RESEARCH PROPSAL CORRECTIONS

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Literature Review: HIV and Gender

National University

COH 611

December 4, 2022

Literature Review: HIV and Gender

Gender is one of the factors that influence exposure to illnesses. Women in most societies are at the periphery and thus face the most discrimination. This section provides a literature review on the relationship between HIV and gender, focusing on stigma and discrimination, psychosocial pressures, and prevalence.

HIV and gender: Stigma and Discrimination

Researchers in different parts of the world have studied how HIV and gender are related. Zinyemba et al. examined the effects of HIV on school attendance among boys and girls (Zinyemba et al., 2021). The study was done in Zimbabwe. Women are disproportionately affected by different illnesses in society compared to men, and the researchers aimed to validate whether girls were most concerned with HIV. The participants were between 6 and 18 years, taken from a nationally representative sample comprising of approximately 11,673 children (Zinyemba et al., 2021). The collected data from the survey wereas analyzed using the decomposition linear multivariate analysis. The results indicated a significant difference in school attendance for boys and girls infected with HIV (Zinyemba et al., 2021). HIV-positive girls were most affected by being HIV positive. Therefore, this study shows that HIV-positive females are more marginalized than their male counterparts. Comment by Austin Porter: This is a good summary! Comment by Austin Porter: cite

Zimbabwe is a low-income country; ideally, it would be expected that these disparities between gender and HIV manifest. In response, researchers have also delved into HIV and gender discrimination in liberal countries (Magno et al., 2019). Magno et al. systematically reviewed different articles to evaluate the correlation between bias associated with gender identity and how it affected exposure to HIV/AIDS (Magno et al., 2019). Further, the researchers aimed to identify which policies could be implemented to reduce higher exposure of some gender to HIV and AIDS. The researchers used five articles, including PubMed, Scopus, Web of Science, Science Direct, and LILACS, published between 2004 and 2018.

Similar to the findings by Zinyemba et al., the researchers found that women and transgender were more exposed to discrimination within the family and public spaces (Zinyemba et al., 2021; Magno et al., 2019). Transgender women in liberal countries such as Japan and the United States faced discrimination in schooling and public spaces. Others found it difficult to reveal their gender identity due to the stigma they encountered due to their gender. With pervasive discrimination, access to healthcare also became a crucial issue for women and transgender women. Consequently, it was difficult for transgender women to access HIV treatment and services in their communities. Comment by Austin Porter: There is no need to compare the results from other studies. There is a place for that and the literature review is not the place. Comment by Austin Porter: cite

Further, transgender women hardly accessed testing and counseling services for the general population, unlike the general population (Magno et al., 2019). This systematic review confirmed a positive relationship between gender and HIV. Gender can influence access to testing, treatment and prevention services, and counseling (Magno et al., 2019). Therefore, gender adversely affects exposure to HIV and treatment outcomes.

According to the researcher, HIV-positive individuals face discrimination because of their status. The study was undertaken to determine whether discrimination was real in hospital settings. The number of participants was 400 (Alaqil & Alshouibi, 2019). The researchers found that some dentists had negative attitudes toward people infected with HIV (Alaqil & Alshouibi, 2019). Therefore, the dentistsy had negative attitudes when dealing with HIV-positive patients. Alaqil & Alshouibi also found the presence of stigma in dental services (Alaqil & Alshouibi, 2019). Mahamboro et al., also found discrimination in healthcare facilities (Mahamboro et al., 2020). Women were more frequently subjected to moral judgment than men. Thus, most studies are consistent that while men and women may experience discrimination for being HIV-positive, the level of discrimination among females is higher. Comment by Austin Porter: New study, new paragraph.

HIV and Gender: Psychosocial Pressures

HIV is associated with a sense of fear. It is one of the infections that can lead to moral judgment by part of society where people do not have enough education about the disease. Further, because of the nature of the virus and the experiences infected persons endure, there are higher risks of psychosocial pressure. These psychosocial issues disproportionately affect women, men, and transgender and gender-diverse people. Researchers have found a positive correlation between gender and exposure to numerous infections, including HIV (Kalateh Sadati et al., 2018; Newcomb et al., 2019). Kalateh Sadati et al., aimed to determine the psychosocial encounters of women infected with HIV and AIDS (Kalateh Sadati et al., 2018). Thiseir study was necessitated by the fact that women were most vulnerable to various forms of discrimination than their male counterparts (Kalateh Sadati et al., 2018). The study incorporated ten Iranian women who were HIV-positive. The study was qualitative, and the researchers collected information from participants using focus groups. Data analysis was accomplished using conventional data analysis methods. The authors’ findings were similar to Magno et al., because, their content analysis revealed that women encountered discrimination, stigma, and self-stigma (Kalateh Sadati et al., 2018; Magno et al., 2019). Not only was discrimination among women manifest in their homes, but it was also revealed in the health sector, where health workers stigmatized the women (Kalateh Sadati et al., 2018). The study is consistent with other findings that HIV-positive men and women experience different societal vulnerabilities. Comment by Austin Porter: Why is this study cited? Comment by Austin Porter: Cite these sentences Comment by Austin Porter: Noooo, don’t compare other studies. Please remove this throughout...remember, only stick with the study you are summarizing.

Newcomb et al., study focused mainly on Transgender and Gender Diverse people (TGD) (Newcomb et al., 2019). The authors’ study objective was to determine the health issues that affected transgender youths and young adults. In addition, the study intended to categorize the health issues the groups were facing (Newcomb et al., 2019). Another objective was to find the relationship between gender-related variables, health issues, and psychosocial variables. The study was longitudinal, with data derived from Chicago. Participants in the study were 1079 with an average age of 20.8 years (Newcomb et al., 2019). One of the findings was that depression and suicidal ideation was high among TDG youths with HIV (Newcomb et al., 2019). Further, some youths resorted to substance abuse to deal with their HIV conditions. Also, TGD people experienced worse health outcomes compared to cisgenders. This study shows that the psychosocial experiences of HIV-infected persons will vary depending on their age and even their surroundings (Newcomb et al., 2019). Psychosocial pressures are more prevalent among people who identify as transgender and diminished in cisgender persons.

In the early years of the HIV outbreak, the rate of infections was unprecedented in many countries. With the virus being novel, many countries grappled with ineffective initiatives and preventative approaches. However, the infection curve has almost flattened in the last few decades, with new infections being lower. Researchers have investigated the epidemiology of HIV and how it varies between genders. In particular, Girum et al., researched the current HIV epidemiology trends among men and women in Ethiopia (Girum et al., 2019). The study objective was to identify whether there were differences in the current infection rate between men and women in Ethiopia. Understanding the infection pattern between men and women would inform government policy-making in Ethiopia. Girum et al., used data from 1990 to 2016 stored in the UNAIDs database. The authors measured the difference in infection trends between men and women using STATA Version II and excel. The researchers’ results showed a difference in infection trends between women and men. First, the analysis highlighted that women contributed to approximately sixty percent of new infections from 1990 to 2016. In addition, the authors’ data showed that women were 1.62 times more likely to be infected with HIV than male (Girum et al., 2018). These findings emerged despite the tremendous efforts put in place by the Ethiopian government to lower the spread of HIV. There was a remarkable reduction in infections for both women and men. Also, access to healthcare has improved among both genders. However, women were still more vulnerable to HIV than men (Girum et al., 2018). This trend in new infections also reveals a need for new public policies to support access to HIV awareness programs among women. Comment by Austin Porter: cite Comment by Austin Porter: Cite.

HIV prevalence among different Genders Comment by Austin Porter: Why is there a new sub heading for the same study? One paragraph per study.

Girum et al., used data from 1990 to 2016 stored in the UNAIDs database. The authors measured the difference in infection trends between men and women using STATA Version II and excel. The researchers’ results showed a difference in infection trends between women and men. First, the analysis highlighted that women contributed to approximately sixty percent of new infections from 1990 to 2016. In addition, the authors’ data showed that women were 1.62 times more likely to be infected with HIV than male (Girum et al., 2018). These findings emerged despite the tremendous efforts put in place by the Ethiopian government to lower the spread of HIV. There was a remarkable reduction in infections for both women and men. Also, access to healthcare has improved among both genders. However, women were still more vulnerable to HIV than men (Girum et al., 2018). This trend in new infections also reveals a need for new public policies to support access to HIV awareness programs among women.

Besides women and men, researchers have also provided studies on HIV prevalence among transgender people. Radix et al., investigated the relationship between different sexual orientations and the prevalence of HIV (Radix et al., 2022). The study’s objective was to identify the nature of the relationship between gender and gender. Further, the researchers explored the effects of socio-demographic factors on HIV prevalence among the participants. Radix et al. reviewed various charts and manuals from the Transgender Data Project with the approval of IRB. Five hundred and seventy-seven participants were included in the study. The HIV prevalence among the trans-masculine gender was high compared to the general population (Radix et al., 2022). The study’s findings were consistent with Girum et al., who found that HIV prevalence varied between genders (Radix et al., 2022; Girum et al., 2018).

Becasen et al., did a similar study to determine the prevalence of HIV among transgender Americans living in the United States (Becasen et al., 2019). The study methodology was a systematic review, and the goal was to find the prevalence of HIV infection by gender. Findings from 88eighty-eight studies showed that while HIV prevalence was 9.2% among the general population, it was higher among trans-women and trans-men (Becasen et al., 2019). These findings are also consistent with Radix et al., on the prevalence of HIV among transgender (Becasen et al., 2019; Radix et al., 2019). Comment by Austin Porter: cite Comment by Austin Porter: What is "it?" Comment by Austin Porter: What are the implications from THIS study as it relates to your research question?

Researchers also have done similar studies in South Africa to determine the prevalence of HIV based on race. The authors used the 2012 population survey data collected in South Africa (Mabaso et al., 2019). The study aimed to group HIV prevalence based on race and other social factors such as race. After data analysis, the researchers found a positive relationship between HIV and race. Black females and males were at higher HIV risk compared to other races. However, unlike other studies (Radix et al., 2019 Girum et al., 2018), this study highlighted that South African males were at higher risk of HIV than females (Mabaso et al., 2019). These unique findings show that HIV gender prevalence may vary according to specific contexts. In other words, while women are more vulnerable in most countries than men, there are some situations where HIV infection rates could be high among men. Comment by Austin Porter: Cite these sentences

Literature Summary

In summary, HIV and gender are interconnected. There are many relationships that associate gender with HIV status. In developing countries like Zimbabwe, HIV-positive girls may face barriers to attending school when they are HIV-positive. Also, women and transgender persons (trans-women and trans-men) are more exposed to discrimination when HIV-positive than men. When looking from the perspective of risk factors, women are exposed to most factors like poverty and lower educational attainment, which makes them vulnerable to HIV. Healthcare stakeholders must implement gender-specific policies that can address the issue of HIV prevalence.

References

Alaqil, F., & Alshouibi, E. (2019). HIV-related discrimination among senior dental students in Jeddah. Journal of International Society of Preventive and Community Dentistry, 9(3), 219. https://doi.org/10.4103/jispcd.jispcd_420_18

Becasen, J. S., Denard, C. L., Mullins, M. M., Higa, D. H., & Sipe, T. A. (2019). Estimating the prevalence of HIV and sexual behaviors among the US transgender population: A systematic review and meta-analysis, 2006–2017. American Journal of Public Health, 109(1). https://doi.org/10.2105/ajph.2018.304727

Girum, T., Wasie, A., Lentiro, K., Muktar, E., Shumbej, T., Difer, M., Shegaze, M., & Worku, A. (2018). Gender disparity in epidemiological trend of HIV/AIDS infection and treatment in Ethiopia. Archives of Public Health, 76(1). https://doi.org/10.1186/s13690-018-0299-8

Kalateh Sadati, A., Taheri, V., Joulaei, H., & Hemmati, S. (2018). Experience of stigma by women infected with HIV by their husbands: A qualitative study. International Journal of High Risk Behaviors and Addiction, In Press(In Press). https://doi.org/10.5812/ijhrba.69185

Mabaso, M., Makola, L., Naidoo, I., Mlangeni, L. L., Jooste, S., & Simbayi, L. (2019). HIV prevalence in South Africa through gender and racial lenses: Results from the 2012 population-based National Household Survey. International Journal for Equity in Health, 18(1). https://doi.org/10.1186/s12939-019-1055-6

Magno, L., Silva, L. A., Veras, M. A., Pereira-Santos, M., & Dourado, I. (2019). Stigma and discrimination related to gender identity and vulnerability to HIV/AIDS among transgender women: a systematic review. Cadernos De Saúde Pública, 35(4). https://doi.org/10.1590/0102-311x00112718

Mahamboro, D. B., Fauk, N. K., Ward, P. R., Merry, M. S., Siri, T. A., & Mwanri, L. (2020). HIV stigma and moral judgement: Qualitative exploration of the experiences of HIV stigma and discrimination among married men living with HIV in Yogyakarta. International Journal of Environmental Research and Public Health, 17(2), 636. https://doi.org/10.3390/ijerph17020636

Newcomb, M. E., Hill, R., Buehler, K., Ryan, D. T., Whitton, S. W., & Mustanski, B. (2019). High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Archives of Sexual Behavior, 49(2), 645–659. https://doi.org/10.1007/s10508-019-01533-9

Radix, A. E., Larson, E. L., Harris, A. B., & Chiasson, M. A. (2022). HIV prevalence among transmasculine individuals at a New York City Community health centre: A cross‐sectional study. Journal of the International AIDS Society, 25(S5). https://doi.org/10.1002/jia2.25981

Zinyemba, T., Pavlova, M., & Groot, W. (2021). Effects of HIV on gender gaps in school attendance of children in Zimbabwe: A non-linear multivariate decomposition analysis. Education Economics, 29(5), 471–489. https://doi.org/10.1080/09645292.2021.1914000