Managing and controlling HIV/AIDS talk among Ghanaians living with HIV/AIDS

Abstract

This study explored the meanings people attribute to talking about living with HIV/AIDS. Framed by interpersonal and health communication scholarship based on disclosure and the meanings of talk about illness, people living with HIV/AIDS are asked to describe how and why they discussed their health condition with others. Interviews (focus group and one-on-one) were conducted with 120 people living with HIV/AIDS. A grounded theory analysis of the interviews revealed how communication about HIV/AIDS may be particularly meaningful because it is something people feel they can control during what is already a highly stressful and turbulent time. However, attempts to manage communication are challenged by constraints imposed by others, such as unfavourable and unpredictable reactions to disclosure, which ultimately place limits on how people living with HIV/AIDS control information about them.     

Global Society's Response to HIV/AIDS: Botswana's Experience

Approximately 37% of Botswana's population was HIV-positive in 2005. This study examines Botswana's experience of the HIV/AIDS threat in order to assess the strengths and weaknesses of the response by global society. Botswana is particularly useful in evaluating the pandemic threat and national and global responses since it is considered a sub-Saharan leader in establishing a national infrastructure of HIV/AIDS governance—one closely coordinated with global society's infrastructure and culture of HIV/AIDS governance. This paper argues that a polyarchic notion of governance and authority has relevance to the sphere of HIV/AIDS governance and this is evident in Botswana's experience. This study analyses the key features of the global response to the pandemic. It then explains and evaluates Botswana's administrative, financial and operational responses to the pandemic. The paper concludes by identifying critical policy challenges for the further development of effective global–national HIV/AIDS governance.     

A policy critique of HIV/AIDS and demobilisation

The objective of this paper is to draw out and encourage debate on the relationship between HIV and the policy challenges that it poses for security. It explores how demobilisation programmes need to incorporate a development perspective, bringing together public health practitioners and security experts, in order to address the pandemic and the future security needs of Sub-Saharan Africa, in particular. It is hoped that integrating two very different disciplines, public policy and public health, will mark the beginning of attempts to establish some practical guidelines for policymakers and field practitioners that focus on prevention. Most important, the paper makes an urgent request for a cross-disciplinary and cross-sectoral approach to tackling such a complex problem as HIV and the military. Development practitioners once shunned any working relationship with armed forces or defence ministries, but it is impossible now to avoid these institutions in countries with high rates of HIV/AIDS in the security sector.     

Towards a bad end: The ethics of intervention in the former Yugoslavia

The United States’ intervention, diplomatically and militarily, in former Yugoslavia demonstrates the complexities of social justice in post‐Cold War Europe. Nominally an action to support ‘vital’ American interests, intervention equally involved a moral and ethical choice to leverage military technology and to prevent the spread of Balkan violence. Ethical politics, as Reinhold Niebuhr defines it, is an area where conscience and power meet, where ethical and coercive factors ‘interpenetrate’ in an uneasy compromise. Whether or not the will to a political ethic is sufficient to bring social justice to the former Yugoslavia remains unclear.     

HIV/AIDS prevention: building on community strengths in Ajegunle,Lagos

This paper builds upon field research in Ajegunle, Nigeria, which suggests that effective HIV/AIDS prevention requires a much higher degree of independent community participation. In exploring ways to achieve this, we suggest that assessing community strengths provides positive scope for understanding and utilising a much wider variety of HIV/AIDS responses which have not been previously used in the context of community development. Community-based approaches also encourage a deeper understanding of locally-specific vulnerability issues that surround HIV and AIDS. Such initiatives can be linked to trends that value the knowledge and capacities of neglected local people and build on their resources, including their networks, relationships and trust. However, the connection to, and use of, the resources of international NGOs (INGOs) remain central to success. If an interactive community-based agenda of working with local level resources receives enough acceptance at the higher levels of the INGOs, the results could be very significant. Such international/local agreements, where INGOs seek to work more closely with local community groups and their people on shared agendas, could begin to tackle some of the key structural issues, especially conflict and poverty, that exacerbate HIV/AIDS at the grassroots and are not responsive to purely medical solutions.

Prévention du VIH/sida: développer les points forts des communautés à Ajegunle, Lagos

Ce document se base sur des recherches menées sur le terrain à Ajegunle, au Nigeria, qui suggèrent que, pour être efficace, la prévention du VIH et du sida requiert un degré beaucoup plus élevé de participation communautaire indépendante. Dans le cadre d'une étude des manières d'arriver à ce résultat, nous suggérons qu'une évaluation des points forts de la communauté donne des perspectives positives pour la compréhension et l'utilisation d'une variété beaucoup plus importante d'interventions en matière de VIH/sida qui n'ont pas été précédemment lancées dans le contexte du développement communautaire. Les approches fondées sur les communautés encouragent par ailleurs une compréhension plus profonde des questions de vulnérabilité propres au niveau local autour du VIH et du sida. Les initiatives de ce type peuvent être reliées à des tendances qui accordent une importance aux connaissances et aux capacités des populations locales délaissées et qui se basent sur leurs ressources, y compris leurs réseaux, leurs relations et leur confiance. Cependant, la connexion avec les ressources des ONG internationales (ONGI) et leur utilisation restent essentielles pour le succès. Si un ordre du jour interactif fondé sur les communautés du travail avec les ressources locales reçoit une acceptation suffisante aux échelons plus élevés des ONGI, les résultats pourraient être très considérables. Les accords internationaux/locaux de ce type, dans le cadre desquels les ONGI cherchent à travailler en plus étroite collaboration avec les groupes communautaires locaux et leurs membres sur des ordres du jour partagés, pourraient commencer à remédier à des problèmes structurels clés, en particulier les conflits et la pauvreté, qui ont pour effet d'exacerber le VIH/le sida au niveau de la base populaire et ne peuvent pas être résolus par des moyens purement médicaux.

Prevenção do HIV/AIDS: aproveitando os pontos fortes da comunidade em Ajegunie, Lagos

Este artigo baseia-se em uma pesquisa de campo em Ajegunle, Nigéria, que sugere que a prevenção efetiva do HIV/AIDS exige um grau muito maior de participação da comunidade independente. Ao explorar maneiras para se alcançar isto, sugerimos que avaliar os pontos fortes da comunidade oferece um escopo positivo para se compreender e utilizar uma variedade muito mais ampla de respostas ao HIV/AIDS que não foram utilizadas anteriormente no contexto de desenvolvimento da comunidade. Abordagens baseadas na comunidade também incentivam uma compreensão mais profunda de questões de vulnerabilidade localmente específica que cercam o HIV e AIDS. Tais iniciativas podem ser conectadas a tendências que valorizam o conhecimento e a capacidade de pessoas locais negligenciadas e aproveitar seus recursos, inclusive suas redes de trabalho, relacionamentos e confiança. Porém, a conexão com recursos de ONGs Internacionais (ONGIs) e o uso deles permanecem centrais para o sucesso. Se uma agenda de trabalho interativa baseada na comunidade com recursos no âmbito local obtém aceitação suficiente nos níveis mais altos das ONGIs, os resultados podem ser muito significativos. Tais acordos internacionais/locais, em que ONGIs buscam trabalhar de maneira mais próxima com grupos da comunidade local e suas pessoas em agendas compartilhadas, poderiam começar a lidar com algumas das questões estruturais centrais, especialmente conflito e pobreza, que agravam o HIV/AIDS na base e não são suscetíveis a soluções puramente médicas.

La prevención del VIH/SIDA: confiando en las fortalezas de la comunidad. Una experiencia en Ajegunie, Lagos

Este ensayo se centra en una investigación de campo realizada en Ajegunle, Nigeria, la cual demostró que para conseguir una prevención efectiva del VIH/SIDA se requiere de una profunda e independiente participación comunitaria. En su investigación sobre cómo lograr este objetivo, los autores sugieren que valorar las fortalezas comunitarias puede ser una base sólida para concebir y utilizar una gama de respuestas ante el VIH/SIDA más amplia de la que hasta ahora se aplica en el contexto del desarrollo comunitario. Los métodos basados en la comunidad también contribuyen a que se entiendan mejor las vulnerabilidades específicas y locales ante el VIH/SIDA. Estas iniciativas pueden contribuir a valorar más los hasta ahora ignorados conocimientos y capacidades de las personas locales, los cuales se basan en sus recursos propios como sus redes, sus relaciones sociales y su confianza. Sin embargo, el acceso a, y el uso de, los recursos de las ONG internacionales (ONGI) siguen siendo factores importantes para lograr el éxito. Si las directivas de las ONGI consideraran una agenda de trabajo interactiva con las comunidades utilizando los recursos locales, los resultados podrían ser muy significativos. Con este tipo de acuerdos internacionales/locales en los que las ONGI intentan trabajar más estrechamente con los grupos comunitarios y las personas a nivel local compartiendo estrategias, podrían comenzar a atajarse algunos de los principales problemas estructurales, en especial en situaciones de conflicto y pobreza, que agravan el VIH/SIDA entre personas de la base y que no pueden resolverse únicamente con soluciones médicas.     

Conflict and gender: the implications of the Burundian conflict on HIV/AIDS risks

Sexual and gender-based violence in many conflict and post-conflict contexts are creating vulnerabilities to HIV. The paper is based on research conducted in Burundi in 2007–2008.The country experienced long-term civil war from the early 1990s until recently and has been the locus of post-conflict disarmament, demobilisation and reintegration programmes, providing a coherent and focused study. The research finds that the relationship between conflict and HIV/AIDS is a function of pre-existing gender relations that also regulate sexual life and determine critical female vulnerabilities. When put under stress by armed conflict, these vulnerabilities become amplified, creating conditions for the increased spread of HIV. Analysis of how gender relations and vulnerabilities change according to the specific social and economic circumstances generated by military mobilisation, organisation and deployment, in relation to civilian displacement and insecurity, in a range of distinct circumstances, provides a framework for understanding HIV vulnerabilities during and after the conflict.     

Achieving behaviour change: Three generations of HIV/AIDS programming and jargon in Thailand

NGOs have played an important role worldwide in the fight to prevent the spread of HIV/AIDS through achieving behaviour change. NGOs have often been at the forefront of innovative changes, influencing government and international programming activities. This paper identifies and analyses the evolution of the HIV/AIDS programmes of one NGO in Thailand over a period of ten years. Three generations of programming are identified both through distinct approaches to this area of work and through the changing jargon used to describe the people the programmes are aimed at.     

Using art and everyday objects to fight HIV/AIDS in Uganda

This paper argues for the importance of enabling dialogue between women and men about taboo subjects of sex and sexuality in HIV/AIDS prevention. It reports the findings of a project that sought to use art (specifically sculpture) for creating dialogue between women and men in rural Uganda. It then provides suggestions for HIV/AIDS practitioners on how to use everyday objects to stimulate similar discussion about sex and disease prevention between women and men. We argue for the utility of art and everyday objects where literacy rates are low, or where modes of communication and information-sharing are predominantly orate.     

HIV/AIDS and governance along the corridors of conflict in West Africa

West Africa demonstrates a sub-regional pattern of violence and political instability that has engulfed Côte d'Ivoire, Liberia, Sierra Leone and Guinea, and now extends out from these states through corridors of violent conflict throughout the region; both physical and figurative. This article makes two arguments. That HIV/AIDS has developed a complex inter-relationship with violent conflict in the West African sub-region; and that the presence of HIV/AIDS in West Africa in zones of violent conflict is not given the recognition needed by the international policy community. The neglect of West Africa in the Pan-African response to HIV/AIDS, and the intractability of the region's Complex Political Emergencies, is creating an emerging phenomenon of Complex Human Emergency in the region. An acknowledged gap exists in social analyses of HIV/AIDS between policy speculations and the actual evidence base that these are built upon. Instead of speculative theorizing, this article presents seven key questions that need to be asked about HIV/AIDS and conflict in West Africa, in order to begin the process of serious policy research on the issue.     

Mitigating impacts of HIV/AIDS on rural livelihoods: NGO experiences in sub-Saharan Africa

HIV/AIDS is having profound impacts on livelihoods in sub-Saharan Africa. These include the deaths of working-age adults, the diversion of resources to caring, and the rupture of traditional chains of knowledge transmission. NGOs are responding by providing assistance to communities affected by the epidemic in the fields of agriculture, skills training, and microfinance, as well as by offering home care and support. A key feature of such initiatives is the focus on previously neglected groups such as women, school dropouts, and orphans. Factors of success include the use of participatory processes to identify target groups, and the involvement of local political leaders and adults trusted by young people in project activities. Challenges include improving monitoring systems, effectively disseminating lessons learned, and persuading donors, whose responses to the epidemic are currently focused on preventive and curative health services, to support livelihoods interventions as a matter of urgency.     

Towards global relational theorizing: a dialogue between Sinophone and Anglophone scholarship on relationalism

Abstract

What is ‘relational theorizing’ in International Relations and what can it offer? This article introduces a thematic section that responds to these questions by showing two things. First, relational theorizing is not a doctrine or a method, but a set of analyses that begin with relations rather than the putative essences of constitutively autonomous actors. Second, relational theorizing has emerged from different geo-linguistic traditions, and a relational approach to International Relations (IR) can offer the language and space for increased and productive engagement beyond Anglophone scholarship. This thematic section takes a significant step in this direction by staging a dialogue between Sinophone and Anglophone scholarship on relational IR theorizing. Such an engagement shows points of comparison and contrast, convergence and divergence. In this way, the essays presented here contribute to developing a more ‘global’ IR.     

Health service utilization among widows living with HIV/AIDS: an interview survey in Manipur, India

Widows living with HIV/AIDS (WLHA) are a vulnerable and often overlooked group. The North Eastern Indian state of Manipur, which has one of the highest concentrations of HIV/AIDS cases in India, is not an exception. This paper aims to describe the pattern of and factors contributing to the use of health services by WLHA in Manipur. Structured face-to-face interviews were conducted among 510 respondents. Only 49% of the respondents were aware of available health facilities. The place of residence (67.8%) and appointment at a convenient time (70.8%) were the main factors affecting the use of health services. To improve access to health services, it is imperative that the services of trained health providers are made easily available. Policy makers and organizations working on HIV/AIDs should work together to remove the barriers to the use of health services, making them user friendly for vulnerable groups such as WLHA.     

Communication,choice and freedom with reference to risk in aspects of communication on HIV/AIDS

Abstract

Where analysis concludes that a context is characterised by high risk, as in thecase given HIV/AIDS in South Africa, individual choice and freedom are often negated, for instance, by social scientists when they resort to the statistical logic of large numbers. Ironically, given that knowledge and rationality are arguably related, the choice and freedom of the individual deemed not to have knowledge about a given issue, is questioned and soon negated. By focusing on the black people in South africa, as a key example, it is argued that such analyses and solutions deny the existential possibilities of the people. The aim of this article is to affirm an individual's possibilities. The situation of the individual who communicates is recalled to argue against approaches that variously seek to blame the individual.

In the time of HIV/AIDS, ideas such as those of Søren Kiekegaard should be engaged to advance understanding of the limitations and possibilities of the individual who communicates. In the trasition from understanding to acting on information on HIV/AIDS, the individual has the freedom to choose. This is humbling for communication scientists and practioners who seek to prevent the further spread of HIV/AIDS.     

Migrant care workers and care-migration policies: a comparison between Italy and Japan

Asia Europe Journal - Japan and Italy are the most aging societies in the developed countries and they both face the rapid increase of the social cost and the demand in manpower for long-term care....     

Churches,mosques, and condoms: understanding successful HIV and AIDS interventions by faith-based organisations

There are an estimated 33 million people living with the Human Immunodeficiency Virus (HIV) worldwide. While national education campaigns have been successful in providing a broad platform of awareness of HIV and AIDS, within some countries faith-based organisations (FBOs) have assumed an important role in educating and supporting local communities to reduce HIV transmission. This article conceptualises the successful characteristics of a Christian organisation in West Papua and a Muslim organisation in Thailand. The ability of both these FBOs to engage successfully with their communities on issues of sexual practice provides important lessons for other FBOs seeking to reduce HIV transmission.     

Corporate wealth or public health? WTO/TRIPS flexibilities and access to HIV/AIDS antiretroviral drugs by developing countries

Between 1994 and 2003, the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement of the WTO was refined to allow for flexibilities in the use of compulsory licences to import and export ‘generic’ varieties of pharmaceutical products, including ARV drugs for the treatment of HIV/AIDS. After summarising this process, and assessing its implications in practice for developing countries, this article briefly places the current regime in a longer-term context of the institutional protection of patents in Britain and Europe dating from the nineteenth century. It traces how that pattern, which benefits major patent holders, continues to be present in TRIPS. The article goes on to demonstrate the continuity of corporate influence over the state, as expressed in the ‘TRIPS-plus’ conditions, which are appearing in bilateral free-trade agreements between the USA and either individual developing countries or regional groupings. This array of what amount to institutional obstacles to the sustained availability of cheap drugs presents serious problems for future operations of the supply chain for many imported medicines and, in the case of HIV/AIDS, has negative implications for the long-term clinical effectiveness of the most widely used drugs.