Understanding physicians' response to AIDS.

Attempts to comprehend physicians'' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians'' attitudes and practices. We suggest a framework developed from the literature on physicians'' and society''s response to other disorders that would provide a basis for organizing the ever-increasing amount of information on physicians and AIDS and would guide systematic research aimed at understanding and predicting physicians'' participation in the prevention and management of AIDS. Within this framework we consider how characteristics of the disease, elements of the health care system and physicians'' attitudes interact to influence clinical and personal practices. AIDS had led to new delineations of physicians'' responsibility, modification of prevailing beliefs about physician autonomy and thus a redefinition of the role of the physician in North America.     

The practice of capoeira: diasporic black culture in Canada

Abstract

This article draws on ethnographic research with Canadians who practise the Afro-Brazilian martial art, capoeira, to discuss, renew and perform African heritage, black circulating cultures and Canadian nationalism. I make several incursions into Paul Gilroy's theory of the Black Atlantic. First I draw attention farther north to Canada to show that diaspora cultures reference an ‘elsewhere’ as they also come to represent ‘here’; capoeira is used to engage with local Aboriginal and multiculturalism politics. I overcome the little attention that has been paid in Gilroy-influenced black cultural studies to embodiment, corporeality and the particular movements of the sporting body, which are deployed to preserve and share diaspora cultures. This examination of the micropolitics of sport reveals the past, ‘tradition’ and ‘African’ symbols and heritage (roots), along with antiphony, innovation and transnational circulation (routes) as essential elements of black expressive cultures.     

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.     

Urban Low-Income African American Men, HIV/AIDS, and Gender Identity

In a 1993 Human Organization article, Jerome Wright called for more research on African American male sexual behavior and the risk for HIV infection. The present article is a response to that call. Wright pointed out a well-known fact of HIV/AIDS prevention programs: such programs have not been very successful in reaching low-income African American males. The present article suggests that perhaps the key to better understanding sex-related health-risk behavior is to conduct more systematic research on gender identity, and the historical and sociocultural origins of such identities. I argue that if we are truly interested in developing effective HIV/AIDS programs targeting low-income African American males, then the sociocultural "meanings" that this population attaches to AIDS-related phenomena must be understood in the broader contexts of American constructs of masculinity, and in the real and perceived experiences of black men in America. Data from several ethnographic and qualitative research projects carried out among low-income African American male and female residents of Baltimore, other parts of Maryland, and Washington, D.C. are used in support of my primary arguments. [HIV/AIDS, African American Males, Gender Constructs, Sociocultural Meaning, Plantation America]     

The reality of despair: AIDS in Malawi.

While completing a recent medical elective in the Central African country of Malawi, medical student Dale Needham learned firsthand that HIV/AIDS represents a true pandemic in Africa. By the end of 1993, Malawi had the continent''s highest per capita number of cumulative reported AIDS cases. Although Canadian physicians have had their own struggles helping patients with HIV/AIDS, many more battles are being fought in countries like Malawi, where financial resources are limited. In Africa, HIV-positive people of all ages suffer incredibly from diseases such as protein energy malnutrition, tuberculosis and cryptococcal meningitis. Primary health care programs, education in the primary schools and community awareness and support are partial answers to the pandemic.     

Rationale,Design and Methods of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men in the Southeastern United States (The MARI Study)

Background

This paper describes the rationale, design, and methodology of the Ecological Study of Sexual Behaviors and HIV/STI among African American Men Who Have Sex with Men (MSM) in the Southeastern United States (U.S.; known locally simply as the MARI Study).

Methods

Participants are African American MSM aged 18 years and older residing in the deep South.

Results

Between 2013 and 2015, 800 African American MSM recruited from two study sites (Jackson, MS and Atlanta, GA) will undergo a 1.5-hour examination to obtain anthropometric and blood pressure measures as well as to undergo testing for sexually transmitted infections (STI), including HIV. Intrapersonal, interpersonal, and environmental factors are assessed by audio computer-assisted self-interview survey. Primary outcomes include sexual risk behaviors (e.g., condomless anal sex) and prevalent STIs (HIV, syphilis, gonorrhea, and Chlamydia).

Conclusion

The MARI Study will typify the HIV environmental ''riskscape'' and provide empirical evidence into novel ecological correlates of HIV risk among African American MSM in the deep South, a population most heavily impacted by HIV. The study''s anticipated findings will be of interest to a broad audience and lead to more informed prevention efforts, including effective policies and interventions, that achieve the goals of the updated 2020 U.S. National HIV/AIDS Strategy.     

The politics of marginalization: The appropriation of AIDS prevention messages among injection drug users

This essay addresses the space between a cultural critique and a class analysis of HIV transmission. It explores how injection drug users, as a disempowered group, resist hegemony through dissent. Distrust of the medical establishment and severe social and legal constraints force injection drug users to reconstruct the AIDS message. Economic and political survival inflates the need for trust and reciprocity within their social network. This makes the meaning of AIDS a continually ambiguous one for drug users. The ways in which dissent to domination is enacted and the effect this has on HIV prevention is explored.IfI'm that fucked up where I'll put a life-threatening drug into myself knowing it's dangerous, I really can't deal with a society that's telling me I deserve it. It takes all my strenght. The moral majority says it's God's way of taking care of these things. I hear too much of that. Drug addicts don't even want to talk about it [AIDS] because of the fear. I talk to people about it and they tune out. I can see their eyes glazing over.-A recovering addict     

Civilization,wilderness and secrecy: Making two Nigerian films

This paper draws on fieldwork and filmmaking experiences and explores the interpretive process shared between the object, filmmaker, and audience. Mammy Water: In Search of the Water Spirits in Nigeria [1989] is the result of extensive field research and close collaboration between the local community, the researcher/filmmaker and team. Mammy Water priviledges local views on the subject over the academic discourse taking place elsewhere. This has evoked diverse reactions. Some miss the (Western) analytical level, others engage in the discourse itself, or assume the film's own position. The issue of cultural perspective is carried even further in cinematography. Both films discussed here were made not only in close collaboration with African communities but also photographed by an African cinematographer, Alhaji Yusufu Mohammed. His camera evokes diametrically opposed reactions from African and Western viewers. Where Westerners perceive “distance”, African audiences perceive “closeness”, where Westerners perceive a scene as “staged”, African audiences perceive it as “natural”. This contrast of perception is further highlighted in Owu: Chidi Joins the Okoroshi Secret Society [1991], mostly filmed by Alhaji, but complemented by two video inserts by my daughter, Saskia Jell, who produced additional behind‐the‐scenes footage in Coming to Nigeria.

Reviewers have raised another important topic. Owu points to three different levels of secrecy surrounding the masquerade and initiation into Oguta's Okoroshi society. This in turn raises questions on if and how to represent secrecy and the dichotomy between civilization and wilderness on film.

A discussion of post‐production at the IWF introduces a negative dimension and questions the undue impact of politics, German rigidity, and other impediments.

In conclusion, my films are strongly grounded in long‐term field research, and indebted to the people whose cultures I have researched, as well as to Alhaji Yusufu Mohammed's cinematic representation. Situated between Africa and the Western world, my films contain elements of both African and Western cultures, as they attempt to mediate between them. 1 am looking to the genre of ethnographic film primarily for its effort to create meaning in interpreting and representing cultures, for its position between the cultural worlds, and for its possibilities for transcultural communication. This goal could be served by a plurality of methods, different film styles, and varied authors within the same genre.     

Cultural and social aspects of HIV/AIDS sex education in secondary schools in Nigeria

This is an exploratory study to examine the social and cultural determinants of the teaching of HIV/AIDS sex education among secondary school teachers in Eastern Nigeria. The research analyses how teachers perceive passing their knowledge of HIV/AIDS prevention measures to their students in the context of their cultural and social norms, which restrict open discussion of sex. This is a qualitative study based on in-depth interviews with 60 teachers drawn from secondary school teachers in Eastern Nigeria, supplemented with five focus group discussions, and content analysis of teachers' lesson preparatory notes. The findings show a high level knowledge of HIV/AIDS preventive measures among teachers. However, teachers are not passing on this knowledge because of cultural and social inhibitions. In addition, teachers have not been receiving adequate training and motivation on information, education and communication for HIV/AIDS sex education. The situation calls for serious policy intervention.     

Knowledge and beliefs of international travellers about the transmission and prevention of HIV infection.

OBJECTIVES: To measure the perceived risk of acquired immunodeficiency syndrome (AIDS) among international travellers, to measure their knowledge of the transmission and prevention of HIV infection abroad and to identify some of the determinants of this knowledge. DESIGN: Survey. SETTING: Travellers'' immunization clinic providing mostly primary preventive care to international travellers. PARTICIPANTS: All clients aged 18 to 50 years seen at the clinic between Oct. 2 and Dec. 21, 1989, before their departure. MAIN OUTCOME MEASURES: Sixteen statements measured knowledge of transmission and prevention of HIV infection. Standardized scales measured health beliefs. RESULTS: The response rate was 81% (331/409). Compared with other diseases AIDS was perceived to be associated with a low risk except by those travelling to countries with a high prevalence of AIDS. Most of the clients were found to have a good knowledge of HIV transmission to travellers, although some myths remained popular and some real routes of transmission, especially blood, remained underrated. In all, 70% of the subjects believed in the efficacy of condoms when used with local people, as compared with 79% when used with other tourists; this difference was greatest among travellers who perceived AIDS as being particularly severe but difficult to prevent. The determinants of the knowledge of HIV transmission and prevention were a high level of education, a mother tongue other than French, unmarried status, a high prevalence of AIDS at the destination, the duration of the trip and a high perceived risk of HIV infection. CONCLUSIONS: Counselling should teach travellers (a) not to underestimate their risk of HIV infection during their trip, (b) to decrease the risk of requiring health care in developing countries and (c) to rely on their own prudent sexual behaviour rather than on their assessment of the level of risk posed by the environment.     

The Cultural Organizing of Youth Ethnographers: Formalizing a Praxis-Based Pedagogy

This article illustrates how elements of praxis within George Spindler's cultural therapy and Paul Willis's cultural production are useful precedents for a praxis-based pedagogy. I argue that combining the praxis elements within cultural therapy and cultural production engenders a third mode of ethnographic praxis that I call "cultural organizing." The article provides an example of cultural organizing among Latina/o high school students in Tucson, Arizona.  [cultural organizing, ethnography, Latina/o students, praxis, pedagogy]     

‘Cross-cultural’ practices: interpreting non-African-American participation in hip-hop dance

This article examines how participants interpret a cultural practice commonly associated with a race other than their own. Determining if, how and why participants experience such ‘cross-cultural’ forms in racialized terms can clarify whether these practices promote tolerance or essentialism in everyday life, and whether they enable appropriation in the field of cultural production. Through interviews and participant observation with non-African-American women learning and teaching hip-hop dance, I capture a spectrum of participant views. Most dancers see hip-hop as African American in its origins. But while novices often speak of an inherent or learned authenticity among blacks, experts rarely express racialized views of the dance's contemporary practice. Experts' views are shaped by personal ability, exposure to dancers whose ability is not racially patterned, and exposure to others who accept their skill. How dancers act on these interpretations challenges common associations of racialized views with tolerance, and non-racialized views with appropriation.     

A Look at Uganda's Early HIV Prevention Strategies Through a Moderate ‘African’ Communitarian Lens

This paper seeks to highlight the benefits of prioritizing moderate African communitarian principles as partly demonstrated in the HIV prevention strategies implemented in Uganda in the late 1980s. Pertinent lessons could be drawn so as to achieve the HIV prevention targets envisioned in the post‐2015 development era. Communitarianism emphasizes the importance of communities as part of healthy human existence. Its core ethical values include the virtues of generosity, compassion, and solidarity. Persuasion through communication, consensus through dialogue, and the awareness and commitment to responsibilities towards other members of the community, are chief practices relied upon to achieve appropriate social behaviour. All these elements signify individual rootedness in communities and contribute to the healthy existence of its members. Communitarianism is usually classified as either authoritarian/radical or responsive/moderate, depending on the primacy given to either community interests or the individual will and rights. Moderate communitarianism recognizes the individual's capacity for moral reasoning, virtue and free choice. The ensuing form of society is deemed more ethical as it relies on education in the virtues, moral persuasion and informal social controls, without stifling individual identity, agency, and capacity for self‐determination. If moderate African communitarianism, in particular, can to a certain extent be associated with the significant aspects of Uganda's HIV prevention strategies in the stated period, then its present‐day relevance for HIV prevention and other public health interventions may be emphasized accordingly. This applies especially in view of the ongoing efforts to achieve a balance between individual and collective interests in bioethics.     

Beyond Socioeconomics: Explaining Ethnic Group Differences in Parenting Through Cultural and Immigration Processes

This study examined both socioeconomic and cultural factors in explaining ethnic differences in monitoring, behavioral control, and warmth—part of a series of coordinated studies presented in this special issue. Socioeconomic variables included mother's and father's educational levels, employment status, home ownership, number of siblings in the household, and single parent status. Cultural factors included nationality or ethnicity, immigrant status of child, mother's/father's age of arrival in the United States, mother's/father's English language use with the child, child's native fluency, and cultural values for independence and interdependence. The sample consisted of 591 European American, 123 African American, 1,614 Asian American, and 597 Latino students in the ninth grade. All the ethnic minority groups were higher than European Americans on behavioral control, and Latinos were also higher than European Americans on monitoring. However, European Americans were higher on parental warmth than Asian Americans and African Americans. These ethnic group differences primarily remained even after controlling for the socioeconomic factors. Finally, in analyses looking within the Asian and Latino groups, differences in parenting were found within both groups due to nationality or ethnicity, youth's fluency in the native language, and cultural values of interdependence, although values of independence were also related to the parenting of Asian Americans.     

Signifying the Pandemics: Metaphors of AIDS, Cancer, and Heart Disease

This article offers a symbolic analysis of the cultural construction and signification of three of the major "pandemics" of the late 20th century: AIDS, cancer, and heart disease. It is based on unstructured interviews conducted in Israel between 1993–94 with 75 nurses and 40 physicians and between 1993–95 with 60 university students. Two key symbols, "pollution" and "transformation" are shown to constitute AIDS and cancer within a symbolic space that I suggest is "beyond culture" where body boundaries are dissolved and cultural categories are dismantled. Heart disease, in contrast, is metaphorized as a defect in the "body machinery." The article concludes by arguing that heart attack is depicted as the pathology of the Fordist, modernist body, while AIDS/cancer are pathologies of the postmodern body in late capitalism. [AIDS, cancer, heart disease, semiotics, metaphorization]     

Association of Y chromosome haplogroup I with HIV progression, and HAART outcome

The host genetic basis of differential outcomes in HIV infection, progression, viral load set point and highly active retroviral therapy (HAART) responses was examined for the common Y haplogroups in European Americans and African Americans. Accelerated progression to acquired immune deficiency syndrome (AIDS) and related death in European Americans among Y chromosome haplogroup I (Y-I) subjects was discovered. Additionally, Y-I haplogroup subjects on HAART took a longer time to HIV-1 viral suppression and were more likely to fail HAART. Both the accelerated progression and longer time to viral suppression results observed in haplogroup Y-I were significant after false-discovery-rate corrections. A higher frequency of AIDS-defining illnesses was also observed in haplogroup Y-I. These effects were independent of the previously identified autosomal AIDS restriction genes. When the Y-I haplogroup subjects were further subdivided into six I subhaplogroups, no one subhaplogroup accounted for the effects on HIV progression, viral load or HAART response. Adjustment of the analyses for population stratification found significant and concordant haplogroup Y-I results. The Y chromosome haplogroup analyses of HIV infection and progression in African Americans were not significant. Our results suggest that one or more loci on the Y chromosome found on haplogroup Y-I have an effect on AIDS progression and treatment responses in European Americans. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

A comment on ‘ethnic discrimination in employment and housing’

This article investigates Los Angeles employers' attitudes towards African American and immigrant Latino low-skill workers. Using 145 in-depth interviews of employers in four industries, I find that a central concern of employers of low-skill jobs is control at the workplace, and employers consequently seek workers whom they perceive as manageable and pliable. As such, the most salient component of employers' attitudes towards African American and immigrant Latino low-skill workers is their perception that the manageability and pliability of workers vary by race, nativity and gender. I also link employers' micro-level attitudes to broader societal level ideologies about race and opportunity. I find that employers' attitudes were embedded within an ideology of individualism, as exemplified by the idea of the 'American Dream', and reflected the growing belief that race-based claims are illegitimate.     

Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales.

OBJECTIVE--To determine the current and potential roles of community pharmacists in the prevention of AIDS among misusers of injected drugs. DESIGN--Cross sectional postal survey of a one in four random sample of registered pharmacies in England and Wales. SETTING--Project conducted in the addiction research unit of the Institute of Psychiatry, London. SUBJECTS--2469 Community pharmacies in the 15 regional health authorities in England and Wales. MAIN OUTCOME MEASURES--Willingness of pharmacists to sell injecting equipment to known or suspected misusers of drugs; pharmacists'' attitudes to syringe exchange schemes, keeping a "sharps" box for use by misusers of drugs, and offering face to face advice and leaflets; and opinions of community pharmacists on their role in AIDS prevention and drug misuse. RESULTS--1946 Questionnaires were returned, representing a response rate of 79%. This fell short of the target of one in four pharmacies in each family practitioner committee area in England and Wales, and total numbers of respondents were therefore weighted in inverse proportion to the response rate in each area. The findings disclosed a substantial demand for injecting equipment by drug misusers. After weighting of numbers of respondents an estimated 676 of 2434 pharmacies were currently selling injecting equipment and 65 of 2415 (3%) were participating in local syringe exchange schemes; only 94 of 2410 pharmacies (4%) had a sharps box for used equipment. There was a high degree of concern among pharmacists about particular consequences of drug misusers visiting their premises, along with a widespread acceptance that the community pharmacist had an important part to play. CONCLUSIONS--Promoting the participation of community pharmacists in the prevention of AIDS among misusers of injected drugs is a viable policy, but several problems would need to be overcome before it was implemented.     

Social,Cultural and Demographic Aspects of AIDS

Both on national and international levels, the acquired immunodeficiency syndrome (AIDS) represents a formidable challenge to social institutions and to cultural assumptions. Its effect thus far, in what must be considered the very early stages of a protracted and unprecedented epidemic, has been to exacerbate existing social tensions and divisions over a surprisingly wide field. Though international leadership by the World Health Organization has been met with an unusually high degree of multinational cooperation, AIDS has also stimulated a degree of xenophobia and racial friction that, if allowed to grow, could handicap global AIDS control and prevention efforts.