The announcement that World AIDS Day would mark its 30th anniversary with the theme “know your status” was the result of significant advancements in the global response to the HIV/AIDS epidemic. In making this declaration, UNAIDS emphasised that knowing one's status is crucial to achieving the 90‐90‐90 targets, namely that by 2020, 90% of all people living with HIV will know their status, receive sustained antiretroviral therapy, and have viral suppression. Far removed from an earlier period when access to antiretroviral therapy was limited or unavailable, the “know your status” campaign represents a more hopeful moment. Yet even with its laudatory goal, the campaign reflects a larger trend in global health emphasising that being responsible for one's own health obligates caring for the health of others. The intention of this paper is to engage with geographic scholarship on care to examine how living with HIV involves both personal responsibility and responsibilisation. Drawing from fieldwork in rural South Africa, the paper outlines the challenges for those living with HIV, particularly when stigma and other needs remain stark. We conclude by identifying points of convergence and divergence between theories of responsibility, responsibilisation, and an ethics of care.
Modeling the Effect of HIV/AIDS Stigma on HIV Infection Dynamics in Kenya
Abstract Stigma toward people living with HIV/AIDS (PLWHA) has impeded the response to the disease across the world. Widespread stigma leads to poor adherence of preventative measures while also causing PLWHA to avoid testing and care, delaying important treatment. Stigma is clearly a hugely complex construct. However, it can be broken down into components which include internalized stigma (how people with the trait feel about themselves) and enacted stigma (how a community reacts to an individual with the trait). Levels of HIV/AIDS-related stigma are particularly high in sub-Saharan Africa, which contributed to a surge in cases in Kenya during the late twentieth century. Since the early twenty-first century, the United Nations and governments around the world have worked to eliminate stigma from society and resulting public health education campaigns have improved the perception of PLWHA over time, but HIV/AIDS remains a significant problem, particularly in Kenya. We take a data-driven approach to create a time-dependent stigma function that captures both the level of internalized and enacted stigma in the population. We embed this within a compartmental model for HIV dynamics. Since 2000, the population in Kenya has been growing almost exponentially and so we rescale our model system to create a coupled system for HIV prevalence and fraction of individuals that are infected that seek treatment. This allows us to estimate model parameters from published data. We use the model to explore a range of scenarios in which either internalized or enacted stigma levels vary from those predicted by the data. This analysis allows us to understand the potential impact of different public health interventions on key HIV metrics such as prevalence and disease-related death and to see how close Kenya will get to achieving UN goals for these HIV and stigma metrics by 2030.
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- Award ID(s):
- 2015425
- NSF-PAR ID:
- 10249733
- Date Published:
- Journal Name:
- Bulletin of Mathematical Biology
- Volume:
- 83
- Issue:
- 5
- ISSN:
- 0092-8240
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Rosenbaum, Janet E. (Ed.)Accomplishing the goals outlined in “Ending the HIV (Human Immunodeficiency Virus) Epidemic: A Plan for America Initiative” will require properly estimating and increasing access to HIV testing, treatment, and prevention services. In this research, a computational spatial method for estimating access was applied to measure distance to services from all points of a city or state while considering the size of the population in need for services as well as both driving and public transportation. Specifically, this study employed the enhanced two-step floating catchment area (E2SFCA) method to measure spatial accessibility to HIV testing, treatment (i.e., Ryan White HIV/AIDS program), and prevention (i.e., Pre-Exposure Prophylaxis [PrEP]) services. The method considered the spatial location of MSM (Men Who have Sex with Men), PLWH (People Living with HIV), and the general adult population 15–64 depending on what HIV services the U.S. Centers for Disease Control (CDC) recommends for each group. The study delineated service- and population-specific accessibility maps, demonstrating the method’s utility by analyzing data corresponding to the city of Chicago and the state of Illinois. Findings indicated health disparities in the south and the northwest of Chicago and particular areas in Illinois, as well as unique health disparities for public transportation compared to driving. The methodology details and computer code are shared for use in research and public policy.more » « less
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null (Ed.)People living with HIV experience a high level of stigma in our society. Public HIV-related stigma often leads to anxiety and depression and hinders access to social support and proper medical care. Technologies for HIV, however, have been mainly designed for treatment management and medication adherence rather than for helping people cope with public HIV-related stigma specifically. Drawing on empirical data obtained from semi-structured interviews and design activities with eight social workers and 29 people living with HIV, we unpack the ways in which needs for privacy and trust, intimacy, and social support create tensions around key coping strategies. Reflecting on these tensions, we present design implications and opportunities to empower people living with HIV to cope with public HIV-related stigma at the individual level.more » « less
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1007/s11538-021-00891-7
