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Query: UMLS:C0277787 (stigma)
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The Singapore Ministry of Health (MOH) developed an Advisory Committee on AIDS in 1985, to be joined by an AIDS Task Force and a National Advisory Committee on AIDS in 1987. MOH figures for 1985-91 indicate that 95 people were infected with HIV in Singapore, of whom 33 developed AIDS. These rate are far lower than those observed in other countries throughout the world. Nonetheless, individuals, the government, and international donor agencies must remain vigilant in the country to stem the spread of HIV. Medical and research communities worldwide struggle to develop effective treatments and vaccines for HIV, but other problems related to individual behavior and social policy also thwart the success of efforts against HIV and AIDS. Specifically, private choices made regarding sexual behavior and drug consumption; the lack of a sense of personal risk; and the justified fear of being socially stigmatized if diagnosed with HIV infection or AIDS impede prevention. These latter factors are closely related to social policy and may include the government's role in the screening of blood for transfusion; mandatory HIV testing; reaching sexual contacts of HIV infected persons and AIDS patients; and educational campaigns. These issues are presented with consideration of how they relate to developed countries and the US. While the lack of a sense of being at personal risk and the fear of social stigma related to AIDS may exist in Singapore, the individual right to privacy has been overlooked in Singapore. AIDS is a notifiable disease under the Infectious Disease Act and includes mandatory reporting and contact tracing as routinely applied to venereal disease. While overall HIV prevalence appears low in Singapore and social policy remains supportive of HIV preventive interventions, preventive efforts must be maintained and intensified in the years ahead. Newly pubescent and adolescent youths must be informed about infection risks and preventive strategy; the entire population should be encouraged to get screened for antibodies to HIV; and more attention should be paid to fostering local medical and social research on AIDS.
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PMID:AIDS and us: are we failing to prevent a highly preventable disease? 145 74

In Brazil, the Prostitution and Civil Rights Program works to fight against stigma and violence against sex workers and to foster self-esteem, self-determination, and greater access to civil rights. It sponsors the Brazilian Prostitutes' Network. In 1988, the Ministry of Health asked the program to join the Ministry to produce sexually transmitted disease/AIDS prevention materials. The materials were ready for distribution in early 1991 when the program began recruiting prostitutes and transvestites for its Health Education Project. The aforementioned groups and the Brazilian chapter of International Planned Parenthood Federation are working together on this project. By mid-1992, the project recruited 17 community-based health agents (15 female and 2 male prostitutes) from different prostitution areas and through a network of contacts from these areas of Rio de Janeiro. After informal training in April or June 1991, they went into their communities to inform people of their health agent role, distributed free condoms and AIDS education material, and promoted the project. Health agents maintain a weekly report of condom and education material distribution. This allows them to monitor their progress. Health agents now meet with their peers to discuss sex and health issues. The communities have opened their doors to the groups. The project is also geographically mapping the sex trade to target health care and other resources in each area. It is pursuing a reference/counterreference relationship within the existing public health system in Rio de Janeiro. Involvement of sex workers in all phases contributes to the success of the project so far. Future research is needed to determine whether the project is reducing risk of HIV transmission, however.
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PMID:Organizing a project with community-based health agents recruited from prostitutes in Rio de Janeiro. 160 25

The AIDS epidemic weighs heavily on the already burdened health care delivery systems of developing countries especially in central Africa. AIDS not only incurs high morbidity and mortality but has a severe impact on productivity, economic infrastructures, and development in those countries which need them the most. HIV is mainly spread through heterosexual intercourse in central Africa. Vertical transmission of HIV and breast feeding are other means. The key vehicle of HIV transmission in the US is still homosexual intercourse. Sexually transmitted diseases (STDs) facilitate HIV transmission via intercourse. Research shows that subsequent infection by other STDs hastens the development of AIDS in HIV-infected people. Some evidence indicates that pregnancy increases the risk of developing AIDS in a woman who is positive for HIV. The main means to prevent HIV transmission is the condom. Yet, in Rwanda, only 7% of women had ever used condoms despite the high rate (32%) of HIV-positive serology. The University of Zimbabwe Medical School believes adolescents are the most appropriate starting point for AIDS prevention since they tend to experiment with sexual behaviors. Its youth counseling program involves education and prevention messages within and outside educational settings through youth meeting places, youth workers, and other mass media. It hosts workshops at meeting places which use the problem solving approach to risk reduction behavior. The program invites schools, churches, and other educational settings to form Anti-AIDS Clubs. It advocates use of drama and music to promote AIDS awareness. The program has also branched out into community counseling where it works to eliminate the stigma and guilt associated with talking about sexual transmission of AIDS. Governments must learn who the STD and HIV transmission high risk groups are and then target them with information, education, and communication AIDS prevention programs.
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PMID:Condom acceptance and HIV prevention in reproductive health: the challenges. 180 57

Contraceptives for teenagers are discussed in detail by type and appropriateness for teenagers, the role of nurses, and the nature of and approach to the client. Contraceptives included are oral contraceptives currently available (24 kinds) and contraindications, condoms, barrier contraceptives such as the diaphragm and sponges, spermicides, IUDs, periodic abstinence, morning after pills, and other methods. Because of the high rates of sexually transmitted diseases (STDS), the method recommended is the condom. There are reservations, however, because some teenagers may lack the maturity to use the condom reliably. When used in conjunction with a sponge or vaginal spermicide, protection against unwanted pregnancy is improved. Females may prefer oral contraceptives, which have the disadvantage of not protecting against STDs. The choices are many, however, and can be tailored to the needs of the client. The role of the nurse practitioner or nurses providing contraceptive advice is important because the information provided by many parents and school-based sex education courses is too little too late. Clients tend to be female and are placed in the position of needing to be more responsible for sexual behavior because males do not take responsibility. The stigma attached to planned sex is a deterrent to using contraceptive protection. The media are partly responsible for enhancing the image of unplanned passionate sex as being the most desirable in relating to a teenaged client, the nurse needs to establish rapport and seek a health history which includes questions about sexual behavior and birth control. Provide guidance so that choice is given, but also state a preference and the justification for its selection. Oral contraceptives (OCs), for example, are 95% effective for 1st year users. The 28-day regimen increases compliance because there is a pill for every day. Consistent time of use (within 4 hours of the time taken the preceding day) is important information to be stressed with the low-dose OCs. Norinyl 1/35 or OrthoNovum 1/35 is recommended for teenagers because of the low dose of estrogen and the good balance. When side effects occur, the balance needs adjustment. Minipills are suggested for lactating mothers or those with headaches, edema, or breast tenderness, but are also less effective. On the other hand, condoms have a failure rate of 9-12% for 1st year use, but increased skill effectiveness is increased. Use instructions are given.
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PMID:Contraceptives for teenagers. 191 98

It is demonstrated how definitions can determine social consequences of impairment and disability. A comparison between leprosy and AIDS provides the basis for the discussion. The United States is the geographic and political arena under consideration. Issues of classification as STD (sexually transmitted disease) or as contagious, communicable disease are relevant. An important factor to predict the social impact is the nomenclature utilized by CDC (Center for Disease Control). CDC represents the government as the official agency to gather and report morbidity and mortality information. Hypotheses to explain stigma on the basis of epidemiological bases are added to the usual sociological concepts or historical considerations. Potential application of the findings are discussed.
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PMID:Issues of definitions and their implications: AIDS and leprosy. 258 43

Psychology professors from the University of California conducted 3 studies to develop a multidimensional, multiple-indicator condom attitudes scale that would include items drawing upon several independent determinants of condom use. These studies would help them correlate 5 factors of the UCLA Multidimensional Condom Attitudes Scale (MCAS) with other criterion variables to establish the construct validity for each factor in the scale. The first study involved 239 male and female 15-35 year old undergraduate students who completed a 15-page, 187-item questionnaire. The professors used these data to develop 5 domains in the MCAS and to correlate the MCAS with relevant criterion variables. The 5 domains of the MCAS were reliability and effectiveness of condoms, sexual pleasure associated with condom use, stigma attached to persons who use condoms, embarrassment about negotiation and use of condoms, and embarrassment about purchase of condoms. 181 undergraduate students, 18-30 years old, completed a modified questionnaire an item added to improve the identity stigma factor) so the researchers could cross-validate MCAS' domains by means of factor analysis (study 2). Study 3 involved 426 undergraduate students whose data the researchers analyzed to test the 5-factor structure against a 1-factor model, to replicate the factor structure using methods of confirmatory factor analysis in structural equations modeling, and to confirm that the reliability and effectiveness domain included reliability and effectiveness as protection against AIDS, other STDs, and pregnancy. Men were not as embarrassed about buying condoms as women, while women had a more positive attitude towards identity stigma-related issues. Overall, men's and women's attitudes towards condoms were different. The studies' results show that condom attitudes are indeed multidimensional, and that the MCAS goes beyond individual decision making to include the social, interpersonal determinants of sexual behavior.
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PMID:The UCLA Multidimensional Condom Attitudes Scale: documenting the complex determinants of condom use in college students. 805 58

The purpose of this paper is to give an overview of the psychiatric aspects of acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD) under the following subheadings: AIDS-related complex, AIDS hypochondriasis, AIDS dementia complex, AIDS and increased risk of suicide, psychiatric aspects of STD, and implications for the management of patients. The psychiatric aspects of HIV infection and AIDS include problems of adjustment to a diagnosis with a stigma and the threat of death, reactive depression and potential risk of suicide, personality disorder, AIDS-related complex (ARC), and AIDS-related dementia. The paper gives an overview of clinical, neuropathological and psychopathological experience in other countries with relevant examples from Papua New Guinea if available. STDs are mentioned because HIV transmission in Papua New Guinea is mostly by heterosexual means. The paper concludes by emphasizing the psychiatric principles of management of HIV-infected/AIDS/STD patients, which include pharmacotherapy but are always based on supportive psychotherapy and counselling.
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PMID:Psychiatric aspects of acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD): an overview. 805 45

Heterosexual intercourse is the mode of HIV transmission in 75% of HIV cases in developing countries. Mass awareness campaigns for the general public and interventions plus supportive services targeted at specific groups have been effective in prevention of the spread of HIV within these groups. These current interventions have not, however, brought about sustained behavior change or prevented the general spread of HIV/sexually transmitted diseases (STDs) in developing countries. Most prevention interventions focus on influencing individual behavior and do not take into account the social, economic, and structural determinants of risk that thwart adoption of risk reduction behaviors. The interventions promote reducing the number of sexual partners, using condoms, and controlling STDs. Some reasons they have failed to translate into effective prevention of the spread of HIV among the general public include: most monogamous women have partners who are not monogamous; non-monogamous women often have multiple sex partners to earn a living for themselves and their families; in some countries, condom use is thwarted by high cost, poor quality, limited availability, and no accessibility; condom use depends on the man's cooperation; there is a stigma attached to seeking STD services; and STD programs often focus on commercial sex workers and male clients. Current interventions do not meet the needs of the groups most vulnerable to HIV infection (e.g., women, youth, and single-gender migrant groups). Sexual health education, relevant health services, and supportive social and economic environments that will touch all vulnerable groups will reduce their vulnerability to HIV infection and strengthen their skills for protection. Leaders in developing countries need to move beyond their complacency and denial of AIDS and face the issues AIDS has forced society to confront.
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PMID:Prevention of HIV infection in developing countries. 897 65

A number of factors influence which treatment sources people seek when symptoms of morbidity occur and a person alone, or with the advice of others, decides that the condition warrants additional attention. Some such factors are related to social structures such as kinship, social networks, gender, and economic status, while others are related to belief systems which define how people conceptualize the etiology of disease. Service quality, the introduction of user fees, and the cost of treatment can also affect health-seeking behavior (HSB). One highly important factor affecting HSB for sexually transmitted diseases (STD) is social stigma. For example, in Zambia, where STDs are a major public health problem, it is considered highly shameful to have an STD, especially for women. This paper describes the HSB, time with symptoms, and sexual activity during symptom period among patients attending 2 urban public health centers and 1 rural mission hospital in Zambia during 4 months in 1994 and 1995 to receive treatment for their STDs. 479 patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for 1-2 weeks before coming to the clinic. During that period, two-thirds in the urban and one-third in the rural areas had had sexual intercourse. 60% of the patients in the urban and 50% in the rural settings had taken some kind of medicine before coming to the clinic. However, more people had used modern rather than traditional medicine, especially in the urban area. Marketplaces, other clinics, physicians, friends, and relatives were common treatment sources, although 10% had received medicine from a traditional healer.
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PMID:Health-seeking behaviour of patients with sexually transmitted diseases in Zambia. 974 41

People with symptoms of sexually transmitted disease (STD) or who merely suspect that they have a STD may in fact be infected. Those who delay having the existence of STD confirmed and treated, yet continue to engage in sexual intercourse, can spread their disease to sex partners. Efforts must be made to understand health seeking behavior when designing and implementing effective STD control programs. However, taboos and stigma related to sex and STDs in most cultures make it difficult to uncover the true nature of such behavior. Relatively little is therefore known about to whom people turn for advice or about how symptoms are perceived, recognized, or related to decisions to seek help. The authors argue that such knowledge would help program planners in the development of more effective and accessible services. Furthermore, studies of health seeking behavior should include a combination of qualitative and quantitative methods, as well as data collection on people who present to health care facilities and those who do not. A pilot protocol for studying STD-related health seeking behavior in developing countries is presented.
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PMID:Health seeking behaviour and the control of sexually transmitted disease. 1016 99


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