Judith A. Levy

Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi

Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16–80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. If MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

Health Benefits and Risks of the Internet

The linking of the Internet with health and medicine involves all levels of society, including individuals, health care providers, professional organizations, communities, and local and federal governments. A growing body of evidence suggests that despite the benefits of the Internet, this means of communication also figures into the creation of new forms of health risk for some users. This paper examines the effects of the Internet on the promotion of both health and illness. The discussion focuses on those factors of online communication that produce positive health outcomes and also the potential for health risk. Implications for health providers and for better serving patients are analyzed together with recommendations for improving services for those who go online to access health information.

Injection drug use and HIV/AIDS transmission in China.

ABSTRACTAfter nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling Chinas AIDS epidemic. The first outbreak of HIV among Chinas IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats.

The role of social networks in health, illness, disease and healing: the accepting present, the forgotten past, and the dangerous potential for a complacent future

Since the 1970s, the role of social networks in tracing the underlying epidemiology of illness, distress, disease and disability; and, in understanding how people identify and respond to these crises, has become a mainstay of social and behavioral science research. In this piece, we introduce the papers in this volume in three ways. First, we summarize basic tenants of a social network approach, laying out what research has been able to support to date. Second, to avoid the danger of continuing to do more and more network studies that merely replicate what we already know rather than opening up new areas of understanding, we return to the earliest roots of the social network perspective. Third, we use this review in tandem with the volumes papers to mark the cutting-edge boundaries of current research and to identify the issues and questions that remain.

HIV/AIDS interventions for midlife and older adults: current status and challenges.

Summary: Drawing on both domestic and global international perspectives, this special issue is devoted to articles that confront the challenges of understanding, preventing, and intervening, with HIV/AIDS as an epidemic that carries increasingly serious consequences for a growing number of adults who are 50 years of age or older. This issue builds on papers first presented at an HIV/AIDS and aging conference sponsored in the fall of 2000 by the National Institute on Aging of the National Institutes of Health. The editors have selected articles that focus dually on what is currently known and what needs to be known to successfully address the needs of persons 50 years of age or older who are vulnerable to the viruss effects. This special issue is organized around a series of subsections representing key issues and research findings related to HIV/AIDS and aging issues, including the epidemiology of HIV/AIDS and aging, HIV/AIDS risk and risk behavior, settings and situations as social contexts of risk, clinical challenges with older populations, living with and managing HIV/AIDS, interventions and research methods, new frontiers and challenges, and strategies for action. Some articles are data driven, whereas others are reflective pieces that recount personal experiences in living with the virus or point to new directions for research and practice. In this introduction, the editors highlight findings and approaches from each article and further add to our knowledge by setting these articles within the context of major themes relevant to the study of HIV/AIDS in an aging population.

The drug career of the older injector

Drug theorists have used the concept of a “career” to understand why some individuals enter and become deeply entrenched in a life organized around illicit drug-use. Previously career analyses have focussed on the lives and activities of chronic users at youth and middle age. We extend this work by examining the drug careers of life-long drug injectors (injection drug users, IDUs) of age 50 and more. Based on in-depth interviews with 40 active injectors between ages 50 and 68, we explore the interactional effects of aging and drug-use as they affect the lives of older injectors on the streets. We show that age forms a career contingency with the power to realign former roles and relationships. Retiring from the life career of chronic users seems doubtful for older users except through illness and death. Our findings point to the developmental aspects of a drug-dependent life style and why patterns and practices of drug-use change over time.

Educational strategies and interventions targeting adults age 50 and older for HIV/AIDS prevention

This article discusses the need for targeting adults age 50 and older for HIV/AIDS prevention education. First, the authors consider a variety of educational strategies that can address both primary prevention (risk reduction) and secondary prevention (prompt identification and treatment) with regard to older adults. Examples of existing prevention education programs designed for older adults are presented together with a discussion of what has been learned about effective educational strategies and interventions among other targeted groups. Finally, suggestions are made for future research needed to help design and implement effective HIV/AIDS education programs for older adults.

Individual, contextual, and social network factors affecting exposure to HIV/AIDS risk among older residents living in low-income senior housing complexes.

Summary: This study examines the influence of individual, contextual (building location and characteristics), and social network characteristics on HIV prevalence and risk behavior among people older than 50 years of age living in low‐income senior housing in two cities, Hartford, Connecticut and Chicago, Illinois. The authors’ study focuses on older residents of six buildings located in impoverished neighborhoods with high rates of HIV transmission through injection drug use and unprotected sexual activity, including the exchange of sex for drugs and money. The article is organized into three sections. First, the authors explore the HIV prevalence, distribution, and risk behaviors that may contribute to new infections among the buildings’ older residents in general. These practices include unprotected sexual intercourse, sex with commercial sex workers, casual or multiple partners, regular use of alcohol and/or illicit drugs, and other high‐risk activities that expose older residents to HIV, sexually transmitted diseases, and other negative health consequences. Next, the authors examine the relationship between building and neighborhood characteristics, the internal social organization of buildings, and the risk behaviors of individual residents by building residency. Finally, the authors use a social network analysis to identify possible entry points and transmission routes for HIV infection through drug and sexual exchanges between and among building residents and visitors. This approach also reveals variations in building structures that may facilitate the diffusion of HIV prevention efforts.

Health-seeking patterns for AIDS in Malawi

Health-seeking practices in Malawi are not well understood and it is not clear where people go for help to manage AIDS symptoms and to receive treatment for AIDS- defining illness. This qualitative study examines the health-seeking practices of families affected by AIDS in rural Malawi. Semi-structured interviews were conducted with family caregivers (N=26) and patients with AIDS symptoms (N=20). Health seeking progressed in three stages: traditional care and treatment by family were used first, followed by remedies from traditional healers. When traditional methods fail and symptoms continue modern treatments from hospitals or clinics were used as a last alternative. We discuss the cultural context of health seeking for HIV/AIDS in Malawi and suggest ways in which traditional practices can be integrated into interventions to improve the quality of care and treatment for people living with AIDS.

SHOOTING GALLERY USERS AND HIV RISK

Recognizing that HIV transmission occurs within situated interactions between two or more people, prevention research has increasingly begun to focus on identifying the influence of situations and settings on the spread of HIV. Examination of the social geography of risk has emerged as a powerful tool for understanding where and among whom risky practices occur. In this regard, shooting galleries represent interactional territories where the normative expectations of participation within their spatial boundaries can both encourage and reinforce sex- and drug-related risky behavior. Indeed, research shows that those who inject in shooting galleries tend to be at a higher risk of transmitting HIV than those who inject elsewhere. Drawing upon data from a sample of 1,113 active injecting drug users, we examined the demographic and psychosocial factors that predict shooting gallery use. Next, we compared shooting gallery users with nonusers in terms of drug use, followed by an examination of differences in sex- and drug-related HIV risk behaviors. Then, we explored preventive practices that possibly differentiate those who use shooting galleries from those who do not. We end our analysis by discussing the implications of our results for HIV prevention and social policy.