”
• “Their misconceptions” was based on
conventional wisdom circulating in the
prevention community
• Wrong for rural Malawi
54. A misconception that matters
• Overestimation of HIV transmission
• Consequences:
– Little incentive to adopt ABCs or other
prevention approaches?
– Barrier to VCT?
55. Recommendations
• For us:
– Skepticism about conventional wisdom
– better research as a foundation for
interventions
• For rural Malawians:
– Dissemination of correct & complete
epidemiological information
This paper is based on a decade of research in rural Malawi that has produced a large number of papers. These are listed on the project web site, where many of the papers are posted. If there is a paper that is listed but not posted, let me know and I’ll send it to you. The data are also available on the project website, so that you can replicate our analyses
The international community has responded to the AIDS epidemic in SSA with an outpouring of humanitarian policies and programs. I think much of this effort may be misdirected because it is based on our misconceptions about what is needed: we’ve tried to fix things that don’t need fixing, but haven’t noticed the things that do. I’m going to talk today only about the setting I know best, rural Malawi, based on analyses of the huge amount of data we have collected over the past decade. Since most policies and programs throughout the area are formulated and funded on a regional, and sometimes global, scale, it may be the case that effort and money has been misdirected elsewhere—but only detailed evidence, which I haven’t been able to find, would show that. Nonetheless, I hope that by documenting our, and their, misconceptions about AIDS in rural Malawi, others will be motivated to collect the necessary data.
Since in my presentation I will not be able to provide exhaustive evidence for each misconception, I’m going to begin by briefly listing the major sets of data we have collected over the past decade in order to convince you that I know what I’m talking about—the Trust Me defense. More precise work is in papers by members of the MDICP team, and I’ll cite the sources.
Many of the authors of these and other papers were graduate students who participated in field work and then went on to write their dissertations using the data they helped to collect: I hope that I’ll be able to attract some of the students in the audience to do the same!
All samples are from rural Malawi. The first four are built on the core MDICP sample, shown in the last slide; the other three use different samples.
The point here is that at the time our study begins, in 1998, prevention programs were few and far between. There was some dissemination, however, of basic information about the epidemiology of HIV. In a survey conducted in a rural area in 1993, 99% of men and women knew that AIDS was transmitted sexually and 95% said there was no cure for AIDS. Most respondents knew that you could be infected but look healthy and most said that AIDS could be prevented: Malawi has a long history of STDs (gonorrhea, syphilis, etc) so once they knew that HIV was transmitted sexually, they knew that it could be prevented by abstinence, fidelity and condom use, even before prevention programs start talking about the ABCs of prevention. .
1 st Misconception—people don’t talk about AIDS because of taboos, so there were campaigns to “Break the Silence”.
The conventional wisdom is that people don’t talk about AIDS or sex. This led to lots of program efforts to “break the silence”.
These newspaper articles and this poster are from 2001 to 2005. People began dying of AIDs in rural Malawi in the mid-late 1990s, so the poster is right, they all did know someone who has died of AIDS—and moreover, it was likely to be a relative, friend or neighbor whom they had seen change from healthy to thin and sick. By the time of our lst survey, in 1998, the respondents were attending 3-4 funerals a month, it is very unlikely a priori that they wouldn’t have talked about why these people died, about AIDS. And indeed they did—in 1998, well before the campaign to Break the Silence, we also asked people with how many they had talked about AIDS, the average was 3-4. And this, as you’ll see later, is likely to be an underestimate. It’s difficult to talk about AIDS without talking about sex if you know that HIV is sexually transmitted, and as early as 1993, a survey in Malawi showed that almost everyone did indeed know that HIV was transmitted sexually. Moreover, of course, sex is the stuff of scandal and gossip, it’s fun to talk about.
These women aren’t talking at the moment the picture was taken, but they surely were before we arrived with a camera. They also talk at the market, walking to the grain mill, or just visiting a neighbor.
These men hanging out at a small trading center look more like they’ve just been talking. When I tell new supervisors that our study is about gossip in social networks, they assume I’m talking about women. When I say No, men gossip also, they disagree, saying No, “men discuss”. But it turns out, of course, that men talk a lot about AIDS—and sex.
How can we learn what they are saying about AIDS and sex? Hard to find out with standard approaches—survey doesn’t provide enough time, in semi-structured interviews they are laconic (see Zulu and Chepngeno 2003), focus groups are particularly poor at getting at this. So we tried a different approach, ethnographic field journals to give us an idea of what people say in natural settings, when they are chatting with each other about AIDS and sex, rather than when they are talking to an interviewer in a project t-shirt with a clipboard or a tape recorder. How can we find out what the women and men are saying to each other?
We asked some people living in or near our research sites to be our “ears”, to simply listen to what people say about AIDS in the course of their daily lives, and then to write it down in field journals in the evening. Handwritten, then typed and sent to me. Now about 700 of these, starting in 1999, so can see change. Our field assistants are form 4 graduates, they work for us as interviewers when we are in the field I the summer, and then go back to being subsistence farmers or selling in the little markets. Their field journals are Being anonymized for public use, and coded for assessing themes and data quality. In some cases we can compare what is said in the journals with our other data. For example, the journals give the sense of profound worry about AIDS, which is supported by survey data.
I’m going to show you an excerpt from a journal that illustrates what sort of data are in the journals and the sorts of things people say about AIDS. News has gotten around the village that a member of the community has died, the journalist knows her and is walking to the funeral when she meets two other women going to the funeral. She knows one of them, but the other is a stranger to her. Nevertheless, the stranger confides her urgent concerns, seeking advice from the other two.
Miss Baidon, the deceased, was a well-known prostitute--in another journal, by another journalist, she is called a “veteran prostitute”. She started to become ill and “retired”, people could see as her body changed and one illness followed another.
It’s clear that the wife knows about her husband’s infidelity. Although newspaper articles often describe women as socialized to defer to men, and especially to their husband, this women, like many others we overhear in the journal, is neither passive for deferential—she quarreled with him. .
The woman may also have talked with her church elders and the traditional elders about her husband, since they give him advice. And it appears that he followed it. Still, she worries that it was too late—as she understands the epidemiology of HIV, he would surely have been infected by the prostitute and then certainly it would have been transmitted to her.
Situations like this are very difficult for those who are living through them, especially those who are married. What should this woman do? . In this case the advice her friends give is, I think, much like the advice that a health professional would have given—that before she does anything drastic she should get tested. But suppose she is tested and finds she is still negative? What then should she do? One solution is to persuade her husband to use condoms every single time they have sex. There’s lots of evidence that women in Malawi are pretty good at getting their way, so maybe she could. But from our data, neither women nor men want to use condoms in marriage—and who could blame them? 30 years of condom use stretching out ahead of you? I doubt that health professionals would have any better advice than frriends, relatives and neighbors who acutely experience the difficulties of living with AIDS.
A favorite topic is AIDS, and it’s hard to talk about AIDS without talking about sex.
One common stimulus to talking about both AIDS and sex is when people see or hear about someone whose body status has changed, or when there is news of a funeral—as with the “veteran prostitute”. They then try to diagnose AIDS, pooling local knowledge to see if the illness or death is due to AIDS, in what we call “social autopsies”, or “social post mortems”. They often begin by describing the symptoms. Then, because they know the symptoms of AIDS are the same as the symptoms of other diseases, like TB and malaria, they act like good empiricists—they consider evidence to confirm or reject the diagnosis. The evidence comes from their local knowledge about the medical history and the sexual history of the person who is ill or who died. This local knowledge is often remarkably detailed—they how long the symptoms have been present, what treatments the person had, whether these were at a hospital or from a traditional healer, and even who paid forit. The sexual biographies are also a crucial part of the social postmortem, and again, these are remarkably detailed—so and so had a partner Jennifer who died of AIDS, or she married a man whose first wife had died of AIDS. Extramarital affairs are the stuff of gossip and scandal, in Malawi as elsewhere: Malawians are fond of saying “there is no secret under the sun”. In interviews conducted by Linda Tawfik with a subsample of the survey respondents, women were asked whether they knew any married women who had affairs, and then how they knew this. About a third of the respondents said they did know at least one woman. Some of them had been told by the woman herself, some by someone else, who then told the respondent (and perhaps many others), and some just observed—”I saw them coming and going.” Not only that, when the interviewer asked whether the couple used condoms, we learn that some did and some didn’t. The journals are also full of stories about a man or a woman caught in flagrante, “red-handed”—typically, neighbors know about the affair and tell the innocent spouse where and when the adulterous couple meet. Among men, there are conversations where the talk about sex is even more explicit, and sometimes quite raunchy—positions, the size of the partner’s clitoris, etc. In summary, it’s quite clear both from the survey data and from the journals that there is a lot of talk about AIDS and about sex, going back to 1998, well before the campaign to “break the silence” began.
WHO tracks several “misconceptions”: surveys all over SSA report the % of respondents with “comprehensive AIDS knowledge”, including rejecting three misconceptions—that HIV is transmitted by mosquitoes, that it is transmitted by sharing plates, and that a healthy-looking person could not be HIV+. Yet in the social autopsies, when someone is diagnosed with AIDS it is never considered to be due to mosquitoes or sharing plates. People may not reject these misconceptions on a survey, but in rural Malawi they reject them in practice, when it counts. This is likely to be the same elsewhere: we analyzed UNAIDS data on these misconceptions vs HIV prevalence, by country, there’s virtually no association.
The ethnographic journals project began in 1999, just a few years after deaths from AIDS began to be evident in the villages. At that there, there were certainly people who debate whether AIDS is really a new disease, or whether it is really witchcraft or just a new name for a traditional illness associated with improper sexual behavior. The arguments can be quite lively. By the early 2000s, hoever, virtually everyone is convinced that AIDS is a new disease, it is here and it has no cure. When friends, relatives and neighbors are getting thin, suffering from diarrhea, TB and other opportunistic infections, it’s not surprising that there would be little denial. Relatives may not want to announce AIDS as the cause of death at a funeral, perhaps out of propriety, but those walking to the funeral have already made the diagnosis.
Seeing friends and neighbors is likely to lead people to worry about their own situation, and indeed they are. The survey data show that more than half are very worried, and more than two-thirds are either very worried or moderately worried. I’ve presented the survey results from 1998, to make clear that this worry goes back nearly a decade, again, well before there were widespread and intensive efforts to sensitize people about AIDS.
They are clearly worried—but are they fatalistic?
Lot of talk at boreholes and trading centers, even on buses, about strategies of prevention, before the govt’s integrated behavior change intervention policy started promoting the ABCs (and in any case, people already knew that these were the ways to prevent gonorrhea and other STIs). However, since AIDS, unlike the other STIs, had no cure, abstinence, fidelity and condom use become more salient and urgent as the epidemic spreads. Some continue to say that AIDS can’t be prevented, we will all die, but the ethnographic journals are full of debates about the best way to prevent AIDS. The main objection to the ABCs is that in their strict form they aren’t realistic. Thus, people try to adapt the ABCs in a way that will work for them. One approach is to modify the ABCs—not perfect abstinence and fidelity but fewer partners and more careful partner selection, based on the detailed local knowledge about sexual histories of neighbors; although consistent condom use is initially rejected, over time it comes to be seen as sensible to use condoms with commercial sex workers. Other strategies are new, i.e. they are not promoted by the international prevention community. This means that surveys didn’t ask about them, we only learned about them through our “ears” in the villages, from the ethnographic journals. One alternative strategy is to turn to religion for social support in resisting temptations or to drink (which they believe makes you muddle-headed so you forget your resolutions to be faithful). A second unexpected strategy is to divorce a spouse you think is infected . Again, there is survey data to support the local importance of these strategies.
This is one of the questions that we initially put on the survey because we wanted to look at women’s autonomy. But after we learned from the journals that divorce was considered a prevention strategy, we looked more closely at the relationship between divorce and AIDS. Here we see a change in attitudes. The proportion saying that divorce is justified in case of adultery is even higher, probably because they think that since if one spouse is infected the other is certain to be, --as in the story following the death of the “veteran prostitute”—there’s no need to divorce, it’s too late.
Divorce is difficult—it really takes a husband and a wife to even barely support a household in rural Malawi. So we might expect that people talk about it but don’t do it. Here, however, we see a change in practice: divorce occurs earlier in the marriage. And I expect that when we get the next rounds of our survey so that we can extend the red line, we’ll find it’s higher. We do know, however, that divorcing a spouse suspected to be adulterous is efficacious: s.An analysis by Reniers that includes a parameter for divorce and an interaction with the suspcian of adultery shows that sticking to a spouse suspected ofdultery increases a woman’s risks of infection by 64%. Divorce in the absence of perceived adultery (i.e. the direct effect of divorce) increases exposure to HIV more than threefold. The interaction effect ( EMA x divorced ), on the other hand, is negative, which indicates that divorcing an unfaithful spouse acts as a buffer against infection.Reniers also shows that In the longer term, however, divorce may incfrease infection due to the risks associated with searching for a new spouse. spouse and taking one’s chances on the marriage market may be counterproductive, resulting in increased rather than diminished exposure to HIV (particularly for women).
It’s not the point of this presentation to say that the local strategies work. but I suspect they can work. Prevalence has stabilized in Malawi, as in several other countries, we don’t know why but it’s plausible that the local strategies contributed.
The international prevention community has paid much attention to stigma and, as a result, so has the government of Malawi. Stigma is expected to have many consequences (e.g. employment, care of PLWAs), although I have not been able to find ANY rigorous evidence for this—it’s either anecdotes about individuals of interviews with people in PLWA support groups, clearly a biased sample—if a rural person is in a support group, it’s very likely because she or he was stigmatized. We find, however, very little evidence of isolating PLWAs or refusing to care for them (and of course, employment discrimination is not an issue when most are subsistence farmers on their own land or small-scale traders). Here I will focus on only one aspect of the conventional wisdom, that stigma inhibits testing. VCT is thought to be an important prevention technology (altho again the evidence is very weak and contradictory). Shortly before we tested for the lst time in
Incentives: Because we were worried about stigma—a recent paper by Yoder and Matinga had concluded that Malawians were not ready to be tested because they were afraid of stigma, or that they would die from the shock of a positive result—we offered incentives to get their results.
People may be worried about being stigmatized or dying from the shock of a positive result, but but it’s clear that that did not keep them from being tested when the test was actually provided conveniently, rather than a hypothetical questions (suggests that hypothetical questions are not a good way to evaluate acceptability of a new approach). .
Near the tents in which results were given there are people waiting to get their own results—although the counseling is indeed private (no one can hear or see), people are not worried that others in their community know that they have been tested or came for their results. Although some who were tested received the result that they were positive, the nurses and interviewers at the testing sites saw no one leaving the tent looking worried or crying—although they must have been upset, they were quite capable of hiding their emotions.
Social event: Receiving results was a social event in the sense that people often came with others—sometimes there were groups of 5-10 coming together. Lab delays: Two thirds received their results, suggesting that they did want to know their status. Because of the lab delays, some who were tested had died, were too sick to come, had moved, were away temporarily. In 2006 we again tested for HIV, and again 91% agreed to be tested; this time we used rapid blood tests, so virtually everyone wanted to, and did, get their results. Happiness: I’ll return to the issue of happiness later.
It’s one thing to talk about other people becoming thin and dying because of AIDS, another thing to say that you yourself are positive. Yet there was a remarkable amount of disclosure about the results to spouses, relatives and friends. Is this too good to be true? Perhaps respondents are lying?
Much attention in the international and national prevention community is given to what is believed to be the particular vulnerability of women to HIV. Ratios such as these have provided the evidentiary basis for targeting vulnerable women, and particularly young single women. It’s true that HIV transmission rates in studies of serodiscordant couples are higher from men to women than VV. But is that all we need to know?
Young women do appear to be more likely to be infected, over twice as likely. . BUT again, is this all we need to know?
There is now considerable evidence, both from Malawi and elsewhere in the region, that marriage is a major risk factor for HIV (see Bracher, Santow and Watkins , 2003, in Demographic_Research.org, an online journal, and Auvert et al, 2001, AIDS, Supplement 1, who also found marriage to be a risk factor in other countries).
Unmarried women: sex infrequent and partners mostly young unmarried men (not “sugar daddies”, that’s a myth. For young men, sex is infrequent until they are old enough to have the resources to buy small gifts for chibwenzi, or, more importantly, to be able to pay CSWs.
Women’s poverty blamed for the epidemic, leads them to transactional sex, don’t have power to say no or to negotiate condom use, don’t like sex. But research in rural Malawi by Poulin shows that they do have power to reject proposals, and they do so; also have power to end sexual relationships, and they do. Also research by Tawfik and Watkins: about a third of married women have extramarital partners because want money (for lotions as well as food), about 1/3 for sex (“husband is useless”), about a third for revenge for husband’s infidelity, “it’s democracy”. See also Mishra et al, 2007, AIDS, which analyzes several DHS surveys in sub-Saharan Africa, including the Malawi DHS. Analyzing individual-level data, they find HIV associated with wealth, not poverty. Reason to believe that AIDS is a disease of wealth as well—men’;s wealth. Richest countries (Safrica, Botswana) have highest prevalence. Malawi De3mographic and health survey 2004 shows prevalence highest among the wealthiest and among the most educated.
As noted earlier, by the time of Tavrow’s 1993 study, people knew the fundamentals of the epidemiology of HIV transmission and prevention: that it was sexually transmitted, that a healthy-looking person could nonetheless be infected, that HIV could be prevented and that there was no cure for AIDS. In early 2006, ART began to be available in the rural areas for the first time, and people know that this is not a cure either—one will live longer, but will still die of AIDS. What they do not know, however, is that HIV is difficult to transmit.
Many were surprised by their test results: in another paper, which accounts for the great happiness in the villages as people learned them.
The common overestimation of transmission probabilities is also evident in the ethnographic field journals: a common saying is that “people who lie together die together”. This is is clearly a misconception: the actual transmission results, based on longitudinal studies of discordant couples, show that transmission probabilities are far lower, on the order of 1/1000 per act of unprotected intercourse with an infected person, about 8/1000 if one of them has an untreated STD, and a bit higher during the period of high viral load following initial infection or at the end-stage, when symptoms of AIDS appear.
The conventional wisdom was probably based on imagination, introspection and/or anecdotes, rather than systematic research. Certainly some people are in denial or fatalistic, even now. But most are not. And in an aggregate phenomenon such as an epidemic, it matters what “most” know and do. Only carefully collected data and rigorous analyses can determine this. But if you believe the conventional wisdom, you won’t ask “how many people did you talk with about AIDS”, or collect ethnographic journals to find out what they say to each other rather than to an interviewer.
The widespread misconception about the infectiousness of the HIV virus, however, has consequences. Most importantly, many people incorrectly think that they are infected, and thus may have little incentive to adopt prevention measures that are perceived to be difficult, such as strictly following the ABCs or divorcing a spouse. It is also likely that this misconception is a barrier to seeking voluntary counseling and testing, widely believed in the prevention community to be an important weapon of prevention. We coded the ethnographic journals for conversations about VCT: by far the most important reason for not testing that people gave to each other was “why get tested, I know I am positive.” As the results of our home-based testing showed, this does not keep most people who thought they were positive from getting tested. On the other hand, we made testing easy for them by bringing it to them, so that there were no costs in terms of transportation or opportunity costs in terms of labor.
Our research shows that for most of our misconceptions about “them”, the rural Malawians, both survey data and qualitative data are consistent in showing that the conventional wisdom is wrong. But this conventional wisdom almost certainly inhibited systematic research, just as rural Malawian’s overestimate of the likelihood they were infected almost certainly inhibited their seeking VCT. The specific results for Malawi may not be generalizable elsewhere: while the conventional wisdom is similar, the response to the epidemic probably depends on local factors, particularly the stage of the epidemic: if prevalence is low, or if people haven’t yet begun to die from AIDS, there is likely to be less talk about AIDS, and possibly more stigma. But a generalization that I think does hold is that good research matters: I think much well-meat effort and many dollars have been devoted to telling people things that they already knew or that weren’t important for their ability to formulate and implement their own strategies of prevention.