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During the 1990s, biomedical scientists and Muslim religious scholars collaborated to construe Islamic responses for the ethical questions raised by the AIDS pandemic. This is the first of a two-part study examining this collective legal reasoning ( ijtihād jamā'ī). The main thesis is that the role of the biomedical scientists is not limited to presenting scientific information. They engaged in the human rights discourse pertinent to people living with HIV/AIDS, gave an account of the preventive strategy adopted by the World Health Organization, and offered an (Islamic) virtue-based preventive model. Finally, these scientists tried to draft a number of Islamic legal rulings ( aḥkām), usually seen in Islamic jurisprudence as the exclusive business of Muslim religious scholars. This multilayered role played by the scientists reflects intriguing developments in the Islamic religio-ethical discourse in general and in the field of Islamic jurisprudence in particular. [ABSTRACT FROM AUTHOR]

Background The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. Methods This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. Results HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. Conclusions While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well. [ABSTRACT FROM AUTHOR]

Rugby league is the national sport of Papua New Guinea and the game's huge popularity and international profile has been used in recent condom promotion campaigns in the nation's fight against the HIV/AIDS epidemic. In this paper, I argue that the promotion of condom use through rugby league requires a national campaign strategy that includes understandings of condom use and masculinity at the rural level. I demonstrate this through a study of Gogodala men's understandings of the epidemic and condom use in Western Province. The Gogodala are a Christian-based society and many blame the national condom promotion strategy for an increase in promiscuity and for 'turning sex into a game'. Condom availability in this rural area continues to be restricted to a family planning program that promotes Christian values and excludes unmarried men. I explore the male condom dilemma where young men are more concerned with avoiding accusations that their sexual behaviour puts them at risk of contracting HIV despite acknowledging the preventative value of using condoms. In this context young men disassociate themselves from the disease and condom use through a process of calculated risk or risk minimisation. [ABSTRACT FROM AUTHOR]

This paper investigates the extent of knowledge about HIV/AIDS among young Yupno women and men. Local understanding of sikAIDS is shaped by cultural, moral and religious concepts and processes that are based on social values and practices. Difficulties these young people face in accessing information about HIV/AIDS and using it to implement preventative measures -- for example by obtaining condoms -- have to be seen in the framework of 'kastom' and a moral discourse coined and influenced by the Lutheran Church. As the research shows, there is an urgent need for a broad and contextually sensitive approach to sexual health, including information about conception, family planning methods, and sexually transmitted diseases when planning awareness campaigns for teenagers in rural regions. [ABSTRACT FROM AUTHOR]

Little attention has been given to understanding the emotional well-being of people living with HIV/AIDS in developing countries, despite the fact that emotions may impact on people's sense of purpose and value, and ultimately their ability and resolve to hold livelihood and familial responsibilities together. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines the use of solicited text and photo diaries in enabling insight into the emotional impacts of HIV/AIDS. The advantages and constraints of diary methods are examined, focusing on informant-directed research and the ethical considerations surrounding their use. [ABSTRACT FROM AUTHOR]

Aims: Lopinavir (LPV) is not a first‐line regimen. According to recent WHO data, LPV usage in low‐ and middle‐income countries accounted for approximately 52% of the adult and 23% of the paediatric protease inhibitor market in 2017. Since LPV is a substrate for the SLCO1B1 (OATP1B1) transporter, the aim of this study was to assess the impact of SLCO1B1 polymorphisms (rs11045819, rs4149032 and rs4149056) on LPV trough plasma concentrations (Ctrough) in Serbian patients. Methods: Plasma samples from 104 HIV/AIDS Caucasians were collected. LPV Ctrough was quantified using liquid‐chromatography‐mass spectrometry. Genotyping was carried out using real‐time‐PCR‐based allelic discrimination. One‐way analysis of variance, t test and linear regression were used for data analysis. Results: The overall mean (SD) LPV Ctrough was 5885 ± 2755 ng/mL. Significant differences were between patients with different rs11045819 genotypes: CC (LPV median Ctrough = 6072 ng/mL, interquartile range (IQR) = 4318–7617 ng/mL), CA (LPV median Ctrough = 4987 ng/mL, IQR = 4300–6295 ng/mL) and AA (LPV median Ctrough = 3648 ng/mL, IQR = 1949–4072 ng/mL) (P =.005). Significant differences were also observed according to rs4149032 genotype: CC (LPV median Ctrough = 6027 ng/mL, IQR =4548–8250 ng/mL), CT (LPV median Ctrough = 5553 ng/mL, IQR = 4300–6888 ng/mL) and TT (LPV median Ctrough = 4408 ng/mL, IQR = 3361–5233 ng/mL) (P =.007). For rs4149056 a statistically significant difference between T‐homozygotes (LPV median Ctrough = 5434 ng/mL, IQR = 3855–6830 ng/mL), heterozygotes (LPV median Ctrough = 6707 ng/mL, IQR = 5088–8063 ng/mL) and C‐homozygotes (LPV median Ctrough = 13906 ng/mL, IQR = 12946–14866 ng/mL) was observed (P =.002). In multivariate regression analysis, only the SLCO1B1 rs4149056 polymorphism was independently associated with higher LPV Ctrough (β = 2834.5 [1442–4226.9] ng/mL [P =.001]). Conclusions: Our results demonstrate a statistically significant influence of the SLCO1B1 rs4149056 polymorphism on higher LPV Ctrough in Caucasian HIV/AIDS patients. [ABSTRACT FROM AUTHOR]

Twelve percent of the Malawian population is HIV infected. Eighteen percent of sexual encounters are casual. A condom is used a third of the time. To analyze the Malawian epidemic, a choice‐theoretic general equilibrium search model is constructed. In the developed framework, people select between different sexual practices while knowing the inherent risk. The calibrated model is used to study several policy interventions, namely, ART, circumcision, better condoms, and the treatment of other STDs. The efficacy of public policy depends upon the induced behavioral changes and equilibrium effects. The framework complements the insights from epidemiological studies and small‐scale field experiments. [ABSTRACT FROM AUTHOR]

Background: Understanding patients' knowledge and belief towards disease could play a vital role from an outcome perspective of disease management and HIV/AIDS patients are not exception to that. Methods: Qualitative methodology was used to explore Malaysian HIV/AIDS patients' perspectives on disease and status disclosure. A semi structured interview guide was used to interview the patients and a saturation point was reached after the 13th interview. All interviews were audio‐recorded and subjected to a standard content analysis framework. Results: Understandings and beliefs towards HIV/AIDS and Perspective on disease disclosures were two main themes derived from patients' data. Beliefs towards causes and cure emerged as sub‐themes under disease understandings while reasons for disclosure and non‐disclosure were resulted as main sub‐themes under disease disclosure. Majority of patients apprehended HIV/AIDS and its causes to acceptable extent, there were elements of spirituality and lack of education involved with such understandings. Though beliefs existed that knowing status is better than being ignorant, fear of stigma and discrimination, social consequences and family emotions were found important elements linked to disease non‐disclosure. Conclusions: The outcomes provided basic information about patients' perceptions towards disease and status disclosure among HIV/AIDS patients which can help in the designing and improvising existing strategies to enhance disease awareness and acceptance and will also serve as baseline data for future research further focusing on this subject. [ABSTRACT FROM AUTHOR]

To determine the association between adherence to universal precaution (UP) and avoidance attitudes toward patients living with HIV/AIDS (PLH) among service providers. A total of 1,760 health service providers were randomly selected from 40 county hospitals in two provinces of China. A self-administered questionnaire was used to collect demographic characteristics, UP knowledge and training, UP adherence, availability of UP supplies at work, and avoidance attitudes toward PLH in a cross-sectional survey. A series of regression models were used to examine associations among the UP-related factors and their relationship to avoidance attitudes toward PLH. UP training was associated with better knowledge of and adherence to UP and perceived availability of UP supplies in hospitals. UP training, knowledge, and adherence were significantly associated with avoidance attitudes toward PLH in medical practice. Being a nurse was also related to HIV-related avoidance. UP promotion campaigns, including in-service training and reinforcement of UP adherence, could play an important role in the battle against HIV-related avoidance in medical settings. Intervention programs should focus on not only individual providers' attitudes and behaviors but also on structural support for norms shifts in the medical community. [ABSTRACT FROM AUTHOR]

A growing critical literature examines the rise of biosecurity. HIV/AIDS has been mentioned in this literature as a biosecurity issue, but despite its importance as a major global health problem, the ways in which HIV/AIDS might be considered a matter of biosecurity have not been explored in depth. This article addresses this issue, particularly in relation to the international response to HIV/AIDS, through the conceptual prism of governmentality and in relation to concerns about globalisation and security. Following a discussion of the relevance of governmentality to research on the intersections between globalisation and security, the article considers biosecurity and the international response to HIV/AIDS in terms of modes of problematisation and institutionalisation. In terms of problematisation, it argues that while some biosecurity issues and HIV/AIDS have been addressed as emergencies, the characteristics of anticipation, preparedness, emergence and pre-emption, which are central to the dominant formation of biosecurity, are less relevant to HIV/AIDS. As the article shows, the two fields have also been institutionalised in rather distinct ways. It therefore cautions against regarding the international response to HIV/AIDS as a biosecurity intervention. In conclusion, the article identifies three broad avenues for further research: unpacking the politics of global health and security during recession; engaging with theoretical debates around governmentality; and engaging with problems of space. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As an epidemic that has emerged since the 1980s, still has no cure, and may bear no symptoms, HIV/AIDS is powerfully linked to questions of knowledge. In this article, I explore intersections of HIV/AIDS and knowledge by drawing from ethnographic and activist work with an HIV/AIDS nonprofit organization in Indonesia that focuses on gay men and warias (roughly, male transvestites). In particular, I look at testimony, a form of knowledge production differing from confession in that it emphasizes form over content. Examining testimony with regard to persons living with AIDS, I show how it produces a “bare” or “asymptomatic” knowledge that may cast light on broader dynamics of epistemology, selfhood, and belonging. [ HIV/AIDS, Indonesia, gay men, transgenderism, knowledge, emotion, nonprofit organizations] [ABSTRACT FROM AUTHOR]

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in-depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long-overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS. [ABSTRACT FROM AUTHOR]

Securitization of infectious diseases may involve suspension of ordinary human rights and liberties. In the event of an epidemic, therefore, it is important to limit the occasions upon which draconian disease control measures are implemented in the name of security. The term ‘security’, moreover, should not be used too loosely if it is to retain force and meaning in political discourse. It may be argued that the bar for disease securitization should be set high so that it is limited to contexts involving rapidly spreading pathogens. Such an approach, however, would rule out securitization of more slowly spreading, endemic diseases such as HIV/AIDS. An advantage of characterizing HIV/AIDS as a security threat in developing countries, where the burden of the disease is concentrated, is that this is likely to mobilize resources needed to improve the situation there. That is, if HIV/AIDS is convincingly framed as a security threat, then governments may recognize self-interested reasons to ramp up control measures. Following consideration of arguments for narrow (excluding HIV/AIDS) versus broad (including HIV/AIDS) conceptions of security, we conclude that the legitimacy of ‘securitizing’ HIV/AIDS ultimately turns on empirical and semantic issues, and we emphasize the importance of distinguishing (1) the nature of the threat posed by HIV/AIDS and (2) the measures required to address that threat. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article considers how different models of sexuality and disease converge and interact to co-produce understandings of HIV and AIDS, and the implications of inter-cultural communication for effective HIV prevention in diverse settings. In the Trobriands Islands of Papua New Guinea, the phenomenon of sovasova, or chronic illness that manifests when members of the same matrilineal clan have sexual relations, is a persuasive and problematic form of cultural knowledge that directly influences comprehensions of HIV and AIDS. As a social proscription, sovasova underscores cultural ideations about the importance of social exchange and the corporeal mixing of difference in sexual relationships. Trobrianders recognize clear signs and symptoms that herald the onset of sovasova, which are similar to descriptions of AIDS-related illness--weight loss, nausea, and malaise. Affected people use various herbal and magical treatments to effectively manage sovasova, and people can avoid the sickness altogether by simply not having sex with a fellow clan member. The cultural resources available for treatment allow people to regard transgression as a safe possibility, albeit socially undesirable. The broad comparisons that Trobrianders draw between sovasova and AIDS create tensions as people contemplate HIV prevention based on the cultural model of sexual disorder and the valued capacity and efficacy of sexuality in maintaining relations of difference. [ABSTRACT FROM AUTHOR]

This article analyses a group of Gogodala Christian women in the Western Province of Papua New Guinea who are referred to as 'Warrior women' and who pray, sing and call upon the Holy Spirit to cleanse their own bodies and 'turn their eyes', so that they are able to see those who threaten the health and well-being of the wider community. These women have focused primarily on bringing male practitioners of magic -- iwai dala -- shadowy and powerful men who operate covertly and away from the gaze of others, out into the open. Whilst this has been happening for many years, the spread of HIV and AIDS into the area, fuelled by what many in the area believe is the rise of unrestrained female and male sexuality and the waning of Christian practice and principles, has meant that those perceived to bring harm to the community through their sexual behaviour have become recent targets for Warrior women. HIV/AIDS, referred to in Gogodala as melesene bininapa gite tila gi -- the 'sickness without medicine' -- is understood as a hidden sickness, one that makes its way through the community without trace until people become visibly ill. Warrior women seek to make both AIDS and those who, through their behaviour, encourage or enable its spread more visible. In the process, however, a small number of them are overcome by the Holy Spirit, so much so that they become daeledaelenapa -- mad -- their behaviour increasingly characterised by childishness and uncontrolled sexuality. [ABSTRACT FROM AUTHOR]

Background Previous studies have found that in Africa, a greater risk of HIV infection is often found in groups with higher educational attainment. However, some serial cross-sectional studies have found greater reductions in HIV prevalence among more educated groups, especially in cohorts of young adults. More recent studies have found some instances where higher schooling levels are associated with lower HIV prevalence. Methods We describe changes in the association between schooling levels, HIV prevalence and condom use in a rural population-based cohort between 1989/1990 and 1999/2000, in Masaka District, Uganda. Results In 1989–1990, higher educational attainment was associated with higher risk of HIV-1 infection, especially among males, but once odds ratios are adjusted for age, no significant relation between schooling and HIV infection remains. In 1999–2000, there is, for females aged 18–29 years, a significant relationship between higher educational attainment and lower HIV prevalence, even after adjustment for age, gender, marital status and wealth ( P for trend 0.01). Tests for interaction, significant for males and both genders combined, show that more schooling has been shifting towards an association with less HIV infection between 1989–1990 and 1999–2000, especially for young individuals. Condom use increased during the study period and this increase has been concentrated among more educated individuals. Conclusions These findings suggest that over a decade more educated young adults, especially females, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour. [ABSTRACT FROM AUTHOR]

Disclosing an HIV diagnosis to his mother may be the first step in a man's successful management of his illness, but it may also lead to added stress due to stigmatization. Analyzing data provided by 166 HIV-positive men who lived in the southeastern United States, we found that the most powerful correlate of disclosure was exposure to HIV through homosexual contact. Additionally, those who had AIDS rather than HIV and exhibited more severe symptoms were significantly more likely to have disclosed to their mothers; older and more highly educated men were significantly less likely to have done so. We discuss the implications of our findings for maternal caregiving to adult sons in middle and later life. [ABSTRACT FROM AUTHOR]

Lay diagnoses of death collected at burial sites were validated against two 'gold standards': the hospital discharge diagnosis of causes of death obtained by a surveillance of hospital deaths (including autopsy results) and the physician review of verbal autopsies (VAs) that were carried out for a sample of cemetery records. The diagnostic indicators of the lay diagnoses were then used to provide estimates of the share of AIDS-attribuTable mortality. The verbal autopsy results provide an independent estimate of the percentage of AIDS deaths. From a total of 21,274 burial records, 2546 hospital discharge diagnoses, 1480 outcomes of autopsies and 200 adult verbal autopsies were gathered over a period of 1 year starting from February 2001. Independent of the gold standard, lay diagnoses such as lung disease and cold have a specificity of about 90% and a combined sensitivity of about 55% in determining AIDS mortality. Without a significant loss in specificity, the sensitivity increases to 60-65% when diarrhoea, TB, herpes zoster and mental or nerve problem are included. We thus conclude that even in the presence of a reluctance to talk of HIV/AIDS, lay diagnosis of causes of death can be used for monitoring AIDS mortality. Lung disease and cold, in particular, have become well-known euphemisms for AIDS in the community. The share of AIDS deaths in the adult population (20-54) is estimated at 68%, without noticeable differences between men and women. Our results confirm the high impact of HIV/AIDS on mortality as was estimated by epidemiological projections for Addis Ababa. [ABSTRACT FROM AUTHOR]

In this essay I explore the heuristic value of the concept of ethics of complexity, chaos, and contingency by applying its framework to the analysis of the HIV/AIDS pandemic. Everyday human moral choices are outcomes of a moral impulse, and such an impulse is grounded in moral competence shaped by moral literacy. This literacy is constructed on the basis of a body of knowledge of culture, social context, environment, and the universe. It also includes the knowledge of religions and religious and secular ethical codes. I also distinguish between the social and cultural aspects of ethical systems. Both societies and cultures provide resources and constraints for the development of literacy and competence. An intentionally developed multifaith and multidisciplinary coalition may help us move away from various forms of social speciation and toward sociological mindfulness. This could help us remake the world into one that has more courage to care. [ABSTRACT FROM AUTHOR]