HIV/AIDS and Adolescents: South Pacific and Caribbean

247 Pages·2019·2.831 MB·English

by  Prem Misir

HIV/AIDS and
Adolescents
South Pacific and
Caribbean
Prem Misir
HIV/AIDS and Adolescents
Prem Misir
HIV/AIDS
and Adolescents
South Pacific and Caribbean
Prem Misir
The University of the South Pacific (USP)
Solomon Islands Campus
Honiara, Solomon Islands
ISBN 978-981-13-5988-0 ISBN 978-981-13-5989-7 (eBook)
https://doi.org/10.1007/978-981-13-5989-7
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F
oreword
Research into the treatment of HIV has come a long way since the dis-
ease was first discovered in the 1980s. Developments in antiretroviral
therapy provided a major milestone in HIV treatment that has changed
the lives of millions and there are currently several new approaches being
followed in the pursuit of a functional HIV cure. While there has been
much publicity around these scientific developments, there has perhaps
been less focus on the importance of education in creating a more toler-
ant and understanding society that is able to support people living with
the disease.
Many people have fears, prejudices, or negative attitudes about HIV
and this can lead to people living with the disease being marked out as
different. The stigma that can result may be manifest in people living
with HIV being insulted, rejected, gossiped about, and excluded from
social activities. At its extreme such prejudice can even drive people to
physical violence. The impact of such treatment can leave people living
with HIV feeling nervous about telling others that they have HIV which
in turn can lead to feelings of isolation which can have a significant
impact on health and well-being.
While stigma is often fueled by myths and misconceptions, its pres-
ence in turn reinforces these beliefs and the importance of engaging peo-
ple of school age if we are to break this cycle is increasingly recognized.
UNICEF has, for example, been doing significant work in this area as
they recognize that HIV can have an enormous impact on education in
v
vi FoREWoRD
the most HIV/AIDS-affected countries and yet at the same time, educa-
tion around HIV can have an enormous impact on HIV prevention and
on care and support.
This book makes a strong contribution to the debate around the role
and impact of HIV-related stigma within schools and the role of educa-
tion in responding to the challenge of HIV. In doing so it makes a valua-
ble contribution to this important area of work.
London, UK Professor David Phoenix
January 2019 o.B.E., D.L., AcSS, D.Sc.
D.Univ., FRSC, F.I.Biol., FIMA
Vice-Chancellor, London South Bank University
P
reFace
A cure for the HIV infection remains elusive even after almost 40 years
into the pandemic. And undoubtedly, the enormous amounts of fund-
ing, numerous scientific studies, and considerable dissemination of data
have a direct relationship with reducing numerous challenges impact-
ing the pandemic. The World Health organization (WHo) in 2016
highlighted four perpetual challenges that plagued the trajectory to
end HIV/AIDS, thus: revitalize attention to HIV prevention, sustain
the drive to increase access to HIV treatment, acknowledge the rising
antiretroviral (ARV) drug resistance, and support financing to address
the global response.
This study addressed two of these WHo’s challenges: HIV preven-
tion and sustaining the drive to increase access to HIV treatment. And
so, without a cure for HIV, there is an urgent and imperative need for
a disproportionate focus on reducing risk behaviors, as well as reducing
stigma and discrimination which represent enormous hurdles to HIV
prevention, treatment, and care and support.
Indeed, there is a continuing flow of studies on prevention interven-
tion focusing on HIV/AIDS knowledge and stigma. But given the vast
range of such studies, there still is a perpetual domain of inconsistent
behavioral findings, incongruously impacting risk behaviors, and imped-
ing access to treatment. Amid this incongruity, a possible catalyst for
myths and misconceptions about HIV/AIDS, the end result may likely
fuel HIV infections, especially among adolescents, where globally, more
vii
viii PREFACE
than 50% of all new HIV infections penetrate the under 25, in which
females feel the full brunt and who are younger than males.
This book HIV/AIDS and Adolescents: South Pacific and Caribbean
presents the findings of a multi-country study of HIV/AIDS knowledge
and HIV/AIDS-related stigma among high school students as ado-
lescents in Fiji, Guyana, Vanuatu, and Antigua and Barbuda, and is an
extension of my HIV/AIDS knowledge and stigma study on Guyana.
The book’s intent was to test, inter alia, whether there was a relationship
between HIV/AIDS knowledge and stigma, with the view that HIV/
AIDS knowledge may constitute a significant factor in reducing stig-
matization vis-à-vis through efficacious stigma-reduction intervention
designs.
For nearly four decades now, the spread of HIV/AIDS education has
been tremendous and undoubtedly has had some impact on increasing
the effectiveness of HIV prevention. And no one will dispute the view
that HIV/AIDS education must continue. There is now, too, a com-
mon understanding that knowledge, attitudes, and practices emanating
from HIV/AIDS education may be significant tools for equipping peo-
ple to embrace risk-free behaviors. With a growing HIV-infected ado-
lescent population globally, especially among females, this multi-country
study provides a sense of the preparedness of adolescents in Fiji, Guyana,
Vanuatu, and Antigua and Barbuda to adopt risk-free behaviors. But
attainment of risk-free behaviors may face huge challenges from sus-
tained stigmatization, thereby raising serious questions about the efficacy
of some types of HIV/AIDS education.
And so, there is no question that HIV/AIDS stigma obstructs pre-
vention, diagnosis, treatment, and care and support, and people living
with HIV/AIDS (PLHIV) may internalize the AIDS stigmas, ultimately
leading to further HIV transmission. But the stigma literature seemed to
suggest that HIV/AIDS studies on stigma lacked conceptual adequacy
and efficacy to generate programs and interventions. What also is clear
from stigma research is that HIV/AIDS-related stigma programs only
intermittently attracted top priority; there also is a general consensus
among researchers that stigma remains a major stumbling block, despite
gallant efforts to end the disease. The stigma literature also showed that
there were sustainability problems with the duration of impact of stig-
ma-reduction interventions, especially pertaining to gendered impact.
However, these studies disclosed a persisting fear of the disease and,
therefore, they continued to highlight the power of stigma to stagnate
PREFACE ix
the growth and effectiveness of stigma-reduction programs and inter-
ventions. A specific motivating factor for this multi-country study was
to determine the relationship between HIV/AIDS knowledge and HIV-
related stigma; in order to assess how stigma interferes with testing,
treatment, and care and support, in the pursuit of designing stigma-re-
duction interventions, grounded in different global cultural contexts.
This book contains seven chapters. Chapter 1 carries the introduction
that presents the global statistics on HIV/AIDS. It also explains the sig-
nificance, purpose, and research questions of this study, and the preva-
lence of HIV/AIDS in Fiji, Vanuatu, Guyana, and Antigua and Barbuda.
Chapter 2 presents a systematic review of the literature on HIV/AIDS
knowledge and stigma. Chapter 3 offers the methodology of this mul-
ti-country study. Chapter 4 proffers the status of HIV/AIDS knowledge
and its relationship to the socio-demographics of gender, age, ethnic-
ity, religion, and socioeconomic status (SES) in Fiji, Guyana, Vanuatu,
and Antigua and Barbuda. Chapter 5 provides the status of HIV-related
stigma and its relationship to the socio-demographics. Chapter 6 focuses
on the predictors of HIV/AIDS knowledge and HIV-related stigma,
inclusive of the general linear regression F-test and the logistic regres-
sion. Chapter 7 presents the discussion and implications of the univari-
ate, bivariate, and multivariate analyses of this multi-country study, and
there is a section in this chapter, too, on the ‘Takeaways’ from this study.
Within a global cross-cultural perspective, HIV/AIDS and Adolescents:
South Pacific and Caribbean will have tremendous significance for health-
care providers and educators working with adolescents living with HIV/
AIDS or at risk for HIV infection. This book will assist health workers
in education, undergraduates, and postgraduates to understand issues
relating to adolescence and HIV/AIDS, thereby presenting a culturally
sensitive interaction with adolescents from culturally diversified back-
grounds. Undoubtedly, the book adds to the stock of empirical knowl-
edge well beyond the scope of HIV/AIDS prevention and epidemiology,
to address other sexually transmitted infections (STIs).
And so, the extensive range of this research process within a multi-
country background, boldly exposes the enormous inputs of several
persons. First, I wish to acknowledge the Research Assistant Kelicia Daniels
for vigorously pursuing the successful completion of the fieldwork process.
I would like to thank the Executive Editor of Springer Nature Sagarika
Ghosh and her team for approving my book manuscript proposal. I appre-
ciate the Assistant Editor of Palgrave Macmillan Sandeep Kaur’s constant
x PREFACE
feedback in relation to checking and analyzing the manuscript. Dr. Deborah
Vitalis was a constant source of inspiration and advisement in the applica-
tion and interpretation of Stata, Version 13, without whose contribution,
the manuscript would still be an impending phenomenon.
I want to emphasize the fact that this project would not have been a
reality without the support of these corporate donors: Guyana Telephone
& Telegraph Co Limited (GT&T); Guyana Bank for Trade and Industry;
Demerara Bank Limited; Republic Bank (Guyana) Limited; and a major
corporation that prefers not to be named.
There is considerable gratitude for the Vice-Chancellor of the
London South Bank University (LSBU) Professor David Phoenix for
penning the Foreword and thereby permanently placing his imprint on
this book. Also, I want to express my gratitude for endorsements from
the former United Nations Secretary General’s Special Envoy for AIDS
in the Caribbean Dr. Edward Greene; the Director of Research at The
University of the South Pacific (USP) Professor Jito Vanualailai; and
Health Lead at the oxford India Sustainable Centre, Somerville College,
University of oxford Dr. Premila Webster.
I also am indebted to the various governmental authorities in Fiji,
Guyana, Vanuatu, and Antigua and Barbuda for permission, inclusive of
ethical clearances, to conduct this multi-country study in their secondary
schools. Finally, I feel a great deal of affinity, admiration, and profound
appreciation to all the Fiji, Guyana, Vanuatu, and Antigua and Barbuda
students who participated in this project. These students are now a per-
petual component of HIV/AIDS and Adolescents: South Pacific and
Caribbean.
Honiara, Solomon Islands Professor Prem Misir, Ph.D.
March 2019 (Hull), MPH (Manchester)
M.Phil (Surrey), B.S.Sc. (Hons)
(QUB-UK), FRSPH (England)
Pro Vice-Chancellor & Professor
and Head of School of Public Health
The University of the South Pacific
Solomon Islands Campus