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      Drinking, Smoking, and Morality: Do ‘Drinkers and Smokers’ Constitute a Stigmatised Stereotype or a Real TB Risk Factor in the Time of HIV/AIDS?

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          Abstract

          This paper follows up an unexpected finding from a community survey that identified drinking and smoking as the most important tuberculosis (TB) risk factor, far ahead of ones commonly associated with TB such as poverty, overcrowded living conditions, and HIV-positive status. It reports perceptions of drinking and smoking from a three-phased study of the stigma associated with TB, consisting of a qualitative pilot study using focus-group discussions (2006), a larger-scale community survey (2007), and follow-up group discussions (2009). The community attitude survey was conducted with a sample of 1,020 adults living in a low-income township in the Eastern Cape Province, South Africa. The study found that the moral and the biomedical understanding of TB risk are intertwined. In the community survey, perceptions of drinking and smoking as TB risk were predicted by fear of contracting TB and being a self-reported born-again Christian. In the follow-up study, heavy drinking and smoking in shebeens (unlicensed township liquor outlets) was associated with a risky lifestyle that can spread both TB and HIV. The paper discusses the similarities and differences in the roles of church and shebeen in providing social support to township dwellers to cope with problems of daily life. It is tentatively concluded that the stereotypical shebeen ‘drinkers and smokers’, alternatively pitied and maligned by moral society, might serve as the scapegoat that deflects pollution from the ‘new’ TB linked to the AIDS epidemic.

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          Most cited references 43

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          Measuring health-related stigma--a literature review.

           Linda Brakel (2006)
          Stigma related to chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, mental illness and epilepsy is a global phenomenon with a severe impact on individuals and their families, and on the effectiveness of public health programmes. To compare stigma measurement in different disciplines, a literature review was conducted. References were obtained through a search of literature databases and through examining relevant bibliographies. Sixty-three papers were selected that addressed the issue of measurement of stigma or related constructs and that contained a sample of the instrument or items used. Five unpublished studies were also included in the review. The aspects of health-related stigma used for assessment can be grouped in five categories. First, the experience of actual discrimination and/or participation restrictions on the part of the person affected; second, attitudes towards the people affected; third, perceived or felt stigma; fourth, self or internalized stigma; and fifth, discriminatory and stigmatizing practices in (health) services, legislation, media and educational materials. Within each of these areas, different research methods have been used, including questionnaires, qualitative methods, indicators and scales. The characteristics of the instruments considered most promising are described and compared. The purpose of stigma assessment is to increase our understanding of stigma and its determinants and dynamics, to determine its extent or severity in a given setting or target group and to monitor changes in stigma over time. The conclusions from this review are that (a) the consequences of stigma are remarkably similar in different health conditions, cultures and public health programmes; (b) many instruments have been developed to assess the intensity and qualities of stigma, but often these have been condition-specific; and (c) development of generic instruments to assess health-related stigma may be possible. To achieve this aim, existing instruments should be further validated, developed or adapted for generic use, where possible.
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            Social inequalities and emerging infectious diseases.

             P S Farmer (1996)
            Although many who study emerging infections subscribe to social-production-of-disease theories, few have examined the contribution of social inequalities to disease emergence. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Outbreaks of Ebola, AIDS, and tuberculosis suggest that models of disease emergence need to be dynamic, systemic, and critical. Such models--which strive to incorporate change and complexity, and are global yet alive to local variation--are critical of facile claims of causality, particularly those that scant the pathogenic roles of social inequalities. Critical perspectives on emerging infections ask how large-scale social forces influence unequally positioned individuals in increasingly interconnected populations; a critical epistemology of emerging infectious diseases asks what features of disease emergence are obscured by dominant analytic frameworks. Research questions stemming from such a reexamination of disease emergence would demand close collaboration between basic scientists, clinicians, and the social scientists and epidemiologists who adopt such perspectives.
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              The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies.

              To summarize the association between alcohol use and human immunodeficiency virus (HIV) infection based on studies conducted in Africa, EMBASE and PubMed were searched for African studies that related alcohol use to HIV infection. Meta-analyses were conducted to obtain pooled univariate and multivariate relative risk estimates. Subgroup analyses were performed for studies having different sample types: males or females and population-based or high-risk, and ones that differentiated between problem and asymptomatic drinkers. Alcohol drinkers were more apt to be HIV+ than nondrinkers. The pooled unadjusted odds ratio (OR) from 20 studies was 1.70 (95% confidence interval, CI = 1.45-1.99). Results from 11 studies that adjusted for other risk factors produced a pooled risk estimate of 1.57 (95% CI = 1.42-1.72). Males and females had similar risk estimates, while studies involving high-risk samples tended to report larger pooled odds ratios than studies of the general population. When compared with nondrinkers, the pooled estimates of HIV risk were 1.57 (95% CI = 1.33-1.86) for non-problem drinkers versus 2.04 (95% CI = 1.61-2.58) for problem drinkers, a statistically significant difference (z = 2.08, P <0.04). Alcohol use was associated with HIV infection in Africa and alcohol-related interventions might help reduce further expansion of the epidemic.
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                Author and article information

                Contributors
                v.moller@ru.ac.za
                Journal
                Soc Indic Res
                Soc Indic Res
                Social Indicators Research
                Springer Netherlands (Dordrecht )
                0303-8300
                1573-0921
                7 November 2009
                2010
                : 98
                : 2
                : 217-238
                Affiliations
                GRID grid.91354.3a, Institute of Social and Economic Research, , Rhodes University, ; Grahamstown, South Africa
                Article
                9546
                10.1007/s11205-009-9546-2
                7088702
                © Springer Science+Business Media B.V. 2009

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                © Springer Science+Business Media B.V. 2010

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