The intersection of antiretroviral therapy, peer support programmes, and economic empowerment with HIV stigma among HIV-positive women in West Nile Uganda.

HIV stigma remains a major problem of the AIDS epidemic in sub-Saharan Africa. Women fear impending social stigma including blame, isolation and abuse. HIV infection and HIV stigma interact cyclically, creating and reinforcing economic and social exclusion for individuals living with HIV. Evidence suggests that interventions for people living with HIV infection that include, in combination, antiretroviral therapy (ART), peer support and economic empowerment are likely to be more effective than if used alone. We report a qualitative study in West Nile Uganda that explored perceptions of HIV stigma among fifty-four HIV-positive women who had similar access to ART and HIV peer support programmes, but varying levels of participation (full-time, intermittent, none) in economic empowerment programmes. Our study found that access to ART, peer support groups, and economic empowerment programmes helped to curb perceptions of deep-seated HIV stigma for participants. More expressions of usefulness, hope and psychological well-being prevailed with participants who had increased participation in economic empowerment programmes. Our findings underscore the value of HIV outreach programmes which combine ART, peer support and economic empowerment to alleviate HIV stigma. Further research to quantify the interaction of these factors is warranted.

Economic empowerment and AIDS-related stigma in rural Kenya: a double-edged sword?

Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education.

STRUCTURAL INEQUALITY AND SOCIAL SUPPORT FOR WOMEN PRISONERS RELEASED TO RURAL COMMUNITIES.

Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses of personal responsibility that detract from the structura violence and injustice shaping reentry experiences for women and their social supporters. We also consider the policy implications of discharge and reentry planning for rural women and their families, as well as strategies to reduce recidivism.

Pedagogy of individual choice and female inmate reentry in the U.S. Southwest.

Much of the mental health, substance use, and educational programming within a particular women's prison in the southwestern United States promotes individual choice and agency. Incarcerated women from rural areas are told that their ability to succeed outside of prison is primarily dependent upon their personal choices. Comparably little attention is given to preparing women for their upcoming release or to overcoming structural barriers that could undermine successful reentry within rural communities. As a result, these returning citizens, many of whom grapple with mental illness and alcohol or drug dependence, blame themselves for their inability to surmount these barriers. In this qualitative research, we draw upon the perspectives of 99 incarcerated women to clarify how ideologies of individual choice promulgated in reentry pedagogy clash with contextual factors within rural communities to derail the reentry process. We also consider community reentry from Amartya Sen's capabilities framework and discuss how this model could inform needed interventions.

Practice-based assessment of tobacco usage in southwestern primary care patients: a Research Involving Outpatient Settings Network (RIOS Net) study.

PURPOSE: Primary care clinicians rely, perhaps erroneously, on general population-based data about risk factors to help form their strategies for allocating time in the brief primary care encounter. We conducted a case study using rates of tobacco usage among people presenting for primary care to explore comparability to general population-based rates. METHODS: Clinicians in RIOS Net, a practice-based research network, gathered data on tobacco use for all patients presenting during a 2-week period. We compared those data to population-based data by gender and ethnicity. RESULTS: Ninety-one primary care clinicians reported data on 2442 patients. Primary care smoking rates differed in important ways from general population-based rates. Hispanic women smoked at more than twice the national population-based rate (25% vs 12%). Youth smoked at higher rates as well, particularly young Native American men. CONCLUSIONS: Patients seen in primary care differ in important ways in rates and patterns of tobacco usage when compared with rates reported in population-based surveys. These differences could have important implications for preventive care within the context of multiple competing demands in the primary care encounter.