Understanding HIV-related stigma in older age in rural Malawi

The combination of HIV- and age-related stigma exacerbates prevalence of HIV infection and late diagnosis and initiation of anti-retroviral therapy among older populations (Heckman et al. 2002; Moore, 2012; Richards et al. 2013). Interventions to address these stigmas must be grounded in understanding of situated systems of beliefs about illness and older age. This study analyses constructions of HIV and older age that underpinned the stigmatisation of older adults with HIV in rural Balaka, Malawi. It draws on data from a series of in-depth interviews (N=135) with adults aged 50-~90 (N=43) in 2008-2010. Around 40% (n=18) of the sample had HIV. Dominant understandings of HIV in Balaka pertained to the sexual transmission of the virus and poor prognosis of those infected. They intersected with understandings of ageing. Narratives about older age and HIV in older age both centred on the importance of having bodily, moral and social power to perform broadly-defined “work”. Those who could not work were physically and socially excluded from the social world. This status, labelled as “child-like”, was feared by all participants. In participants’ narratives, growing old involves a gradual decline in the power required to produce one’s membership of the social world through work. HIV infection in old age is understood to accelerate this decline. Understandings of the sexual transmission of HIV, in older age, imply the absence of moral power and in turn, loss of social power. The prognosis of those with HIV, in older age, reflects and causes amplified loss of bodily power. In generating dependency, this loss of bodily power infantilises older care recipients and jeopardises their family’s survival, resulting in further loss of social power. This age-and HIV-related loss of power to produce social membership through work is the discrediting attribute at the heart of the stigmatisation of older people with HIV

Sex that Gives and Takes: sexuality in older age in rural Malawi

This poster presents research on sex in older ages in Malawi. It offers data that indicate sexual desire & activity do not decline in a linear pattern, and highlights sexual behaviours and understandings that challenge the relevance of dominant HIV & STI prevention messages in Malawi. The poster presents a set of complex competing discourses that highlight the importance of qualitative approaches to the collection of data on sexual behaviour. It won the annual British Society for Population Studies Conference Poster Prize in 2011, judged by Professor Ken Hill and Professor John Hobcraft

Neither “foolish” nor “finished”: identity control among older adults with HIV in rural Malawi

Prevalence of HIV after age 50 is considerable, especially in southern Africa. Negative social constructions of HIV in older age, and the health consequences of ageing with the virus, mean that having HIV presents a challenge for many people’s roles and social memberships, threatening to disrupt their sense of self. Using constructivist grounded theory and qualitative data from rural Malawi, this paper describes how older men and women deal with these identity challenges. Drawing on a symbolic interactionist framework, it uses identity control theory (Burke, 2007) to explore how the study’s participants presented their post-diagnosis behaviours in ways that maintained their most significant pre-diagnosis identities as “adults”, a label they gave to the core identity of being a person who belongs in the social world. Considering the processes through which older people with HIV navigated challenges to their identities in light of the intersectional influences of HIV and age-related stigma and illness, provides insight into how older people might experience HIV, as well as informing theoretical understandings of identity formation and maintenance in light of chronic and/or stigmatising illness more broadly

Equitable, sustainable and acceptable long-term care in Malawi? Unpacking the implied universalism of key terms in international Ageing Policy discourse

Indications of a care deficit for older adults in Africa and the need for long-term care that is acceptable for recipients and providers is well established, as are calls for its format to be ‘home-grown’. However, there is a discrepancy between the desire for evidenced African solutions, and the framing of both the problem and possible solutions derived from the Global North. This article draws on qualitative data from men and women needing and providing care in rural southern Malawi to challenge the implied universalism of the key terms of reference in the African long-term care discourse: ‘care’ and ‘family’

Older adults’ experiences of ageing, sex and HIV infection in rural Malawi

This thesis contributes to understanding two demographically important phenomena: African ageing, and the ageing of the African HIV epidemic. Building on the body of interpretivist demography that privileges context and meanings, it explores older adults’ experiences of becoming old, sexuality and living with HIV in rural Malawi. The research uses a constructivist grounded theory framework. It is based primarily on data produced using repeat dependent interviews (N=135) with older men and women(N=43). These are supplemented by fieldwork observations, as well as data from a three-month multi-site pilot study, interviews with HIV support groups (N=3), and key informant interviews (N=19) and policy documents. The thesis identified sets of meanings surrounding old age and ways of discussing ageing that, taken together, formed an analytical framework. The framework is focused on the importance of maintaining an ‘adult’ identity and draws insights from sociological and psychological identity theories. The adult identity was aligned with personhood. It was situated within the body-centred livelihood system of rural Malawi, and associated with physical production. Old age was understood to limit productivity and thereby an individual’s adult identity. This thesis argues that ostensibly contradictory narratives about ageing experiences can be understood as rhetorical strategies respondents employed to maintain their adult identities. A central tenet of the thesis is that the adult identity (and its childlike counter identity) influenced older adults’ broader experiences and behaviours. This framework is used to explore ageing, as well as sex and HIV infection. The grounded understandings of older adults’ experiences developed in the thesis are presented against dominant understandings of the situation of older adults documented by the academe and in policy and programmatic arena emerging in Malawi. The findings highlight the centrality of wider experiences of ageing for older adults’ experiences of sex and HIV, as well as the broader importance of identity for understanding demographic behaviours and processes. In addition, they demonstrate how grounded theory and repeat dependent interviewing can be used within demographic studies to produce nuanced analytical accounts of the experiences that are most salient for the population of interest

Writing supports for older students with significant disabilities: examining two students\u27 journeys towards becoming writers

This study describes the changes in linguistic and social communicative competencies that occurred when two older students with significant disabilities where provided with writing opportunities, instruction, and supports over a semester of the academic year. The goals of the study were to identify themes and patterns in the skills associated with linguistic and social communicative competence as evidenced in writing over time. A second aim of this study was to identify instruction methods and assistive technology supports being used in the classroom and describes the themes and patterns that emerged in the students’ writing given the presence of these curriculum components. Video and writing samples from the two students were collected and analyzed using a checklist of selected linguistic and social skills from the formal assessment, Augmentative and Alternative Communication Profiles. The checklist was determined to be not sensitive to the subtle changes in linguistic and social communication competence skills that were seen over time frame of this study. Themes of engagement with the writing process and access methods became evident and were explored. Instruction and opportunities in the areas of revision and writing for different audiences and purposes were identified as critical components of the writing process that were not addressed consistently for the two participants studied. Overall, the two students in this study demonstrated improvements in linguistic and social communication skills with the addition of writing instruction and support

Where Do New US-Trained Science-Engineering PhDs come from?

This study shows that the demographic and institutional origins of new US trained science and engineering PhDs changed markedly between the late 1960s-1970s to the 1990s-early 2000s. In 1966, 71% of science and engineering PhD graduates were US-born males, 6% were US-born females, and 23% were foreign born. In 2000, 36% of the graduates were US-born males, 25% were US-born females, and 39% were foreign born. Between 1970 and 2000 most of the growth in PhDs was in less prestigious smaller doctorate programs. The undergraduate origins of bachelor's obtaining science and engineering PhDs changed only modestly among US colleges and universities while there was a huge growth in the number of foreign bachelor's graduates obtaining US PhDs.

Lack of awareness of Zambia’s abortion law leads to unsafe practices

LSE’s Ernestina Coast and Emily Freeman discuss how the lack of knowledge of the Zambia’s laws on abortion means that unwanted pregnancies frequently end in unsafe procedures