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Article

Kosta N. Kalogerogiannis, Richard Hibbert, Lydia M. Franco, Taiwanna Messam, and Mary M. McKay

For over 20 years, social workers have been involved in service delivery for HIV and AIDS infected and affected individuals. It is estimated that more than 1 million people are living with HIV or AIDS in the United States. The rates of HIV infections continue to rise, with more than 40,000 individuals being diagnosed each year in the United States. This entry explores the current trends in HIV primary prevention, secondary prevention, and counseling and psychotherapy services for people living with or affected by HIV/AIDS.

Article

The risk of HIV infection looms large among male, female, and transgender sex workers in India. Several individual, sociocultural, and structural-environmental factors enhance the risk of HIV infection among sex workers by restricting their ability to engage in safer sexual practices with clients and/or intimate partners. While most HIV prevention programs and research focus on visible groups of women sex workers operating from brothels (Pardasani, 2005) and traditional sex workers, for example, Devadasis (Orchard, 2007); there is a whole subgroup of the sex worker population that remains invisible within HIV prevention programs, such as the male, female, and transgender sex workers operating from non-brothel-based settings. This paper provides an overview of the different types and contexts of sex work prevalent in Indian society, discusses the factors that increase a sex worker’s risk of HIV infection, describes the varied approaches to HIV prevention adopted by the existing HIV prevention programs for sex workers, discusses the limitations of the HIV prevention programs, and concludes with implications for social work practice and education.

Article

Robert L. Miller Jr.

This chapter explores salient concepts of social work practice with gay men. These concepts are described within a life cycle context. The illuminated concepts have been identified based on the biopsychosocial and spiritual developments in the social work literature related to this population since the printing of the 19th edition of the Encyclopedia of Social Work.

Article

Larry D. Icard, Jacqueline J. Lloyd, and Gisoo Barnes

HIV/AIDS has introduced an array of issues and needs for children, youth, and their families. Family-focused interventions have emerged as a viable strategy for researchers and practitioners seeking effective and appropriate responses for the prevention, treatment, and care of children, youth, and families affected by HIV/AIDS. This discussion provides an overview of the epidemiology of HIV infection among children and youth, and highlights common elements and trends in the development, implementation, and testing of family-focused interventions. The discussion concludes with a commentary on areas for future attention.

Article

Rebecca Hodes

Approximately 36.7 million people worldwide are living with the Human Immunodeficiency Virus (HIV). Almost 20 percent of South Africa’s adult population (aged fifteen to forty-nine) is HIV-positive, and about one in every five people living with HIV worldwide is in South Africa. The pandemic, and the political controversies it elicited, have come to define both local and global understandings of the post-apartheid nation. The history of HIV in South Africa begins in the 1980s during an era of heightened repression by the apartheid state, in which discriminatory laws and fearful public responses tapped into broader prejudices relating to race and sexuality. During the 1990s, as South Africa transitioned to democracy and as rates of HIV reached pandemic levels, partnerships were built between civil society and state actors to confront the many challenges that the HIV epidemic presented. However, from the late 1990s, corruption and the abuse of political power within the Department of Health, together with the government’s refusal to provide life-saving antiretroviral treatment (ART), ignited a new era in health advocacy. While the HIV-treatment activist movement won the struggle for public access to treatment, Jacob Zuma’s succession to President Thabo Mbeki heralded a new era of political controversies in the state’s HIV response. A copious historiography on the HIV epidemic in South Africa maps the contemporary chronology and evolution of the disease, including a focus on changing public understandings and responses

Article

Since the start of the human immunodeficiency virus (HIV) pandemic, numerous biomedical advances have caused the social-work response to shift from management of a crisis to prevention of an incurable, but treatable chronic disease. About 1.3 million people in the United States and more than 33 million people worldwide are estimated to be living with HIV. Rates of incidence in impoverished, marginalized communities are highest, with the rates continuing to increase among young African American gay and bisexual men. Other communities at high risk are people who are incarcerated, engage in sex work or other kinds of exchange sex, and participate in risky injection-drug use. Minority groups are often impacted because of reduced access to quality medical care and HIV testing. Social workers in HIV prevention work are challenged to educate clients and communities on the sexual risk continuum, provide more interventions that are culturally tailored for disadvantaged at-risk groups, and implement evidence-based HIV prevention and testing programs worldwide. The National HIV/AIDS Strategy now provides structure to funding opportunities for HIV prevention programs, and there is disparate access to effective treatments worldwide for those living with HIV.

Article

Shrivridhi Shukla, Sneha Jacob, and Karun Singh

India has witnessed a substantial decline in the rate of new HIV infections in the past decade. Despite the reduction in incidence, the social determinants of health, such as poverty, gender inequality, and stigma, have made tackling the disease challenging for medical practitioners, health educators, and social workers, among other stakeholders. This article describes social determinants of HIV/AIDS and provides a brief history of shifts in the HIV/AIDS policies in India, with an overview of the current policy that is complicated by regional variations in HIV prevalence and transmission. In addition, it discusses the nature and impact of HIV in different communities vulnerable to the infection, major interventions supported by the Indian government, and the diverse roles played by social workers in combating the epidemic and providing services to people living with HIV/AIDS.

Article

Adele Weiner

Social workers often come in contact with women, men, and adolescents who use prostitution as a means of survival. Individuals may earn their entire income in this manner. They may use it to supplement low earnings or welfare benefits, or they may exchange sex for drugs, shelter, or the protection of pimps. Violence, drug use, arrest, and transmission of sexually transmitted disease (STD) or HIV are constant risks of prostitution. Those who engage in prostitution, whether as prostitutes or as clients, represent the entire spectrum of American society. This entry discusses a number of psychosocial issues relevant to understanding the lives of women who engage in prostitution and implications for providing social work supports and services.

Article

In the past 50 years, lesbian, gay, bisexual, transgender, and intersex (LGBTI) activism in Australia has grown from small, localized organizations to national campaigns calling on all Australians to affirm LGBTI people’s equality. While the issues and activist strategies have evolved over the past 50 years, there have been two persistent patterns: most organizations and activism have been state based and have drawn on international influences, especially from the United Kingdom and United States. In the 1970s the organizations CAMP (Campaign Against Moral Persecution) and Gay Liberation presented competing visions of LGBTI equality, but both recognized the importance of visibility in order to change societal attitudes and influence law reform. Campaigns to decriminalize male homosexuality began in the 1970s and continued across the states through the 1980s and even into the 1990s in Tasmania. After law reform, activists shifted their advocacy to other areas including anti-discrimination laws, relationship recognition, and eventually marriage equality. HIV/AIDS was another important cause that generated grassroots activism within LGBTI communities. State AIDS councils worked in partnership with the federal government, and Australia had one of the world’s best public health responses to the epidemic. Pop culture, international media, and visibility at events such as the Sydney Gay and Lesbian Mardi Gras gradually shifted public opinions in favor of LGB equality by the 2000s. Transgender and intersex rights and acceptance were slower to enter the public agenda, but by the 2010s, those two groups had attained a level of visibility and were breaking down preconceived stereotypes and challenging prejudice. Indeed, politicians lagged behind public opinion on marriage equality, delaying and obfuscating the issue as the major political parties grappled with internal divisions. In 2017 the Commonwealth government held a postal survey asking Australian voters whether or not they supported same-sex marriage. This was an unprecedented exercise in Australian polity that was divisive, but LGBTI activists succeeded in their campaign and secured an overwhelming victory. The postal survey’s outcome also set the stage for new political fights around LGBTI people’s rights: so-called religious freedom, transgender birth certificates and support for LGBTI young people.

Article

Peter Hegarty

LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) psychology is a loosely organized subfield of psychology. The field emerged, principally in the United States, in the late 1960s in concert with the de-pathologization of adult homosexuality in the Diagnostic and Statistical Manual of Mental Disorders. Over the decade of the 1970s, psychologists stopped researching adult lesbians and gay men as a psychiatric category and initiated new research on relationships, parenting, and the prejudice experienced by this stigmatized group. The HIV/AIDS epidemic lead this subfield to grow rapidly, to focus on men, to gain far wider engagement from mainstream psychologists, and to make health outcomes central to LGBTQ psychology’s raison d’etre. The 1990s were described as a period of “coming of age” as the field began to address bisexuality more directly, to internationalize, and to become more central to strategies in the United States to use psychological evidence to support the civil rights of minorities in court cases. The development of transgender-affirmative psychologies, a literature on the particular psychological issues of LGBTQ people of color in the United States, and an emphasis on the rights of same-gender couples to legal recognition of their relationships were new and prominent themes in the 21st-century literature. This subfield of psychology has been characterized by its historical emergence in the United States, a relative lack of attention to children, an urge to affirm under-represented groups by researching them, and a frustration that descriptive research does not always bring about the desired social transformations that motivate it.

Article

Peter A. Newman

AIDS (acquired immunodeficiency syndrome) is the most deadly epidemic of modern times. Since HIV (human immunodeficiency virus), the virus that causes AIDS, was first identified in the United States in 1981, nearly 1 million Americans have been diagnosed with AIDS and 530,756 have died. Forty million people are living with HIV worldwide. Although AIDS is still a fatal disease, new drug therapies have greatly slowed the course of disease progression and enhanced quality of life for persons living with HIV. Nevertheless, monumental disparities persist within the United States and between the developed and developing worlds in this two-tiered epidemic.

Article

Sub-Saharan Africa has the world largest proportion of adults and children living with AIDS. To mitigate the multiple consequences of the epidemic, novel forms of governance arose as international organizations usurped the roles traditionally played by states; new funding streams emerged that led to asymmetries in biomedical resource allocation; and diverse partnerships among international agencies, nation-states, and local and international nongovernmental organizations emerged. Global health actors attempted to define AIDS policy and programming as an apolitical biomedical intervention. However, political dynamics were evident in the negotiations between international donors and African state bureaucracies in setting AIDS policy agendas and the contestations between African and international social movements and global health agencies over AIDS treatment drug prices and access to treatment interventions across the continent. During the first two decades of the African AIDS epidemic (1980–2005) the dominant approach to AIDS disease mitigation was the focus on AIDS prevention, and across sub-Saharan Africa standardized prevention interventions were introduced. These interventions were founded upon limited evidence and ultimately these programs failed to stem rates of new HIV infections. Social movements comprising coalitions of local and international activists and scientists brought extensive pressure on global health institutions and nation-states to reform their approach to AIDS and introduce antiretroviral therapy. Yet the path toward universal provision of antiretroviral treatment has been slow and politically contentious. By the second decade of the 21st century, antiretroviral therapy interventions together with AIDS prevention became the dominant policy approach. The introduction of these initiatives led to a significant decline in AIDS-related mortality and slowed rates of transmission. However, health disparities in treatment access remain, highlighting ongoing shortcomings in the political strategies of global health agencies and the public health bureaucracies of African states.

Article

James I. Martin

This entry explains who gay men are, how gay identity constructions have evolved since their inception, and how they continue to evolve. It also describes the health and mental health problems that gay men may present to social work practitioners. In addition, it identifies several social policies that are relevant to gay men. The entry argues that a systemic perspective that takes into account the social, political, and cultural influences on gay men is necessary for understanding the problems that such men commonly experience.

Article

Doug Rossinow

The decade of the 1980s represented a turning point in American history—a crucial era, marked by political conservatism and an individualistic ethos. The 1980s also witnessed a dramatic series of developments in U.S. foreign relations, first an intensification of the Cold War with the Soviet Union and then a sudden relaxation of tensions and the effective end of the Cold War with an American victory. All of these developments were advanced and symbolized in the presidential administration of Ronald Reagan (1981–1989), a polarizing figure but a highly successful political leader. Reagan dominates our memories of the 1980s like few other American leaders do other eras. Reagan and the political movement he led—Reaganism—are central to the history of the 1980s. Both their successes and their failures, which became widely acknowledged in the later years of the decade, should be noted. Reaganite conservatives won political victories by rolling back state power in many realms, most of all in terms of taxation and regulation. They also succeeded in putting America at the unquestioned pinnacle of the world order through a victory over the Soviet Union in the Cold War, although this was unforeseen by America’s Cold Warriors when the 1980s began. The failures of Reaganite conservatism include its handling of rising poverty levels, the HIV/AIDS crisis, and worsening racial tensions, all problems that either Reaganites did little to stem or to which they positively contributed. In foreign affairs, Reaganites pursued a “war on terror” of questionable success, and their approach to Third World arenas of conflict, including Central America, exacted a terrible human toll.

Article

Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families. Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties. Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned. CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.

Article

HIV/AIDS in Europe highlights the centrality of politics at local, state, and international levels to the successes and failures in fighting transnational, global threats. Though several European states have led the international struggle against HIV/AIDS and have made great strides in treatment and prevention, others host the fastest-growing epidemics in the world. Even in states with long histories of treatment, specific subpopulations, including many LGBTQ communities, face growing epidemics. This variation matches trends in public policy, the actions of political leaders, and social structures of inequity and marginalization toward affected populations. Where leaders stigmatize people living with HIV (PLHIV) and associated groups, the virus spreads as punitive policies place everyone at increased risk of infection. Thus, this epidemic links the health of the general public to the health of the most marginalized communities. Mounting evidence shows that a human rights approach to HIV/AIDS prevention involving universal treatment of all vulnerable communities is essential to combating the spread of the virus. This approach has taken hold in much of Europe, and many European states have worked together as a political force to shape a global human rights HIV/AIDS treatment and prevention regime. Despite this leadership, challenges remain across the region. In some Eastern European states, tragic epidemics are spreading beyond vulnerable populations and rates of transmission continue to rise. The Russian case in particular shows how a punitive state response paired with the stigmatization of PLHIV can lead to a health crisis for the entire country. While scholars have shed light upon the strategies of political legitimization likely driving the scapegoating and stigmatization of PLHIV and related groups, there is an immediate need for greater research in transnational social mobilization to pressure for policies that combat these backward political steps. As financial austerity and defiant illiberalism spread across Europe, key values of universal treatment and inclusion have come into the crosshairs along with the European project more generally. Researchers and policymakers must therefore be vigilant as continued progress in the region is anything but certain. With biomedical advances and the advent of the “age of treatment,” widespread alleviation from the suffering of HIV/AIDS is a real possibility. Realizing this potential will, however, require addressing widespread political, social, and economic challenges. This in turn calls for continued interdisciplinary, intersectional research and advocacy.

Article

Scott Rosenberg

During the pre-colonial period, women were valued for their productive and reproductive abilities. When women married, their parents received bohali (bridewealth) from the man’s family. During the colonial period women became increasingly responsible for running the household while men were away. Although this gave women more power on a daily basis it also led to increasing domestic violence. In order to support themselves and their families, women have sought out domestic economic opportunities as well as participating in migrant labor. Historically, beer brewing and sex trafficking were two of the economic opportunities available to women in Lesotho and South Africa. Today, women make up the overwhelming majority of labor in the textile factories. Although Lesotho is a patriarchal society, women have made gains in terms of being elected to parliament and serving as regents, yet they are still not allowed to serve as a chief in their own right. The HIV/AIDS pandemic has hit women in Lesotho especially hard.

Article

AIDS is a new disease that was first recorded in 1981. In the 1980s and early 1990s, there were concerns that it would decimate populations; prevention was slow to take hold, and there was no cure. By the mid-1990s it was clear, in the developed world, that it would be mostly contained to specific populations. Effective but expensive treatment was unveiled in 1996. However, in Africa there were fears of a continent-wide epidemic. AIDS emerged in central Africa (HIV1) and west Africa (HIV2) and spread from there. In the 1990s it reached southern Africa, the current epicenter. It has become evident that AIDS has not meant the collapse of economies and nations or the hollowing out of populations. Treatment options mean people can live normally provided they adhere to the drug regime, but they are costly. The worst epidemic is in the southern cone of Africa. Here it continues to have political consequences, although causality is hard to ascribe. Unique features of the disease are that the modes of transmission include its geographic location and the excessive involvement of donors in the response; the lack of African ownership makes it a global political problem. At the moment the lives of millions of Africans depend on the generosity of the West, and that future is uncertain. AIDS is a greater challenge to southern and eastern African states than anywhere in Africa and indeed the world. The international engagement particularly in the provision of treatment means the disease has global political ramifications.

Article

The fight to effectively treat and stop the spread of the human immunodeficiency virus (HIV) has made meaningful progress both in the United States and globally. But within the United States that progress has been uneven across various demographic groups and geographic areas, and has plateaued. While scientific advances have led to the development of medicine capable of both treating and preventing HIV, law and policy dictate who will have ready access to these medicines and other prevention techniques, and who will not. Law and policy also play a crucial role in determining whether HIV will be stigmatized, discouraging people from being tested and treated, or will be identified for what it is—a preventable and treatable disease. To make further progress against HIV, the United States must address healthcare disparities, end the criminalization of HIV, and devote additional resources toward combatting HIV stigma and discrimination.

Article

Hijras are described as eunuchs and hermaphrodites, and they are a subgroup within the transgender community in South Asia. They go beyond Western descriptions of LGBT persons and are better understood as a complex interplay of gender, sexuality, traditions, and kinship. Hijras face social stigma and legal discrimination due to their nonconformance with the gender and sexual norms of hetrosexuality dominant in India’s society. They negotiate their identity through religion and mythology, whereby they undergo rituals of castration and emasculation, by virtue of which they play a significant role in ceremonies and festivals. Previously, legal frameworks like the anti-sodomy law of Section 377 of the Indian Penal Code (IPC) and the lack of a gender category for the transgender in official government documents resulted in discrimination and marginalization of the Hijra community. They faced harassment and violence from the police, medical establishment, and other individuals, and they experienced systemic exclusion from vital social services like employment and healthcare. Legal reform in India, such as the Supreme Court’s recognizing the transgender community as a “third gender” in 2015 and the decriminalization of sodomy in 2018, have been positive steps to improve the status of Hijras. However, inconsistencies in the definition of transgender persons and ambiguity in operationalizing the self-identification process remain, posing a challenge to effective policy implementation. Sociocultural norms of Hindutva and homophobic ideology are still prevalent, resulting in little improvement in the marginalized status of Hijras and the transgender community in India.