Eileen Moyer

A Disease Unlike Any Other? Why HIV Remains Exceptional in the Age of Treatment

Since 1996, when effective antiretroviral-based therapies (ARTs) first became available to treat HIV, various discursive, legal, health policy, and institutional moves have been made to reframe HIV as a chronic disease that should be treated ‘like any other.’ Arguments for this framing have come from diverse positions, including AIDS activists who want to challenge stigma; medical professionals who want HIV patients to be treated like other patients, with a diminished focus on consent and confidentiality; health administrators, who want to routinize and integrate HIV care into existing programs; public health policymakers who want to test and treat as many people as possible in the shortest period of time; and international donors who want to break with the 30-year-long crisis framing of HIV responses, and to push national governments to incorporate HIV care into existing public health budgets and strategies. Despite these efforts to ‘normalize’ HIV, the experiences of those infected, as well as many of those involved in providing care and support to the infected, demonstrate that the disease continues to be seen as exceptional. In this special issue, we explore the resulting tensions between individuals and institutions pressing for routinization and normalization of HIV in multiple settings in North America and east and southern Africa, by focusing on case studies of everyday practices of care that resist attempts at such normalization. We ask: What is it about HIV as a biosocial phenomenon and those it affects that limits its capacity to be subsumed in a chronic

Faidha gani? What's the point: HIV and the logics of (non)-disclosure among young activists in Zanzibar

Most HIV treatment guidelines advise people who test positive to disclose their status to improve adherence and garner psychosocial care and support. Similarly, advocacy groups for people living with HIV encourage disclosure as a key component of fighting self- and community-based stigma. Although there is arguably much to be gained by disclosing, there is also much at stake, including issues of individual and family honour and the possibility of living a ‘normal’ life. Starting with the question, Faidha gani? or ‘Whats the point?’ this paper attempts to shed light on motives for disclosure and non-disclosure. The arguments draw from a qualitative study among young HIV-positive adults in eastern Africa and, most specifically, an in-depth case study of one couple in Zanzibar.

A Qualitative Exploration of Barriers to Condom Use among Female Sex Workers in China

Background Sex workers in China continue to engage in unprotected sex acts that put them at risk for contracting HIV (Human Immunodeficiency Virus) and other STIs (Sexually Transmitted Infections). The purpose of this study was to explore women’s work history, the context of sex work, condom use, HIV testing services, and potential barriers to condom use in a sample of FSWs (female sex workers) in Guangzhou, China. Methodology/Principal Findings In-depth, semi-structured, face-to-face interviews were conducted with 24 FSWs in Guangzhou, China. Informants were recruited using a purposive sampling technique. Qualitative data were coded and analyzed using NVivo 8.0. The majority of respondents were internal economic migrants who had entered the sex industry in pursuit of greater financial reward. Most women in the study were married or had steady boyfriends, and were young, with secondary education and limited knowledge about HIV and STIs. Most were not satisfied with their current living conditions and expressed a desire to leave the sex industry. Women reported that they were more likely to use condoms during sex acts with commercial partners than with non-commercial partners. The potential stigma of being seen as a sex worker prevented many from accessing HIV testing. Three key factors put these FSWs at risk for HIV and STIs: unreasonable trust toward clients, stereotypes and assumptions about customers, and financial incentives. Conclusions/Significance These findings suggest that social and economic factors play an important role in shaping sexual decision-making among female sex workers in Guangzhou. We argue that greater insight into and attention to these factors could enhance the success of HIV prevention efforts.

Study on sexual and reproductive health behaviors of unmarried female migrants in China

Aim:  The purpose of this study was to broadly assess the level of knowledge, attitude and behaviors related to sexual and reproductive health (SRH) among unmarried female migrants in China.

Sexual and reproductive health status and related knowledge among female migrant workers in Guangzhou, China: a cross-sectional survey

OBJECTIVE The objective of this study was to investigate the current sexual and reproductive health (SRH) status including SRH-related knowledge and associated factors, self-reported symptoms of reproductive tract infection (RTI), medical assistance seeking behavior, sexual experience and contraceptive use, reproductive information approach and reproductive service utilization among female migrant workers in Huangpu district, Guangzhou city, China. STUDY DESIGN A cross-sectional study was conducted in 2008 in eight factories, which were selected randomly from 32 eligible factories in the Huangpu district in Guangzhou. Descriptive statistics were used to describe the SRH status of migrant workers. Factors associated with the level of SRH knowledge were determined by a logistic regression model. RESULTS Of 1346 female migrant workers, 831(61.7%) were unmarried and 515 (38.3%) were married. 27.2% of the unmarried respondents and 40.2% of the married respondents had suffered self-reported RTI symptoms. Among unmarried respondents, the median knowledge score was 5 points, compared to 8 points for the married. For unmarried migrant workers, factors associated with the knowledge level were age, education level, access to SRH information and service, sexual experiences and RTI symptoms. For married migrant workers, factors associated with the knowledge level were age, education level, access to SRH services and RTI symptoms. CONCLUSIONS A high prevalence of self-reported RTI symptoms and a low knowledge level were found among young female migrant workers. Unmarried migrant workers are more vulnerable to SRH problems. Those findings demand more specific interventions targeting female migrants and in particular the unmarried.

Determinants of unmet need for contraception among Chinese migrants: a worksite-based survey.

Background Considerable sexual and reproductive health (SRH) challenges have been reported among rural-to-urban migrants in China. Predictors thereof are urgently needed to develop targeted interventions. Study design A cross-sectional study assessed determinants of unmet need for contraception using semi-structured interviews in two cities in China: Guangzhou and Qingdao. Results Between July and September 2008, 4867 female rural-to-urban migrants aged 18–29 years participated in the study. Of these, 2264 were married or cohabiting. Among sexually-active women (n = 2513), unmet need for contraception was reported by 36.8% and 51.2% of respondents in Qingdao and Guangzhou, respectively; it was associated with being unmarried, having no children, less schooling, poor SRH knowledge, working in non-food industry, and not being covered by health insurance. A substantial proportion of unmarried migrants reported they had sexual intercourse (16.6 % in Qingdao and 21.4% in Guangzhou) contrary to current sexual standards in China. Conclusion The study emphasises the importance of improving the response to the needs of rural-to-urban migrants and recommends strategies to address the unmet need for contraception. These should enhance open communication on sexuality, increase the availability of condoms, and improve health insurance coverage.

Sex is never the same: Men's perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland

Faced with an HIV prevalence of 31% among 18- to 49-year-olds, Swaziland developed a male circumcision policy in 2009, following compelling scientific evidence from three randomised controlled trials. Utilising United States Agency for International Development funds, the state set out to circumcise 80% of adult men in 2011. Only 8667 of the targeted 150,000 men were circumcised during the campaign. This paper presents findings from a 2012 to 2013 in-depth qualitative study among Swazi men. Methods included 13 focus group discussions, 20 in-depth interviews, 16 informal interviews and participant observation. We argue that the campaigns failure can be partly explained by the fact that circumcision was perceived as a threat to Swazi masculinities, a factor hardly considered in the planning of the intervention. Results show that men believed circumcision resulted in reduced penis sensitivity, reduced sexual pleasure and adverse events such as possible mistakes during surgery and post-operative complications that could have negative effects on their sexual lives. Given the conflicting state of scientific data about the effects of circumcision on sexuality or sexual pleasure, this study addresses important lacunae, while also demonstrating the need for more research into the relationship between sexuality, masculinity and health interventions seeking to involve men.

When families fail: shifting expectations of care among people living with HIV in Nairobi, Kenya.

The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment – pre-treatment, treatment scale-up, and post-crisis – the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV.

Street-Corner Justice in the Name of Jah: Imperatives for Peace among Dar es Salaam Street Youth

Young men throughout the world seem fascinated with Bob Marley. Especially fascinated with him are poor, disenfranchised youths, like those living and working in the streets of Dar es Salaam, Tanzania, who are the subjects this article. What is it about Bob Marley and Rastafari-inspired discourses of peace and love that make them so appealing? Why are street youths throughout the world growing dreads and praising Jah? By taking a close look at internal peacekeeping strategies employed on a specific street corner located in the middle of the central business district of Dar es Salaam, this article demonstrates that such questions are best answered from a local perspective. While Marleys global appeal may be attributed to shared experiences of inequality, the ways this popularity emerges locally sheds light on the particularities of those experiences.

Putting sex on the table: sex, sexuality and masculinity among HIV-positive men in Nairobi, Kenya

Psychosocial support groups offer an important space for people living with HIV to pursue greater wellbeing as they learn how to accept and live with their HIV status. They are critical for the cultivation of responsible and adherent patients. Occasionally, support groups provide spaces where members are encouraged to discuss sexual struggles related to being HIV-positive, including sexual performance issues, sexual relationships, fertility desires and communicating with sexual partners. This paper examines an HIV-positive mens sex therapy support group at Kenyatta National Hospital in Nairobi, Kenya, where HIV-positive men access information about HIV and treatment, while getting tips on restoring sexual functioning and improving sexual gratification from medical experts, peer counsellors and fellow group members. In the group setting, members worked to rediscover and reconstruct masculinity under the guidance of a range of experts, while focusing on regaining or improving sexual prowess.