Abstract/Introduction:
Though Apartheid is over it's remnants still exist maintaining a system of economic difficulty for citizens.  Men are forced to work outside of their villages far away in the big cities in Africaand must leave their families for weeks and months.  While the men are away pimps hustle the workers into relations with prostitutes and the workers contract HIV/aids.  They then return home with the disease and give it to their wives.  In much of the African culture, women are to stay married and not even question their husbands and produce offspring or their own family (parents) will disown them.  Also the stigma of the disease prevents discussion in the culture and testing and treatment is never saught.  So the virus spreads to the mother and then any children she has after that.  This has been going on for decades and their is folklore about the monkey (the trickster or the pimp), the lion (the John), and the Elephant (the prostitute) I can maybe find and post that also maps out this issue in terms the people could understand, and tosses it up a little bit because the Elephant is usually the victim in these stories, but if you want to make a difference penetrate the culture by helping to get women a voice and resources.  That way they can have conversations with their husbands and have some where to go if they must leave him because he has had unprotected sex outside of the marriage.  Prostitutes need resources so they don't have to make their bodies commodities.  This only solves part of the problem still because marriages are still being corrupted.  The present economic system is the problem and there need to be more jobs closer to home and less glamorization of the sex trade.  So that is just some aspects you can work with.  Please read the following research paper for more facts.  It still needs interviews, discussion, and a conclusion.  The questions I have provided where ment to inquire about lifestyle choices made in reguards to one's knowledge of HIV/AIDs.  Feel free to take this on or put it into practice.

           

Introduction and Statement of the Problem

It has been about twenty years since the world first became aware of AIDS and it is clear that humanity is facing one of the most devastating epidemics in human history.  Strides in human development are being undermined as countries lose young productive people to the epidemic, economies stagger, households experience more intense poverty, and the cost of the epidemic continues to escalate.  Countries that fail to bring the epidemic under control risk becoming locked in a vicious cycle as worsening socioeconomic conditions render people, communities, and enterprises even more vulnerable to the Aids epidemic.  However, the impact of the epidemic can be dealt with through community action, national programs, or other institutions that can be equipped to defend societies against the ravages of AIDS (UNAIDS: Report of the Global AIDS Epidemic, 2002).

The Current Study

HIV/AIDS continues to have devastating social, political, and economic implications. Many people wear a red ribbon as a political statement for the AIDS awareness movement. AIDS education and research can help put a stop to the spread of HIV/AIDS.  Although AIDS awareness has been in action for some time now I would like to discover how much others know about HIV/AIDS and its implications.  How much do subjects incorporate knowledge about HIV/AIDS into their lives? Furthermore, where do we need to implement HIV/AIDS awareness initiatives?  I will administer structured interviews to my sample of five men and five women, age groups 18-25 and 26 and up. The participants will also be categorized as high school graduate or at least some college.  Specifically, I want to explore how much effect age, education, ethnicity, gender, and how one became aware of the disease have on knowledge of AIDS and its implications.

My study will show that the variables age, gender, ethnicity, education, and how one first became aware of HIV/AIDS impact how one incorporates knowledge about the disease into everyday life.  Less educated adolescent women are the least educated about AIDS and its implications and the most vulnerable to the disease (Collymore 2002).  As the literature reports, there are adolescent girls who have never heard of AIDS (Collymore 2002).  HIV/AIDS has been the number one cause of death for African American women aged 25-34 years (HIV/AIDS Among African Americans, 2005).   Due to anatomical differences, women of all ages are more vulnerable to HIV/AIDS (Collymore 2002).  Better educated women tend to have sex later, however people with more education are more likely to have casual partners, though more likely to use protection (Collymore 2002). The stigmatization associated with HIV/AIDS makes it more difficult to reach people through prevention programs and less likely to be a topic of discussion in institutions such as the family (Lamptey et al 2002).  This is likely to vary by ethnic group, gender, and education.  Thus an understanding of age, gender, ethnicity, education, as well as how you became aware of the disease are foremost in the in the fight against HIV/AIDS.

National Serosurveilance

National Serosurveilance conducted a study about HIV prevalence trends in selected populations in the United States.  As part of a serosurveillance system to monitor the prevalence of human immunodeficiency virus type 1 (HIV-1) in the United States, the Centers for Disease Control and Prevention (CDC), in collaboration with state and local health departments, conducted standardized anonymous unlinked surveys in selected sites from 1988 through 1999. In addition, the Department of Labor, the Department of Defense, and the American Red Cross provide CDC with statistical data from routine HIV testing for surveillance purposes (Divisions of HIV/AIDS Prevention, 2001).

                The objectives of the serosurveillance system are where to provide federal, state, and local health officials and the general public with standardized estimates of HIV prevalence among selected populations and to describe the magnitude and changes over time of HIV infection in these populations within regions and within selected demographic and behavioral subgroups.  Other objectives where to recognize new or emerging patterns of HIV infection among specific subgroups of the U.S. population and to assist in directing resources for HIV prevention and care (Divisions of HIV/AIDS Prevention, 2001).

            The survey sites where sexually transmitted disease clinics, adolescent medicine clinics, and drug treatment centers chosen on a basis of client demographic and behavioral characteristics, local public health priorities, projected sample size, availability of voluntary counseling and testing, and the willingness of the clinic staff to conduct surveys in accordance with standardized protocols.  Several steps were taken to ensure the surveys were both anonymous and ethical (Divisions of HIV/AIDS Prevention, 2001).

            CDC also monitored HIV prevalence in three populations in which HIV screening is routinely performed. Since 1985, the American Red Cross has provided CDC with HIV test results for blood donors. In addition, the U.S. Department of Defense has provided HIV test results for applicants to the military service since 1985. Beginning in 1987, the U.S. Department of Labor has provided HIV test results for entrants to the Job Corps, a federally funded job-training program for disadvantaged youth. As is true of all the unlinked surveys, personal identifiers for participants in these screening programs are not available to CDC (Divisions of HIV/AIDS Prevention, 2001).

            The sexually transmitted disease clinics and drug treatment centers serve populations at high risk for HIV infection.  The adolescent medicine clinics serve populations at low risk.  Results from routine HIV screening of Job Corps entrants, military applicants, and blood donors provide important additional information on the evolving HIV epidemic. Although geographically diverse, each of these groups is disproportionately composed of persons with particular demographic and socioeconomic characteristics. Job Corps entrants comprise young men and women who are educationally or economically disadvantaged. Military applicants and blood donors are low-risk populations because persons with known HIV infection are not accepted into the military and potential blood donors with known HIV infection or risk factors for HIV infection are likely to have self-deferred (Divisions of HIV/AIDS Prevention, 2001).  

            Among youth populations in the serosurveillance system, HIV prevalence remained low.  For the five-year study period the rate was 0.4%.  Among the Job Corps participants the rate was 0.2%.  The prevalence rate for military applicants was less than 0.04%.  The lowest observed HIV prevalence rate of all the selected populations in the report was among first time blood donors with a rate of 0.027% for men and 0.011% for women (Divisions of HIV/AIDS Prevention, 2001). 

            HIV prevalence continues to differ by race/ethnicity.  Rates are substantially higher among blacks in nearly every serosurveillance population. Overall prevalence rates among men who have sex with men, a high-risk population, at STD clinics were 40% among blacks, 26% among Hispanics, and 21% among whites. Among heterosexual patients at these clinics, prevalence for race/ethnicity differed by region but remained relatively high among blacks in all regions. The highest overall prevalence for these high-risk heterosexuals was in the Northeast for blacks (4.3%) and Hispanics (4.0%) (Divisions of HIV/AIDS Prevention, 2001).  

            The association between HIV prevalence and race/ethnicity differed considerably by region. In the Northeast, prevalence rates were higher among IDUs who were black (42%) and Hispanic (38%) than among those who were white (17%). A similar pattern was observed in the South, where rates were higher among black IDUs (20%) and Hispanic IDUs (24%) than among white IDUs (6%). In the Midwest, prevalence was higher among Hispanic IDUs (27%) than among black IDUs (11%) or white IDUs (6%). In the West, prevalence among black IDUs (11%) was considerably higher than among Hispanic IDUs (1%) or white IDUs (2%) (Divisions of HIV/AIDS Prevention, 2001).  

            Prevalence was 6 times higher among black adolescent medicine clinic patients (0.6%) than among Hispanic (0.1%) and white patients (0.1%). The overall prevalence of 0.32% among black Job Corps entrants was 4 times that for Hispanics (0.08%) and more than 6 times that for whites (0.05%). Among military applicants, the overall prevalence among blacks (0.15%) was 5 times higher than among Hispanics (0.03%) and 15 times higher than among whites (0.01%) (Divisions of HIV/AIDS Prevention, 2001).  

            These are just some of the findings from the serosurveilance study on HIV trends in selected populations in the United States.  Older men who have sex with men in the Northeast are the populations with the highest risk for contracting HIV/AIDS.  HIV prevalence was also high among Black and Hispanic high-risk injection drug users in the South.  In the Midwest, the highest prevalence for IDUs entering treatment was Hispanics. HIV prevalence was higher among IDUs who were 30 years of age or older than those who were younger.  HIV prevalence rates among adolescents are likely to reflect recent infections because of the limited time since they began the high-risk behaviors (Divisions of HIV/AIDS Prevention, 2001).    

HIV/AIDS Among African Americans

            In 2001, HIV/AIDS was among the top 3 causes of death for African American men aged 25-54 years and among the top 4 causes of death for African American women aged 20-54 years.  It was the number one cause of death for African American women aged 25-34 years (HIV/AIDS Among African Americans, 2005). 

            According to the 2000 Census, African Americans make up 12.3% of the US population.  However, they accounted for 368, 169 (40%) of the 929,985 estimated AIDS cases diagnosed since the epidemic began.   By the end of December 2003, an estimated 195,891 African Americans with AIDS had died (HIV/AIDA Among African Americans, 2005).  Of the persons given the diagnosis of AIDS since 1995, a smaller proportion of African Americans (60%) were alive after 9 years compared with American Indians and Alaska Natives (64%), Hispanics (68%), and whites (70%), and Asians and Pacific Islanders (77%) (HIV/AIDS Among African Americans, 2005).   

            During 2000-2003, HIV/AIDS rates for African American females were 19 times the rates of white females and 5 times the rates for Hispanic females: they also exceeded the rates for males of all races/ethnicities other than African American.  Rates of African American males were over 7 times those of white males and 3 times those of Hispanic males (HIV/AIDS Among African Americans, 2005). 

Of the 59 US children younger than 13 years of age who had a new AIDS diagnosis, 40 were African Americans.  Of the 90 infants reported as having HIV/AIDS, 62 were African American  (HIV/AIDS Among African Americans, 2005).

The leading cause of HIV infection among African American men was sexual contact with other men; the next leading causes were heterosexual contact and injection use.  The leading cause among African American women was heterosexual contact; the next leading cause was injection drug use.  Race and ethnicity are not, by themselves risk factors for HIV infection.  However, African Americans are more likely to face challenges associated with risk for HIV infection including substance abuse, partners at risk, denial, and socioeconomic issues (HIV/AIDS Among African Americans, 2005).

Where African Americans are disproportionately affected the Center for Disease Control has announced new initiatives for advancing HIV prevention among minority populations.  The initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models of diagnosing HIV infections outside medical settings, preventing new infections by working with HIV infected persons and their partners, and further decreasing prenatal HIV transmission.  There are CDC funded prevention programs at the state and local levels that provide for African Americans.  A program in Washington DC provides information to and conducts HIV prevention activities for MSM who do not identify themselves as homosexual.  The activities include a telephone help line, an Internet resource, and a program in barbershops that include risk reduction workshops, condom distribution, and training of barbers to be peer educators. A program in Chicago provides support to help difficult to reach African American men reduce high-risk behaviors.  The program also provides high-risk women with culturally appropriate, gender specific prevention and risk reduction messages.  South Carolina also has a program that focuses on changing behaviors in adolescents in ways that will reduce their risk of contracting HIV and other STDs (HIV/AIDS Among African Americans, 2005).      

      

HIV/AIDS in North Carolina USA

According to the Raleigh News and Observer, the number of new HIV cases in North Carolina, most of which are among African Americans, women and the poor, has been rising over the past three years and is now are reaching a historic high after peaking in the 1990s (2005). African Americans account for 22% of the state's population but 71% of its HIV/AIDS cases, and African-American women in the state are 14 times as likely as white women to be HIV-positive (Raleigh News & Observer, 2005). As a result of the increasing number of new cases, 2,100 people were newly diagnosed in 2003.  The costs associated with the disease are rising, particularly as more of the state's poor and disadvantaged are affected, and a prevention challenge has emerged, as many high-risk behaviors have their roots in the despair of poverty (Raleigh News & Observer, 2005).

The news observer reports that Congressional members from Southern states this year are "poised to battle big cities" over how Ryan White CARE Act funding is allocated (Raleigh News and Observer 2005). The act, which is scheduled for reauthorization this year, provides $2 billion annually for HIV/AIDS care and treatment nationwide. In 2003, AIDS advocates from 14 states published the "Southern States Manifesto," which called for increased federal funding to fight the epidemic in the region, where the disease is increasingly moving into rural areas and minority populations (Raleigh News & Observer, 2005).

 HIV/AIDS Knowledge Among High School Students

Data from the 1989 Secondary School Student Health Risk Survey indicate that 54 percent of high school students in the United States had some form of HIV/AIDS education in school.  The SSSHRS is a national probability sample self administered to students in grades nine through twelve.  The sampling frame was drawn from Quality Education Data (QED), a national school database, consisting of all regions in the United States.  Ninety-nine out of the 122 selected schools participated in the survey, yielding a response of 81 percent.  Ninety six percent of all participants required parental consent while 10 percent did not and another seven percent where absent on the day of the survey.  8,098 or 83 percent completed the survey.  Weighted factors were developed to compensate for the missing students (Anderson et al 1990).

Responses to the questionnaire show that nearly all students knew the two main modes of transmission of HIV/AIDS, which are intravenous drug use and sexual intercourse.  Students who had been taught about HIV/AIDS in school gave correct answers to questions about the virus more often than those who had not received instruction.  Students who knew more about HIV/AIDs transmission were less likely to report having had two or more sexual partners and more likely to report consistent condom use.  Ninety one percent knew HIV/AIDS could be passed from a pregnant woman to her baby.  However, twelve percent believed birth control pills provide some protection against HIV/AIDS infection, and 23 percent believed that it was possible to tell by looking at a person whether a person was infected.  Moreover, 36 percent believed that donating blood could result in HIV infection and 55 percent thought insect bites could transmit HIV/AIDs.  Knowledge of HIV/AIDS was significantly lower among black and Hispanic students.  Females had a slightly higher number of correct responses than males (Anderson et al 1990). 

A relatively small (1.2 percent) proportion of HIV/AIDS cases have been reported among 13-21 year olds.  About three quarters of the adolescents probably became infected through sexual behavior or intravenous drug use.  In 1986 HIV/AIDS moved from the seventh to the sixth leading cause of death in 15 to 24 year old age group.  Research has indicated that risk related behavior might be changing among some groups, though in a review of studies about behavior change related to HIV/AIDS, the review concluded that as the HIV/AIDS epidemic has progressed, high risk groups such as make homosexuals and intravenous drug users have modified there behaviors, but there is less evidence of this change among adolescents.  Though other studies show that that has been a change including the rapid increase of condom use among teenagers in the 1980s (Anderson et al 1990). 

   

HIV/AIDS Background

The human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS).  Once the virus is in the body it multiplies and acts by weakening the immune system.  Thus with a weakened immune system the body is more susceptible to infections and less able to fight disease.  When the immune system becomes seriously compromised, the illness progresses to AIDS.  AIDS is therefore defined by the degree of deterioration of the immune system, which in turn is defined by the extent of opportunistic infections that take advantage of the weakened immune system.  Nearly all Africans who have HIV eventually die from AIDS-related illnesses, most within ten years of the infection.  In most of the developing world, tuberculosis is the most common opportunistic infection for people living with HIV/AIDS.  Once HIV is in a population it is transmitted through sexual contact (heterosexual or homosexual).  An infected woman can also transmit the virus to her infant during pregnancy, delivery, or while breastfeeding.  Furthermore, a person can become infected through transfusion of contaminated blood or by sharing needles used for injections and drug use (Goliber, 2002).

 The Social, Political, and Economic Impact of HIV/AIDS

Since the epidemic began, more than 60 million people have been infected with the virus.  HIV/AIDS is now by far the leading cause of death in sub-Saharan Africa, and the fourth biggest global killer. In 2001, the epidemic claimed about 3 million lives.  In many countries, AIDS is erasing decades of progress made in extending life expectancy. Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS.  The impact of AIDS on life expectancy, which signifies a major blow to a society’s development, has spread beyond Africa.  Haiti’s life expectancy is nearly six years less than it would have been with the absence of AIDS.  In Asia, Cambodia has experienced a four-year reduction in life expectancy (UNAIDS: Report of the Global AIDS Epidemic, 2002).

In the 45 most affected countries, it is projected that between 2000 and 2020, 68 million people will die earlier than they would if AIDS was not in the picture.  The projected death toll is greatest in sub-Saharan Africa, where 55 million additional deaths can be expected (39% more deaths than without AIDS).  AIDS has a particularly potent effect on mortality of young children between the ages of one and five.  Most children infected at birth or through breastfeeding will develop AIDS and die before they reach their fifth birthday.  In the worst affected countries, HIV/AIDS has had a major impact on child survival.  In seven countries in sub-Saharan Africa, mortality for children under the age of five has increased from 20% to 40% due to the epidemic (UNAIDS: Report of the Global AIDS Epidemic, 2002).

AIDS is undoubtedly a global epidemic.  However, social conditions such as poverty aggravate population’s vulnerability to HIV/AIDS in particular regions. HIV’s amplification began in the 1960’s when African societies underwent a change from colonialism to rule by indigenous nationalist rulers.  South Africa and Southern Rhodesia (later Zimbabwe) remained under fascist apartheid throughout this period. Armies of male migrant workers left the countryside for the newly crowded cities. Their wives remained behind in remote rural areas.  Prostitution became a major growth industry; in fact, in some countries European companies set up whorehouses near their factories for their workers.  A seemingly endless series of wars sent masses of soldiers and refugees all over central Africa.  One insight is that HIV likely spread from Uganda to Tanzania by Tanzanian soldiers returning after war (Bonds 2000).

Post-colonial African societies have experienced a continuation and worsening of the conditions created by colonialism and Apartheid.  The virus spread like wildfire through populations ravaged by poverty, famine, and disease. By the 1970’s it spread to Europe and the U.S., amplified among gay males by profitable bathhouses and by multiple partners, and among IV drug users and their sex partners. In the U.S., AIDS is now mainly a disease of poverty, and the number one cause of death among African American women between the ages of 25 and 34. From Europe and the U.S. HIV spread to Haiti and Thailand, primarily through sex tourism, which is mostly child prostitution.  Prostitution and dirty needles spread it to Latin America, India, and Eastern Europe, centers of new epidemics.  In poor countries, massive unemployment, promoted prostitution, imposed cutbacks in health care and education, and unaffordable life-saving drugs fuel the epidemic (Bonds 2000).   

In Africa, traditional oppression of women has meshed with new, profit-driven forms of oppression. In southern Africa, married women don't dare ask their husbands to wear condoms, and are pressured by relatives to stay unprotected for maximum fertility. Husbands are expected to have many sex partners while their wives are expected to be monogamous. A Zimbabwean saying is “for a woman, the greatest HIV risk factor is to be married.” (Bonds 2000).

Sex tends to be distracting for researchers as much as for the general public. The sexual transmission of HIV diverted attention from the broader epidemiological environment in which the epidemic developed in Africa. Both rich and poor countries are characterized by high rates of unprotected multi-partnered sexual activity. Populations in poverty are also characterized by malnutrition, parasite infection and lack of access to medical care and antibiotics for bacterial STDs, which are important co-factors for transmission of HIV. To acknowledge the relationship among malnutrition, parasite infestation and infectious disease is not to say that AIDS itself is a nutritional disease, nor does it deny that HIV is sexually transmitted in Africa and causes AIDS. It merely subjects STDs, including HIV/AIDS, to the same methodology employed in the study of other infectious diseases, however they are transmitted (Sillwagon 2001).

A brief survey of economic conditions in sub-Saharan Africa in the years in which the AIDS epidemic began reveals an extremely compromised health environment. From 1970 to 1997, sub-Saharan Africa was the only world region to experience a decrease in food production, calorie supply and protein supply per capita. In ten countries (including Zimbabwe, Kenya, Uganda, Zambia and Malawi), protein supply fell by more than 15 percent.  Eighteen of the nineteen famines worldwide from 1975 to 1998 were in Africa, and 30 percent of the total population of the region was malnourished.  Refugees from internal and external conflicts crowded into unsanitary camps where food rations were deficient in necessary nutrients. Sub-Saharan Africa is not the only region in which malnutrition is associated with HIV/AIDS.  Among all low- and middle-income countries, HIV prevalence is strongly correlated with falling protein consumption, falling calorie consumption, unequal distribution of national income and, to a lesser extent, labor migration. Almost all of sub-Saharan Africa is tropical, with a very high prevalence of parasite infection, including malaria and various intestinal and skin ailments.

A large body of mainstream biomedical literature documents the mechanisms by which malnutrition and parasite infection undermines the body’s specific and nonspecific immune response. Protein-energy malnutrition (general calorie deficit) and specific micronutrient deficiencies, such as vitamin-A deficiency, weaken every part of the body’s immune system, including the skin and mucous membranes, which are particularly important in protecting from STDs, including HIV. Parasite infestation plays a dual role in suppressing immune response. It aggravates malnutrition by robbing the body of essential nutrients and increasing calorie demand.  Moreover, the presence of parasites chronically triggers the immune system, impairing its ability to fight infection from other pathogens.

Poverty not only creates the biological conditions for greater susceptibility to infectious diseases, it also limits the options for treating disease. Infection with other STDs is an important co-factor for transmission of HIV; genital ulcer diseases in particular, provide an entry point for HIV. Such painful bacterial STDs are relatively uncommon in rich countries because of the availability of antibiotics. In Africa, South Asia and Latin America, however, even when poor people have access to healthcare, the clinics may have no antibiotics to treat bacterial STDs that act as co-factors for AIDS. These are among the conditions to consider in poor countries, and they are standard variables in epidemiology (Stillwagon 2001).

Social conditions in Latin America aggravate the population’s vulnerability to HIV/AIDS. As in Southern Africa, highly concentrated land ownership forces millions of workers to migrate for work, internally or internationally, increasing risk of HIV and other STDs through new sexual liaisons, including prostitution. Forty million children in Latin America live on the street; they eat from garbage cans, and many of them sell sex to survive. Sex tourism has shifted from Asia to the Americas, with children as the primary targets of an Internet-based industry. Considering the extent of poverty and the effects of that deprivation on the immune system, an AIDS epidemic of African magnitude is possible in parts of Latin America.  Throughout the region, the preponderance of new cases has shifted from upper to lower income and from men to women and children (Stillwaggon 2001).

AIDS is believed to progress more slowly in industrialized countries than in less developed countries that are experiencing mass impoverishment largely because residents in industrialized countries have greater access to antiretroviral drugs and high quality health care.  Current drug treatments slow the replication rates in the body.  Slower replication rates lessen the burden on the immune system, thereby reducing HIV related illnesses and allowing patients to live longer, high quality lives.  Termination of treatment leads to resurgence of the disease.  Also, I would add that people are more likely to be tested in developed countries if they can afford treatment so they can live longer high quality lives, whereas in less developed countries they may see no reason to be tested if they can not be treated, thus the disease surges within victims and spreads in the population (Lamptey et al 2002).

AIDS/HIV Awareness

The AIDS epidemic is as well aggravated by ignorance about the disease.  Most of the American population is well informed on HIV transmission but not as many people know about other topics related to AIDS. Only a small minority knows that latex condoms are more effective than natural membrane condoms. Only one in four people know that oil –based lubricants can cause latex condoms to disintegrate. Only 67% of the general population knew that drugs for AIDS are available and 51% had heard of AZT among the respondents who heard of AZT, 89% knew that the drug can not cure AIDS while 81% understood that the drug can slow the onset of the symptoms and 59% were aware that AZT has side effects. Only 34% knew that AZT should be administered only at certain times during the illness. More than 50% of respondents knew that early treatment of HIV can reduce symptoms in an infected individual and that AIDS can damage the brain (Stewart 1993).

Black infants are 2-3 times likelier as white infants to be born with a weighting less than 1,500 grams (~3.3 pounds), this elevated risk is closely related to the incidence of a number of serious maternal complication infections or premature rupture of the membrane pre-term labor of unknown cause, pregnancy-related high blood pressure and hemorrhage were all more common among black mothers of very low birth rate weight babies than among comparable white mothers (Stewart 1993)

Young African girls are dangerously undereducated about AIDS and how to protect themselves from it.  Reports show that more than 70% of adolescent girls in Somalia and more than 40% in Guinea-Bissau and Sierra Leone have never heard of AIDS.  In Kenya and Tanzania, more than 40% of young girls have serious misconceptions about how AIDS is transmitted.  More than half the women who are HIV positive have withheld this from their partners fearing abandonment or violence.  These gaps in understanding and education about the disease along with fear and discrimination fuel the epidemic.  Education along with gender equity goals and targeted HIV preventive education, including reproductive and sexual health information, promises to be the most effective means of stemming the epidemic's spread (Caldwell 2000).  Overcoming associated stigmas allows for more communication about the disease and how to protect ones self from it.  Education is seen as crucial in the diffusion of HIV/AIDS awareness.

Universal education can be critical in the fight against the AIDS epidemic.  Countries' ability to cope with the epidemic will depend on the extent to which their educational institutions can continue to be essential parts of the society's infrastructure. Studies show that educated people generally have greater access to information, are more likely to make well- informed decisions, and have better jobs and greater access to resources that can help them to support healthier lives.   For girls, in particular, better education contributes to economic independence, delayed marriage, and greater self-assurance and self-reliance. Women of all ages are more vulnerable than men to HIV infection. Anatomical differences make transmission of the virus through sexual contact far more effective from men to women than vice versa.  Furthermore, powerlessness and dependency diminish girl’s ability to make healthy decisions (Collymore 2002).  According to a UNAIDS analysis of studies of 15–19-year-olds in 17 African and four Latin America countries, better educated girls tended to have sex later. Though, both girls and boys with more education were generally more likely to have casual partners, at the same time, people with more education were more likely to protect themselves by using condoms during sexual intercourse (Collymore 2002).  Thus, education plays a foremost role in the fight against Aids. 

The AIDS awareness movement has been shrouded by fear, ignorance, and denial from the beginning.  The epidemic has been confined to groups perceived as socially deviant.  This has led to stigmatization and discrimination towards people with HIV/AIDS.  Many people with the disease have lost their jobs, been denied medical care, housing insurance, and travel opportunities due to their HIV status.  Children have been denied access to childcare and school facilities.  Individuals with the disease, in many instances have been exiled from their families and communities.  In Africa, stigma within the family has been described as one of the most subtle and de-habilitating forms of this problem and one of the most difficult to address.  This discrimination and stigmatization surrounding the epidemic has contributed to its spread.  Stigma leads people to avoid being tested and renounce their HIV status if they have been tested.  Due to stigmatization, those at highest risk of contracting the disease (i.e. homosexual men, prostitutes and injecting drug user) conceal their life styles, making it difficult to reach them through prevention programs.  Furthermore, stigma and discrimination also make people with HIV/AIDS more vulnerable to sickness and death because they are less likely to seek appropriate medical care and support and are more likely to be denied services if they do seek them (Lamptey et al 2002).

In most of Africa there are examples of excellent HIV/AIDS prevention, mitigation, and care projects. However these projects reach only a small fraction of the population. An estimated 200,000 of the region’s 1.9 million are AIDS orphans. Some 10 non-governmental organizations (NGOs) provide HIV/AIDS services. They are staffed by dedicated volunteers but they are under-funded they operate in mainly two out of five districts leaving the other three with virtually no services in the other two districts they reach no more than 5% of the population with any HIV/AIDS services. The USAID financed the NGO in Guinea. A lot of NGO HIV/AIDS projects are help by systems such as public schools, or health programs but Africa does not have as many of these services as say Thailand. Denial and fear are active forces in Africa are hindering the HIV/AIDS progress over the last 12 months the national HIVAIDS program has made impressive gains its collaborating with 23 NGO program ten of which are in Africa it has trained its staff in STD treatment and the required medication is more available most of the workers were chosen because they were trained in livestock health (Binswanger 2000)

The AIDS epidemic is not only pushing biomedical research to its frontier, but is also taking public health into uncharted territories in the national and global political arenas. It is sometimes argued that AIDS is treated unnecessarily as a special issue rather than as another disease added to the long list of old and new health problems plaguing the developing world. Such a view does not take into account the full extent and nature of the pandemic (Binswanger 2000). 

Further measure taken toward combating the Aids epidemic should involve enforcing the already prescribed measures.  Governments, communities, families, and individuals should promote Aids awareness.  Efforts should be made by the former institutions to target women, who are at high risk because of the activities of their spouses.  Communication about the AIDS virus among the family can provide an important source of Aids education and contribute to deterring stigmatization.   Teenagers should as well be targets for Aids consciousness and sex education in general.  Success in the fight against Aids is likely to come from diffusing consciousness through various mediums and endorsing Aids prevention as popular wisdom.  

Theory and Methods

Employing the qualitative component reflexivity, I would argue that quantitative an qualitative research are equally valid (depending on the topic of study) and can be used to compliment each other.  However, quantitative methods better accommodate my research interest.  Qualitative research produces insight from diverse experiences and legitimizes non-dominant epistemologies, often giving voice to those who have been silenced and acknowledging the validity their realities.  

Although in-depth interviews, descriptive observations, and other methods that yield descriptive data, have been employed as far back as any history, qualitative research was not signified as such until it gained its popularity at the Chicago school in 1910 up until its sensational decline in 1940.   Since its conception into social research, qualitative methodology has faced confrontational appraisal due to its positivistic deficiencies.  The use of qualitative methods reemerged in the 1960s, more accepted into applied fields (Taylor and Bogdan 1998).  Today, qualitative research is reaching the prevalence of its quantitative counter, where their various forms continue to be distinguished by researchers (Creswell 1998).  Where positivist or quantitativist seek facts pertaining to social phenomena, qualitative methodologist focus in on the subjective states of individuals; what phenomena mean to actors in the social world (Taylor and Bogdan 1998). 

            Qualitative research can exist in many diverse forms.  Here I will describe a few of these qualitative inquiry methods.  A biography is one form, where the author tells the story reconstructing the experiences of a single individual.  A phenomenology enlists a researcher to interpret meanings and produce themes from descriptive materials.  A researcher may use a grounded theory approach to qualitative methods that take on a scientific, objective, and systematic format.  Case studies are another form of qualitative methods.  Cases of phenomena are bounded by place and time and multiple resources are used to provide a detailed picture of phenomena in that temporal setting.   The last form described here is an ethnography in which the author tells his story informally, using extensive detailed descriptions to explore themes in the every day lives of persons (Creswell 1998).  Qualitative methodology can utilize many of these forms in triangulation.

            With an understanding of its history and its diverse forms, still, what is qualitative research and methodology?   I offer the following consensus of authors Creswell (1998), Miles and Huberman (1994), Flick (1998), and Hammersely (1992) as an inter-subjective sum of the essential features of qualitative research.  Qualitative research entails contact to real life situations.  Social relationships and social phenomena are at the center of qualitative research.  Also, qualitative research involves reflexivity; it strives for internal validity, and searches for meaning behind the social.  It is often a prolonged study in a natural setting that is subject to interpretation.  Qualitative research prescribes an inductive rather than a deductive analysis.  Qualitative research attempts to encompass a holistic overview of a situation.  Furthermore, Qualitative research involves collecting words and pictures, a focus on participant views, expressive and persuasive linguistics, and embededness in the research.  Qualitative research is explanatory, flexible, and inclusive of a variety of methods.

                         Qualitative researchers approach their studies with a particular paradigm or worldview, a basic set of beliefs or assumptions that guide inquires (Creswell 1998).  The ideological perspective for this study is a critical perspective.  A critical approach helps people to be aware of the conditions of their existence (Creswell 1998).  My approach as well resembles constructivism where I adopt a relativist position and reconstruct understandings.  I will use this distinct approach in aim of sparking a realization about society that will encourage transformations of social relations.  The ontological issue, or way of being, addresses the nature of reality for the qualitative researcher.  The ontological assumption for this study is that reality is a set of multiple mental and social constructions.  Although shared, they are local and specific and dependent for their form and content on the groups holding them, which is relativism.  Also, reality is shaped by factors such as social, political, cultural, economic, ethnic, and gender.  Overtime, these structures become real, that is historical realism (Guba and Lincoln 1994).  Epistemology, or way of knowing, addresses the relationship between the researcher and that being researched (Creswell 1998).  For this study the epistemological assumption is that findings are created interactively between the researcher and subjects, that is transactional and subjectivist (Guba and Lincoln 1994).  Axiological assumptions concern the role of values.  Values play an important role in this research and create outcomes.  The values of the subject and I, the researcher, are given equal weight (Guba and Lincoln 1994).  The rhetorical assumption or language for this study is the voice of a passionate participant, actively engaged in multi-voiced reconstruction.  Changes come when reconstructions are facilitated and individuals are motivated to act in it.  Another facet of the paradigm is the role of ethics.  For this research, ethics are intrinsic.  The research is to be transformative.  Deception is considered unethical because it is destructive to the aim of uncovering improved constructions (Guba and Lincoln 1994).  The last paradigm assumption discussed here, is the methodological assumption, or how one conceptualizes the entire research process.  In qualitative research, the researcher starts inductively.  Dialogue between the researcher and subject are needed.  This dialogue is dialectical in order to uncover myths changing them to informed consciousness with hope of transforming those involved.  (Guba and Lincoln).    

Research Populations and Questions

Qualitative research can have flexible methodology. For the qualitative component of the study I will administer a structured set of questions with open-ended responses to probe how subjects incorporate knowledge about HIV/AIDS into their lives.  Age, gender, ethnicity, and education, and how respondents became aware of HIV/AIDS are the variables for this study.  The population of interest includes men and women of various ages and ethnicities.  The sampling frame will consist of men and women categorized ages 18-25 and 26 and up.  Furthermore their education high school or at least some college will classify participants. 

Respondents will be questioned in person and on paper as well as via email and instant messenger about their degree of HIV/AIDS awareness and knowledge about its implications.  Respondents were selected at random to meet my quota of ten.   Each member of the population has an equal chance of being included in the sample if he or she has agreed to participate in the study by cooperative instant messaging, telephone communication, or by personal encounter, and their phone numbers or email addresses are available to me.

Conveyance sampling was also used to recruit respondents who were easily accessible.  The sampling frame is non-representative in that it does not include numbers of elements in the same proportions as they occur in the general population.  Interviews were evaluated to discover trends and themes that are supported by the literature.

             The importance of accounting for advantages and disadvantages of the methods exist as well.   Limitations to this study include respondent reluctance to respond sincerely to questions concerning due to the position of the interviewer.  These shortcomings were overcome by recognizing the limitations and accounting for potential and existing biases. 

            The use of ten structured interviews may eliminate the unreliability that may arise from the researcher’s observation or from the respondents’ interpretations of the questions if I used fewer interviews for comparison.  Thus, the use of the ten interviews partially resolves unreliability by providing supplementation for the probable weakness that accompanies verbal and written questioning (Babbie 2001).  Other advantages of the methodology include the opportunity to draw further conclusion from established primary data sources and test the validity by making comparisons to similar research and to the questions constructed for the current study.

    

Bibliography

Anderson, John E., Kann, Laura, Holtzman, Deborah, Arday, Susan, Truman, Ben,

Kolbe, Lloyd.  HIV/AIDS Knowledge and Sexual Behavior Among High School

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Babbie, Earl.  2001.  The Practice of Social Research.  9^th edition.  Belmont, California:

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Binswanger, Hans P.  2000.  Scaling Up HIV/AIDS Programs to national Coverage.

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Bond, Patrick.  2000.  A Political Economy of South African AIDS

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Caldwell, John C.  2000.  Rethinking the AIDS Epidemic.

Collymore, Yvette.  2002.  Universal Education Seen as Crucial in AIDS Fight.

Creswell, John W.  1995.  Qualitative Inquiry and Research Design.  Sage Publications.

Divison of AIDS/HIV Prevalence.  2001.  HIV prevalence Trends in Selected

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Flick, Uwe.  1998.  Qualitative Research: Relevance, History, Features.

Goliber, Thomas.  2002.  Background to the HIV/AIDS Epidemic in SUB-Saharan Africa.

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HIV/AIDS Among African Americans.  February 2005.  Available at:

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HIV/AIDS Pandemic.

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Appendix A- Proposed Time Line

Review of relevant literature on AIDS/HIV awareness –December 2004

Interview respondents – January 2006

Write up – January 2005

Analysis and conclusion – February 2006

Appendix B- Interview Questions

1.      Do you remember when you first learned about HIV/AIDS?  What or who first informed you about HIV/AIDS?

2.      Under what conditions did you learn about the disease?  Were you sexually active at the time or did you learn about it before you became active?

3.      Who were you with when you found out about the disease?  How did you feel when you first heard about it? 

4.      How seriously did you take HIV/AIDS at the time?  When did you start to take HIV/AIDS seriously?  Why?

5.      When were you first aware of the implications of the disease?  How did the implications impact your life and your choices?

6.      Did your sexual behavior change because of your knowledge of HIV/AIDS?  How did it change?  Under what conditions did it change?

7.      Will your lifestyle change in the future because of your knowledge of HIV/AIDS?

8.      Have you ever been tested for HIV/AIDS?  If yes, what led you to be tested?  If no, what factors account for you not having the test?

9.      Do you ask or inform your partners of your HIV/AIDS status?

10.  Are you male or female?

11.  What is your education level?

12.  How old are you?

13.  What is your race/ethnicity?