Methodological considerations in the measurement of institutional and structural forms of HIV discrimination

The systematic measurement of HIV/AIDS-related discrimination is imperative within the current rhetoric that holds discrimination as one of the two &lsquo;biggest\u27 barriers to HIV/AIDS pandemic intervention. This paper provides a methodological critique of the UNAIDS (2000b) Protocol for the Identification of Discrimination against People Living with HIV (the Protocol) . Specifically, the paper focuses on the Protocol\u27s capacity to accurately identify and measure institutional levels of HIV-related discrimination that allows data that are reliable and comparable across time and contexts. Conceptual issues including the Protocol\u27s objective as an indicator versus a direct measure of discrimination and the role of the Protocol as a tool of research versus a tool of advocacy are explored. Design issues such as the operationalization of discrimination, appropriateness of indicator content, sampling and data collection strategies and issues of scoring are also evaluated. It is hoped that the matters outlined will provide readers with ways of critically reflecting and evaluating the findings of the research papers presented in this Special Issue, as well as pointing to ways of improving research design.<br /

The social determinants of HIV: a review

This Working Paper is the review of the social determinants of HIV/AIDS commissioned by the World Health Organization (WHO) in 2007 and completed in 2008 as part of the work of the Commission on Social Determinants of Health. The review considers the available evidence particularly but not exclusively from existing reviews (i.e., a meta-review), but includes some novel secondary analyses of available data. The review highlights the heterogeneity in the social determinants of HIV, and the heterogeneity in the social determinants of access to treatment for HIV

Social support and care arrangements of older people living alone in rural Malaysia

Malaysia has an ageing population and an increasing number of older people who live alone. This study explores the social support and care arrangements of older people living alone in rural Malaysia. The study took a qualitative approach: semi-structured interviews were conducted with a purposive sample of Malay (N = 20) and Chinese (N = 20) Malaysians aged over 65. Five cross-cutting themes were identified through a thematic analysis: degrees of aloneness; relationships and social support; barriers to social support; and future illness, care and death. All participants said they lived alone; living arrangements, however, were often complex. For Malays, most support came from nearby adult children and relatives, whereas Chinese participants, who less frequently had adult children living locally, emphasised support from friends and neighbours. Emigrant adult children's assistance was mostly informational and financial, instrumental assistance was either substituted for money, or provided solely during periods of ill-health. Physical decline, limited telephone use, inadequate transportation and fears of crime were barriers to social support. Participants avoided thinking or talking about future care needs. These findings have implications for Malaysian old age policy, which is currently focused on supporting families to care for older relatives. Child migration and a growing preference for a period of independent living in old age may require policies and resources directed at older people as individuals to support their own efforts to remain independent, active and age ‘in place’

`He hath the French pox` : stigma, social value and social exclusion

Goods and resources are finite, and social forces heavily pattern their distribution. One of the principal mechanisms for shaping the distribution of resources is by regulating entitlement to community membership itself. By restricting groups\u27 membership of community, so access to social goods and resources diminishes, which in turn has a negative impact on the health and wellbeing of the excluded groups. It is argued here that community membership is determined on the basis of the perceived social value of groups and individuals and stigmatisation is the marking of individuals and groups who are \u27unworthy\u27 of social investment. Using the notion of reciprocity we show how groups may be stigmatised and socially excluded as a mechanism for protecting limited social resources from exploitation. This perspective provides an empirically testable framework for the understanding of stigma and social exclusion that goes beyond the largely descriptive work that currently populates the field. We illustrate the process of stigmatisation and social exclusion and discuss how this suggests new styles of intervention, as well as new directions for research.<br /