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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.10.033 Byline: Edward Kumakech (a), Elizabeth Cantor-Graae (b), Samuel Maling (d), Francis Bajunirwe (c) Abstract: Accumulating evidence suggests that AIDS orphanhood status is accompanied by increased levels of psychological distress such as anxiety, depression, intense guilt, shame, and anger. However, few studies have examined the possible reduction of psychological distress in AIDS orphans through the help of interventions that promote well-being. The objective of the study was to evaluate the effects of a school-based peer-group support intervention combined with periodic somatic health assessments and treatment on the psychosocial well-being of AIDS orphans in the Mbarara District of southwestern Uganda. In a cluster randomized controlled design, 326 AIDS orphans aged 10-15 years were assigned to either peer-group support intervention combined with monthly somatic healthcare (n =159) or control group (n =167) for follow-up assessment. Baseline and 10 week follow-up psychological assessments were conducted in both groups using self-administered Beck Youth Inventories. Complete data were available for 298 orphans. After adjusting for baseline scores, follow-up scores for the intervention group in comparison with controls showed significant improvement in depression, anger, and anxiety but not for self-concept. This study demonstrated that peer-group support intervention decreased psychological distress, particularly symptoms of depression, anxiety and anger. Thus, the use of peer-group support interventions should be incorporated into existing school health programs. Author Affiliation: (a) Nursing, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda (b) Department of Clinical Sciences, Lund University, University Hospital UMAS, Malmo S-20502, Sweden (c) Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda (d) Department of Psychiatry, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.08.016 Byline: Felicity Thomas Keywords: Namibia; HIV/AIDS; Stigma; Solicited diaries; Caring; Well-being Abstract: It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a 'private' household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through 'seeing for yourself', i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks. Author Affiliation: Department of Geography, University of Sheffield, Winter Street, Sheffield S10 2TN, UK

Street children in South Africa are, in the main, between the ages of 11 and 17 years. Rape, prostitution, sexual bartering and exchange, casual sex and romantic sexual relationships all occur in the experiences of young people who live and work on inner-city streets. In this study, the AIDS-related knowledge, attitudes and behaviour of 141 street youth, living in seven large cities in South Africa, were elicited in focus group discussions. At the time of the study, 79 boys (56%) were living in shelters run by nongovernmental and welfare organisations, while 62 boys (44%) were sleeping 'rough'. The results, both qualitative and quantitative, indicated that the AIDS knowledge of South African street children was comparable to levels reported for groups of 'hard-to-reach' youth in other parts of the world. Fear of HIV infection did not appear in a list of day-to-day priorities constructed by the children, a list dominated by survival concerns with food, money and clothes. However, more than half of the boys conceded that they engaged in sex for money, goods or protection, several boys indicated that they had been raped, and most reported being sexually active with 'girlfriends', who themselves frequently engaged in transactional sex. The findings are interpreted in terms of the relationships between power dynamics surrounding race and age, and how they affect self-initiated controls over sexuality and sexual protection. Key words - AIDS, street youth, South Africa

This paper explores the perceptions of HIV/AIDS held by a group of women working as prostitutes in San Jose, Costa Rica. Adopting the theoretical perspective of critical medical anthropology, the analysis of the prostitutes' constructions of HIV/AIDS is linked to the political and historical context of power that constitutes a medical cultural hegemony. The way in which the research participants associate threats of HIV/AIDS with violence to create a complex of contagion that both perpetuates and challenges the hegemonic model of disease is discussed. Specifically, biomedicine's designation of the prostitute as the 'vector' of disease is contrasted with the position that the prostitutes create for themselves. Through a critical analysis of this complex of contagion, oppressive power structures come into sharp focus. Key words - Costa Rica, contagion, prostitute, HIV/AIDS, violence

The dominant image of an intravenous (IV) drug user in U.S. society is that of the unbridled 'dope fiend'. It is common in treatment literature to refer to users as diseased and pathologically unable to control their lives. Female IV drug users, as the bearers of children, even more than males, are faced with the paradox posed by conflicting social messages labeling them as irresponsible, dirty 'dope fiends' while approaching them as responsible citizens who need to 'clean up their act' for their children. The paradox of these messages creates a profound moral dilemma involving agency - the ability to develop a flow of conduct by reflexively monitoring intention, purpose, and accountability of actions in the pursuit of a goal - and the social identity of 'junkie'. This article examines this social condition and how it affects the life and options of a woman diagnosed HIV positive. Using narrative discourse and analyzing it through the study of voice I show how an IV drug using woman uses her diagnosis to redefine her life and her social identity, as she changes a negative 'deviant' image into a positive one.

The emphasis in the psychosocial literature on Human Immunodeficiency Virus (HIV) has been placed, correctly, on the traumatic impact of AIDS in terms of mortality, bereavement, suicide, psychopathology, and coping with life amid enormous multiple stressors. However, an important aspect of the HIV epidemic has been paid only minimal attention: many HIV-positive gay men have experienced beneficial, or even life-transforming, aspects of their situation. Seven HIV-positive gay men are described here who have successfully integrated HIV into a framework of world- and self-beliefs that allows for coherence, stability, emotional vitality, and positive self-regard. Eight general characteristics of these men are presented. These men represent a subgroup from a sample of 19 subjects in a qualitative clinical interview study exploring how HIV-positive gay men ascribe meaning to AIDS and their own HIV infection.

A study based on a sample of 2500 individuals aged 18 years and over in six west African cities was undertaken for the purpose of determining the cross-cultural consistency and replicability of fears about AIDS. A factor analysis of the data obtained confirmed a similar factor structure to that reported in Australia. Implications for the prevention of HIV transmission in Nigeria and other west African countries is discussed. Our findings showed that the fear of AIDS Scale (FAIDSS) is a reliable index of fear of aids and is readily scaleable. Other implications for health education are considered.

In this study, the authors examine the worry and discomfort experienced by direct care health professionals in treating AIDS patients and how their profession, attitudes, knowledge, experience and demographic characteristics influence their emotional reaction to those patients. The research focuses on experienced emotion as distinct from expressed emotion, as an important factor in explaining health behaviors among professionals. To address these issues 536 health care professionals comprising 132 physicians, 378 nurses and 26 social workers employed at a University teaching hospital in Chicago were surveyed. The findings suggest that health care workers' emotional reactions to HIV depend on the type of patient interaction. We found for all three professions, as the invasiveness of contact increased, the level of worry and amount of discomfort also increased. Nurses however, on the whole were the most adversely affected by their patient contacts. We conclude that emotional reactions in the workplace cannot be explained by cognitions, beliefs and attitudes alone. This study suggests that work roles, work assignments, and professional authority contribute to emotional reactions to patients with AIDS. Key words--AIDS, hospital, health, professionals

Although young, sexually-active heterosexuals have always been at risk for contracting sexually transmitted diseases, the recent appearance of Acquired Immunodeficiency Syndrome (AIDS) has increased the possible peril of sexual experimentation. Currently, behaviors to reduce the risk of contracting AIDS are being widely advocated. The present study examines predictors of self-reported risk reduction behaviors in a sample of 188 young, sexually-active heterosexuals. Three factors (perceptions of personal vulnerability, sexual behavior history, and homophobia) were hypothesized to predict levels of worry about contracting a sexually transmitted disease. Worry, in turn, was hypothesized to predict behavior change. Structural equation modeling provided support for these predictions, but found somewhat different patterns for women and men. For both sexes, higher levels of worry were a significant predictor of risk reduction behavior implementation. For women only, more extensive sexual behavior histories significantly predicted levels of worry. In contrast, for men only, perceptions of personal vulnerability and homophobia were significant predictors of worry. Results suggest that gender plays an important role in understanding cognitive predictors of sexual risk reduction behaviors. Key words--AIDS, sexual behavior, risk perception, young adults

Better methods of psychosocial research with people affected by AIDS are required; and narrative analysis may help to meet this need. It is based on the assumption that people create meaning in events by telling stories about them, and that these stories can be identified in interviews. The paper examines some conceptual issues underlying the method: the psychosocial functions of narratives, their structure, their embeddedness in interview responses, their linguistic macrofunctions and the concept of core narrative. An account of the method is provided, together with two alternative ways of doing it. Then the results of a small study of the value of the narrative analysis for the research interviews of HIV-infected men are reported, with the answering of questions about its consistency and usefulness and a brief account of the 12 narratives identified by the method. Some questions were answered in the affirmative but others were not. However, the narratives identified proved both vivid and useful. Evaluations of the study and of the method led to recommendations that narrative analysis be used to augment other methods in AIDS research.

This paper examines the relationships between instrumental and emotional social support and the experience of grief reaction in a sample of 180 gay men who had lost a lover or close friend to AIDS during the first 5 years of the epidemic. Structured, face-to-face interviews were conducted in mid-1985. Grief reaction was assessed through a newly developed 12-item scale (alpha = 0.85). Availability and adequacy of instrumental and emotional support were assessed with reference to the tasks of caretaking and emotional pain experienced during the lover's or close friend's illness with AIDS. The findings indicate that gay men who lost a lover or close friend to AIDS experienced symptoms of grief similar to those reported in studies of bereaved spouses and parents. The intensity of these grief reactions appears to be influenced by a number of factors. First, more intense grief reactions were observed among those who had taken care of their lover or close friend during his illness compared with those who did not act as caretakers. Second, while the simple availability of instrumental and emotional support was unrelated to grief reactions, the perceived inadequate help with caretaking responsibilities experienced more intense symptoms of grief subsequent to the death compared with those who reported receiving adequate caretaking support. Similarly, respondents who did not obtain adequate emotional support for the pain they experienced during the course of the illness reported more intense symptoms of grief compared with those who felt they had received adequate support. These findings are discussed with reference to their implications for informal and formal helping networks, and the critical role of providing 'care for the caregiver' in both professional and non-professional settings involved with the care of individuals in AIDS.