Living with HIV: recent research from France and the French Caribbean (VESPA study), Australia, Canada and the United Kingdom.
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Biomedical subjects
Publications and source records attributed to Peter Aggleton.
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BACKGROUND: Recent reviews and studies suggest distinctive health needs among gay men. METHODS: Swiss residents in the Geneva Gay Men's Health Survey (GGMHS, n=477) were matched with controls from the Swiss Health Survey (SHS, n=477) along sex, age, nationality, and region of residence and compared along standard indicators of health status, health behaviors, and health care utilization. Both health surveys were conducted in 2002 using probability sampling--i.e., time-space sampling (GGMHS) and household probability telephone sampling (SHS). RESULTS: Although gay men were significantly less likely to be overweight (adjusted odds ratio (AOR)=0.54), they reported significantly more and severe physical symptoms (AOR ranged from 1.72 to 9.21), short-term disability (AOR=2.56), risk factors for chronic disease--i.e., high cholesterol, high blood pressure, high glucose, and smoking (AOR ranged from 1.67 to 3.89), and greater health services utilization (AOR ranged from 1.62 to 4.28), even after adjustment for differences in socio-demographic characteristics and health behaviors. CONCLUSIONS: Evidence of greater morbidity among a community sample of gay men along standard health indicators underlines the relevance of sexual orientation as a socio-demographic indicator in public health in general and in the health inequalities discourse in particular.
Zimbabwe is one of the countries most affected by HIV/AIDS, and as elsewhere in southern Africa, the impact on children and young people living in affected households is significant. Loss is highly complex and dependent on developmental stage, resilience, quality of care, and social support networks, and often includes a progression of experiences from the onset of a parent's or caregiver's illness, through to the aftermath of death. For several reasons, AIDS-related bereavement is likely to be especially complicated and difficult to accommodate. Understandings of bereavement and grief among African children, and adults' responses to orphans' psychological difficulties, remain under-developed. This paper focuses on the narratives of older children in their teens, who have experienced parental AIDS-related illness and death in six sites in Zimbabwe. A key finding is that, while many orphaned teenagers desire direct communication with adults about parental illness and death, adults themselves--whether the sick parent, other relatives in the household or a caregiver following parental loss--are often ill-equipped to identify and manage children's distress positively. While most existing psychosocial interventions focus on bereaved children, this paper suggests that, in order to create an enabling environment for orphans, building the capacity of key adults in orphans' lives, particularly surviving relatives, caregivers, and teachers to address emotional issues relating to parental loss constructively is an essential, but neglected, area of programming.
Previous research has shown increased vulnerability to teenage parenthood for young people with experience of local authority care. This study explored factors contributing to early pregnancy and parenthood among young people in and leaving care; the types of support available; and the extent to which services are perceived as accessible. Semi-structured interviews were undertaken with 63 young people. The study findings suggest that young people's experiences both prior to, and during care, influence their decisions in relation to pregnancy and impact on how they view and engage with services. The implications of these findings are discussed in the light of recent changes in legislation and services throughout England.
Schools are important settings in which to promote children's and young people's physical and emotional health. An evaluation of the National Healthy School Standard in England showed that education and health professionals have implemented a range of projects and activities to improve pupils' health. Although these were generally well received by parents and pupils, they were not uncritical of them. Perceptions of the value of health-related work were influenced by the contextual characteristics of schools--whether primary or secondary, the quality of social relationships, the quality of teaching, and the extent of pupil and parental involvement in the life of the school. With local responsibilities for children's services in England being reorganized in response to the Green Paper, Every Child Matters: Next Steps, there are new opportunities to develop a coherent set of outcome measures that pay due regard to pupils' and parents' views, and which inform collaborative reviews of healthy school programmes, in particular, and local services, more generally.
An evaluation of the National Healthy School Standard (NHSS) was undertaken by the authors on behalf of the Department of Health and the Department for Education and Skills. One part of the evaluation involved gaining access to a number of datasets derived from previous research and analysing the health-related outcomes of schools which had attained Level 3 of the NHSS, compared with those of other schools. The sources which provided the most interesting findings were the Health-Related Behaviour Questionnaire (HRBQ) survey and the Ofsted database of school inspection ratings. This paper describes the statistical methods used, and the results of the HRBQ and Ofsted analyses. Using HRBQ data, many pupil-level outcomes were explored, but relatively few indicated significant differences and even those tended to be quite small. The Ofsted school-level data yielded stronger evidence of NHSS impact. The paper concludes by suggesting possible reasons for these findings.
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Internationally, there has been a recent resurgence of interest in HIV and AIDS-related stigma and discrimination, triggered at least in part by growing recognition that negative social responses to the epidemic remain pervasive even in seriously affected communities. Yet, rarely are existing notions of stigma and discrimination interrogated for their conceptual adequacy and their usefulness in leading to the design of effective programmes and interventions. Taking as its starting point, the classic formulation of stigma as a 'significantly discrediting' attribute, but moving beyond this to conceptualize stigma and stigmatization as intimately linked to the reproduction of social difference, this paper offers a new framework by which to understand HIV and AIDS-related stigma and its effects. It so doing, it highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality. It highlights the limitations of individualistic modes of stigma alleviation and calls instead for new programmatic approaches in which the resistance of stigmatized individuals and communities is utilized as a resource for social change.
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Gay bars have been frequently identified as suitable environments in which to conduct HIV prevention activities among homosexually active men. In theory, they provide easy access to a relatively diverse group of men. However, gay bars are environments in which the primary purpose is a social one. Gay men use them to take time out, to socialize, and, on occasions, to find new sexual partners. They are also settings in which social reputations often have to be managed. This study examined the HIV/AIDS educational potential of four gay bars in London, Britain. Semistructured observations and interviews took place in four contrasting bars with a focus on men's perceptions of HIV/AIDS-related health promotion activities including condom promotion, the use of posters and small media, and understandings of safer sex. Respondents were ambivalent about AIDS-related health education activities being undertaken. The implications of such responses for the development of HIV primary prevention activities in such settings are discussed.
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Only if we understand where HIV/AIDS-related stigma and discrimination come from, and how they are connected to broader social inequalities and the denial of fundamental human rights, can we develop effective strategies to combat them. This article is a much-condensed version of a keynote presentation given at "Meeting the Stigma Challenge: New Paradigms for Civil Society," a satellite meeting held in Barcelona on 8 July 2002, and sponsored by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The presentation described the conceptual framework underpinning the 2002-2003 World AIDS Campaign, whose theme is "HIV/AIDS-Related Stigma and Discrimination," and whose slogan is "Live and Let Live." In this article, Peter Aggleton provides a conceptual overview of the relationship between the stigma and discrimination associated with HIV and AIDS and the human rights violations that ensue from them, with the goal of demonstrating the interconnectedness of these concerns. He also provides some examples of concrete steps that can be taken to counter the stigma, discrimination, and human rights violations.
This paper contributes to understanding of young people's help-seeking behaviour. A conceptual framework is proposed that seeks to integrate differing sources of influence and their implications for policy and programme development. Data was collected by means of an international literature review followed by a purposive international survey of expert informants. Findings suggest that it is important to distinguish between individual and structural determinants of young people's help-seeking behaviour. Policy and programme influences also impact upon the demand for help and the supply of social support that is available. It is important to focus on the normative needs of young people as well as specific health needs and problems. Creating trust, rethinking adult attitudes toward young people, and reducing the stigma associated with seeking help are key to promoting help-seeking behaviour. Many young people are hindered from seeking help, or are not offered help because of social exclusion, violence, poverty, prejudice (including homophobia) and gender inequalities. Future actions to promote help-seeking and enhance social support must consider these structural barriers, making special efforts to reach and work with excluded populations.