Women and AIDS: an analysis of media misrepresentations

The discursive construction of HIV stigma in Irish print media

As interlocutors in national level discourse with the power to influence public opinion and inform policy, the news media are an important data source in understanding the constitutive roles played by culture and discourse in shaping health experiences and outcomes. This paper reports on a critical discourse analysis of news media coverage of HIV in the Republic of Ireland between 2006 and 2016. This period is significant because of the considerable increase in new HIV diagnoses that occurred in Ireland after the 2008 recession. Analysis of articles (n = 103) demonstrated a pattern of dividing practices whereby people living with or affected by HIV were frequently positioned as somatically and morally deficient via discourses of risk and responsibility. Little focus was given over to examination of the structural drivers of HIV, occluding the social context of the epidemic. The findings suggest that media discourses on HIV have the potential to other people living with HIV and generate stigma by invoking a dynamic of blame and shame frequently implicated in the stigma process.

Community HIV Prevention: What Can We Learn from the Perceptions and Experiences of HIV-Positive Women Living in Metropolitan Toronto, Canada?

Researchers and practitioners have pointed to a number of gender issues that influence women's ability to practice safer sex and protect themselves from HIV. Many of the studies, however, are based on research with HIV-negative women. This qualitative study sought to explore with forty HIV-positive women (for whom prevention was not effective) the types of issues that they believe need to be addressed to ensure effective prevention for other women. Participants also were asked to discuss the impact of HIV on their sexual lives as a means of exploring the types of issues that are needed to ensure effective secondary prevention efforts. Many of the women interviewed suggested that not only is there a need to challenge gender inequities as a means of ensuring women's protection against HIV, but that different “accommodation strategies” are necessary in the short-term to ensure women's health. In addition, many of the women pointed to the fact that women's identity—as wife or girlfriend—is often based on the belief that their sexual relationships are “safe” from HIV. The importance of addressing gender identity (rooted in gender inequities) when developing HIV prevention efforts is discussed.

Women's Sexual Health: The Need for Feminist Analyses in Public Health in the Decade of Behavior

Women's sexual health is directly affected by women's low status in society. This low status, and subsequent lack of sexual autonomy not only increases risk for sexual health problems, it also decreases ability to obtain treatment and support when a sexual health concern arises. This has clearly been demonstrated in the HIV epidemic within the U.S. Earlier in the epidemic, women were simply ignored by public health research and practice. Once they could no longer be ignored, they were blamed and viewed as vectors. Current seroprevalence rates among men reveal that women are not significant vectors. In contrast, rates among women indicate that infection from men is the primary mechanism by which women are contracting HIV, and male-controlled sexual decision-making, male partner violence against women, and histories of sexual assault all contribute to increased HIV risk for women. Once infected, women are not given the support and resources they need as mothers and caretakers of HIV-positive partners and/or children. These findings are especially true for marginalized women such as women of color, poor women, women addicted to alcohol or drugs, and women who exchange sex for drugs or money. Findings from this review demonstrate the need for feminist approaches in understanding and addressing this issue in the Decade of Behavior. Such approaches must include an understanding of the needs of diverse women. An empowerment approach is needed to better contend with the sexual health needs of women; this must include the goal of ensuring women's control of their own bodies.

Perceived Advantages and Disadvantages of Using Pre-Exposure Prophylaxis (PrEP) among Sexually Active Black Women: An Exploratory Study

Knowledge of pre-exposure prophylaxis (PrEP) continues to remain scarce among Black women who are disproportionally affected by HIV in the United States. A thematic analysis of open-ended questions from a sample of Black women (n=119) who completed a mix-methods, online, e-health study was conducted to examine the perceived advantages and disadvantages of using PrEP. Being a female controlled method, empowerment, option for women with risky sex partners, and serodiscordant couples were advantages described. Disadvantages of PrEP were identified as the complexity of the choice, encouragement of sex with risky partners, increased burden, promotion of unprotected sex, and newness of the drug.

Incarcerated Black Women in the Southern USA: A Narrative Review of STI and HIV Risk and Implications for Future Public Health Research, Practice, and Policy

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

Waging war: discourses of HIV/AIDS in South African media

This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South African daily newspaper, from 1985 to 2000, and discusses the implications of this in terms of the way in which HIV/AIDS is constructed. The discursive framework of the war depends, fundamentally, on the personification of HIV/AIDS, in which agency is accorded to the virus, and which allows for its construction as the enemy. The war discourse positions different groups of subjects (the diseased body, the commanders, the experts, the ordinary citizens) in relations of power. The diseased body, which is the point of transmission, the polluter or infector, is cast as the 'Other', as a dark and threatening force. This takes on racialised overtones. The government takes on the role of commander, directing the war through policy and intervention strategies. Opposition to government is couched in a struggle discourse that dove-tails with the overall framework of war. Medical and scientific understandings pre-dominate in the investigative practices and expert commentary on the war, with alternative voices (such as those of people living with HIV/AIDS) being silenced. The ordinary citizen is incited to take on prevention and caring roles with a strong gendered overlay.

Sex worker activism, feminist discourse and HIV in Bangladesh

This paper explores the relationship between sex worker activism and HIV-related discourse in Bangladesh, relating recent developments in activism to the influence of feminist thought. Following their eviction in 1991 from brothels from red light areas, Bangladeshi sex workers started a social movement, at just about the same time that programmes started to work with sex workers to reduce the transmission of HIV. This paper argues that both sex worker activism and HIV-prevention initiatives find impetus in feminist pro-sex-work perspectives, which place emphasis on individual and collective agency. However, by participating in these programmes, sex workers failed to contest the imagery of themselves as 'vectors' of HIV. In this way, they were unwittingly complicit in reproducing their identity as 'polluting others'. Moreover, by focusing on individual behaviour and the agency of sex workers, HIV programmes ignored the fact that the 'choices' made by sex workers are influenced by a wide range of structural and discursive factors, including gender norms and notions of bodily purity, which in turn have implications for the construction of HIV-related risk.

Prevalence and correlates of sexual risk among male and female sex workers in Tijuana, Mexico

We investigated prevalence and correlates of sexual risk behaviours among male and female sex workers in Tijuana, Mexico, the busiest border crossing area on the US - Mexico border, analysing survey data from a purposive, cross-sectional sample of male and female sex workers who worked in a range of indoor and outdoor settings. Logistic regression was used to determine factors that were associated with sexual risk-taking, defined as failing to use a condom with last client. In bivariate regression models, gender, work setting (e.g., indoor vs. outdoor), poverty, engaging in survival sex, marital status and perceived drug addiction were correlated with sexual risk. When controlling for work location, housing insecurity, poverty, survival sex, marital status and perceived drug addiction, male sex workers were still 10 times more likely than female sex workers (FSW) to engage in sex without a condom during their last encounter with a client. And, although FSW were significantly more likely than males to have used a condom with a client, they were significantly less likely than males to have used a condom with their regular partner. Future research should further examine how gender shapes sexual risk activities in both commercial and non-commercial relationships.

“I Don't Know Who to Blame”: Hiv-Positive South African Women Navigating Heterosexual Infection

Women who become HIV infected through heterosexual transmission are faced with the task of making sense of how they became infected. This paper presents a qualitative analysis based on interviews with 35 HIV-positive South African Black women. A specific theme, that blame of a male partner was avoided or disavowed in interviews, is explored in relation to broader contexts concerning gender and HIV. It is suggested that the repeated phrase “I don't know who to blame” expresses gender-differentiated speaking rights. It also protects women from voicing their own anger, guilt and internalization of badness as a result of an HIV-positive diagnosis. Further, it protects women from exposure to male destructiveness and from confronting the possibility that they themselves are implicated in the infection of others. Analysis offers opportunities for exploring how women both resist and repeat dominant discourses and dominant fears related to HIV-infected womanhood.

"The VIHsibilite Project": HIV-positive people in the Quebec press and community responses

The VIHsibilite Project is a community-based action-research initiative that examines newspaper coverage of HIV/AIDS issues in Quebec from 1988 to 2004. Using standard qualitative research methods, and in consultation with an advisory committee of people directly impacted by HIV/AIDS news coverage, the project discerns trends in reporting on HIV/AIDS and undertakes discursive content analysis of these, aiming to better understand in what normative ways seropositive people are represented in print media, and, ultimately, to reduce the stigma attendant upon HIV infection. Preliminary findings include indications that seropositive women tend to be represented markedly differently from men in the news.

'Taking charge of your health': discourses of responsibility in English-Canadian women's magazines

This article presents an examination of the ways in which responsibility for health is constructed in popular English-Canadian women's magazines. Women's magazines are a unique media form, acting as guidebooks for women on matters relating to feminine gender roles and are important to examine as part of the corpus of societal discourses which frame our understandings of what it means to be healthy and how good health is achieved. Using discourse analysis several techniques were found which reinforce women's individual responsibility to create and maintain good health for themselves and their families. The magazines instruct women/readers directly about their health-related responsibilities and outline the negative consequences of inaction or incorrect action. The magazines also use the traditional discursive technique of women's personal accounts as both cautionary tales and inspirational stories to encourage readers to actively pursue healthy behaviours. Reflecting and reinforcing the discourse of healthism, women's magazines consistently present health as an important individual responsibility and a moral imperative which creates an entrepreneurial subject position for women. The article concludes by discussing the implications for women's magazine audiences within the ongoing feminist debate about this cultural industry.

Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization

As stigmatization has a large impact on patients, therapists need a measure of this impact to provide patients with adequate services. This study, therefore, examined the reliability and validity of the Social Impact Scale (SIS) when applied to three groups of individuals diagnosed with major depression, schizophrenia, or HIV/AIDS. The study sample (N=580) included 237 patients with depressive disorder, 119 with schizophrenia, and 224 with HIV/AIDS. Of these, 56% were men, 45.5% had an elementary school education or less, 48% were employed, and 56% were single. The Rasch measurement model, an item-response theory, was used to analyze the SIS structure and quality. The Rasch model solves several statistical problems of traditional measurement theory, such as misuse of ordinal data as interval data and sample dependence. Rasch analysis indicated that the 24 items of the SIS fit the measurement model. The match between item difficulties and person abilities was adequate. All items showed acceptable rating scale structure. The separation reliability of the scale reached 0.99. The SIS had acceptable psychometric qualities in terms of internal consistency, item validity, person validity, sensitivity, and concurrent validity when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan.

The portrayal of HIV/AIDS in two popular African American magazines

Mainstream magazines and other media have been found to both reflect and influence existing values and beliefs regarding health and medicine. Little is known about how media directed toward specific cultural or other market groups may differ. The present study examined how HIV and AIDS are portrayed within a specific ethnocultural medium, the two highest circulating magazines directed toward African American and African Canadian readers. The portrayal of HIV/AIDS from January 1997 to October 2001 in Ebony and Essence magazines was examined through manifest and latent content analysis. African American people were described paradoxically both as powerless victims in the face of the disease and as members of a strong and identifiable community of "sisters" and "brothers" available to respond to prevent and cope with the disease. Polarization between Blacks and Whites was accomplished by frequent emphasis on the higher rates of HIV/AIDS amongst Black Americans. Both the church and spirituality were highlighted as means of prevention education and coping.

'It's in the nature of men': women's perception of risk for HIV/AIDS in Chiang Mai, Thailand

The paper examines the context of women's risk for HIV by assessing men's and women's sexual behaviour, attitudes towards sex work, and perception of risk for HIV in the city of Chiang Mai, Thailand. The findings are based on data collected in the mid-1990s, at the height of the epidemic. A range of significant issues were highlighted by the men and women who participated in this study. First, some men continued to have unsafe sex with sex workers. Second, fear of HIV motivated men to seek out friends and acquaintances instead of sex workers for sexual encounters because they were considered 'safe' from infection. Third, women in this study were largely unaware of this expansion of the sexual network beyond the sex work itself. Lastly, women's sexuality was largely unrecognized in public health responses, or by the male and female participants, leaving them at risk for HIV.

Social stigmatization and hepatitis C virus infection

GOAL

Our aim was to assess stigmatization by evaluating the impact of hepatitis C virus (HCV) on social interactions, feelings of rejection, internalized shame, and financial insecurity, and behavior.

BACKGROUND

HCV patients suffer from slowly progressive disease. Although much research has improved the long-term prognosis of chronic HCV, quality of life may be affected by perceived social stigmatization.

STUDY

In a cross-sectional study, HCV patients without cirrhosis or significant comorbidities were recruited from the University of North Carolina viral hepatitis clinic. Subjects completed a questionnaire administered by a trained interviewer that assessed changes in sexual behavior, personal hygiene habits, social function, and interactions. Additionally, subjects completed validated, standardized questionnaires, the Health Status Questionnaire, and the SCL-90-R. Frequencies were calculated for the prevalence of stigmatization and altered social interaction. Correlations between education and behavior changes were assessed. A series of multivariate analyses controlling for age, sex, and education were performed to assess the association between HCV acquisition risk and stigmatization.

RESULTS

One hundred seventy-five of 217 potential subjects (81%) participated in the survey. The average age was 45.2+/-7.7 years. Fifty-five percent were men and 53% were single. Twenty-nine percent had some college education. Risk factors for HCV acquisition included transfusion (21%) and injection drug use (29%), whereas 32% had an unknown mode of infection. Among common activities, 47% were less likely to share drinking glasses, 14% were less likely to prepare food, and one-third of subjects were less likely to share a towel. Thirty-five percent of respondents reported changes in their sexual practices. Decreased frequency of kissing and sexual intercourse was reported in 20% and 27% of individuals, respectively. Almost half of the single subjects reported increased use of condoms compared with only 20% among married couples. The majority of subjects perceived financial insecurity, internalized shame, and social rejection. Only 39% reported health impairment. Education level did not influence behavior change.

CONCLUSION

The majority of HCV subjects alter common behaviors and report financial insecurity, internalized shame, and social rejection, regardless of the method of HCV acquisition or socioeconomic status. These findings indicate that all HCV individuals be counseled and encouraged to participate in educational programs at the time of diagnosis to reduce unnecessary behavioral changes and stigmatization perceptions to improve quality of life.

Representations of SARS in the British newspapers

In the Spring of 2003, there was a huge interest in the global news media following the emergence of a new infectious disease: severe acute respiratory syndrome (SARS). This study examines how this novel disease threat was depicted in the UK newspapers, using social representations theory and in particular existing work on social representations of HIV/AIDS and Ebola to analyse the meanings of the epidemic. It investigates the way that SARS was presented as a dangerous threat to the UK public, whilst almost immediately the threat was said to be ‘contained’ using the mechanism of ‘othering’: SARS was said to be unlikely to personally affect the UK reader because the Chinese were so different to ‘us’; so ‘other’. In this sense, the SARS scare, despite the remarkable speed with which it was played out in the modern global news media, resonates with the meanings attributed to other epidemics of infectious diseases throughout history. Yet this study also highlights a number of differences in the social representations of SARS compared with earlier epidemics. In particular, this study examines the phenomena of ‘emerging and re-emerging infectious diseases’ over the past 30 or so years and suggests that these have impacted on the faith once widely held that Western biomedicine could ‘conquer’ infectious disease.

Risk factors associated with posttraumatic stress disorder symptomatology in HIV-infected women

This study examined risk factors for posttraumatic stress disorder (PTSD) symptomatology in a sample of 102 HIV-positive women. The magnitude of HIV-related PTSD symptoms was associated with a greater number of HIV-related physical symptoms, more extensive history of pre-HIV trauma, less perceived availability of social support, greater degree of perceived stigma, and greater degree of negative life events. Hierarchical multiple regression analysis revealed three individual predictors of PTSD symptomatology: total impact of negative life events, total stigma score, and total number of present symptoms. Stigma emerged as the strongest individual predictor. Social support failed to moderate relationships between PTSD symptomatology and HIV-related physical symptoms and negative life events. These findings may inform helping professionals about risk factors associated with PTSD symptomatology in HIV-positive women.

At the margins? Discourse analysis and qualitative research

Discourse analysis is a qualitative research approach that offers the potential to challenge our thinking about aspects of the reality of health and health care practice. In this article, the author explores one approach to discourse analysis and examines how it offers possibilities for different ways of viewing health and health care practices. She concludes by raising questions as to whether discourse analysis is at the margins of qualitative research, whether that matters, and where discourse analysis might take those margins.

Sex, Sexuality and Sickness: Discourses of Gender and HIV/AIDS among Kwazulu-Natal Women

Current HIV-prevention work indicates that simply providing HIV-related information plays a limited role in changing sexual practices, and instead stresses the need to address the social and cultural forces shaping individual behaviour. The aim of this study was thus to explore the social influences that shape women's sexual behaviour with specific attention given to discourses of gender and HIV/AIDS. Material was generated through seven focus group discussions with black women living in a peri-urban area in Durban, and was interpreted using discourse analysis. The study clarified the ways in which women are not necessarily in a position to make purely rational, individual decisions about safe sex, since these decisions are intimately linked to social constructions of sexuality and the power relations that operate in cultures. It identified specific cultural practices linked to the organisation of gender roles and how these influence safe sex practices. The analysis then examined the implications of these findings for future HIV/AIDS education interventions.

“Typhoid Mary” and “HIV Jane”: Responsibility, Agency and Disease Prevention

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

Media activism and Internet use by people with HIV/AIDS

This paper seeks to understand better the media practices of people who are directly affected by an illness or health problem. Internet sites that have been created by people with HIV/AIDS are examined as a strategy for self-representation. This analysis identifies four prominent 'organising themes' in Internet sites: autobiography; expertise; self promotion; and dissent. It is argued that there is a connection between media activism within the contemporary AIDS movement and Internet use among people with HIV/AIDS. This paper discusses the potential of the Internet, as a form of media activism, to raise the private troubles of people with health problems as public issues through a revitalisation of the public sphere in contemporary post-industrial societies.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention.

Patient impact of negative representations of HIV

This paper is based on a study undertaken in 1995-1998 and is concerned with the impact that negative media representations can have on the individual living with HIV. This work took place in the United Kingdom in areas of low HIV prevalence and involved a group of people living with HIV (N = 18) and their closest supporters (N = 15). In writing this brief report, the experiences of the participants will be highlighted through presentation of their words taken from interviews. This work is put briefly into context by reference to the relevant literature.

Stigma and rejection: living with AIDS in villages in southern Thailand

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

Grandmothers and women's health: from fragmentation to coherence

There is a paucity of models that drive integrated research agendas, and coherent approaches to development and progress of knowledge about women's health. In this article, we review four major models of women's health, present conditions supporting more integrative and coherent models of women's health based on the recommendations by two international conferences, and address major paradoxes inherent in women's health areas. For integrative and coherent models of women's health, we propose to incorporate visions and insights of previous models in developing a more coherent model that includes three major components-integration, transition, and marginalization.

Discourse analysis of an 'observation levels' nursing policy

The practice of special observation (or constant observation) is widely used in inpatient psychiatric facilities for the care of people who are suicidal. In this study, the policy of special observation was examined using a discourse analysis method to discern prevailing ideas and practices highlighted within the policy. After reading, studying and analysing the special observation nursing policy, the authors briefly describe the document and outline the terms and phrases prevalent within the document. These recurrent ideas are then organized into five categories: professional responsibilities, suicidality, the patient's immediate context, the patient's observable behaviour and the nursing checklist. In discussion of the policy document, the invisibility of the authors, target audience and patients is noted. The authors attempt to elicit evidence for the therapeutic nurse-patient relationship in the document. In the analysis of patient, nurse and doctor roles and responsibilities, it is evident that the policy document reinforces the traditional medical hierarchy of power relations. Some assumptions that underpin the document are postulated. Questions regarding the nature of risk assessment and the evidence base for the medical prescription of special observation are raised. As well as ideas and themes evident in the document, the absence of some relevant issues is explored. While the need for succinctness and clarity in policy documents is acknowledged, the fact that patient rights, therapeutic processes and ethical dilemmas are absent is deemed significant.

Poverty, disease progression and employment among people living with HIV/AIDS in Australia

A national survey of 925 people living with HIV/AIDS (PLWHA) in Australia is used to examine the relationship between disease progression, employment status, poverty and economic hardship. While disease progression has some impact on economic hardship, employment status is found to be the strongest determinant of both poverty and economic hardship. The most commonly cited reasons for leaving work were psychosocial (71%), with declining health cited by half of respondents. It is therefore argued that psychosocial issues are at least as important as changes in health in causing unemployment and therefore poverty and economic hardship among PLWHA in Australia.

Gender, sexuality, and the prevention of sexually transmissible diseases: a Brazilian study of clinical practice

Epidemiological tendencies in the spread of HIV/AIDS in Brazil demonstrate the increasing importance of heterosexual transmission to women who are not included in those traditional categories of 'risk' which have so far guided research and attempts at prevention. While more attention is now being given to other STDs as part of HIV prevention, this same view of 'risk' prevails, as does a tendency to rely on strictly quantitative indicators and conceptions which treat health care workers' beliefs and attitudes as individual phenomena. This study, an examination of clinical practices of STD management in gynecological and antenatal programs in public health posts in Rio de Janeiro, reveals the mutually-reinforcing relationship between gender norms in sexuality and gynecological clinical practices, which results in the reproduction of both gender hierarchy and vulnerability to infection by all STDs.

Fears of disease and disability in elderly primary health care patients

Some diseases are more frightening than others to patients and every culture or society has its own most dreaded disease(s). In some previous studies it has been shown that the fears of the patients sometimes have their roots in events in family history. In this qualitative study fourteen men and women aged 66-83 years, all of whom were primary care patients were interviewed with regard to their fears in connection with their present symptoms as well as in general. The results showed that diseases believed to entail disability, bodily changes and/or loss of control over body or environment, were the most feared. These diseases are also likely to stigmatise or shame the bearer, i.e., to change the identity for the worse. This is in line with other studies, where control and autonomy is demonstrated to be essential for elderly people's self-esteem.

Factors influencing condom use among African American women: implications for risk reduction interventions

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.

Beyond empowerment: heterosexualities and the prevention of AIDS

AIDS-related research on sexuality has demonstrated both the importance of investigation of the meanings of sexual categories, practices, and relationships, and the fact that such meanings may vary--among cultures, historical periods, and even among individuals within the same social setting. This paper considers AIDS-related research on sexuality as itself an important instance of the social construction of meaning. It is argued that the concept of empowerment, when understood as the power to use condoms, can in fact contribute to the reproduction of both gender hierarchies and dominant conceptions of sexuality in consumer society.