HSCI 431 Lecture Notes - Lecture 2: Deeper Understanding, Paternalism, Condom
24 May 2018
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WEEK 2: SOCIAL AND ST‘UCTU‘AL FACTO‘S SHAPING
VULNE‘ABILITY TO HIV/AIDS
Basic infectious disease epidemiology:
R0 = BCD
BD = HIV treatment
BC =HIV prevention
Contextual influences that affect health and wellbeing?
T‘ADI TIONAL ‘I SK FA CTO‘ EPIDEMIOLOGY
Ex. Blood transfusions (method of transition)
INDIVIDUAL LEVEL: HIV risk behaviour (ex. Unprotected sex, syringe sharing) → HIV Infection
Risk behaviours involved → taught to stay safe to avoid risk of HIV
LIMITAITONS OF TRANSITIONAL EPIDEMIOLOGY
1.Tends to ignore underlying social + structural determinants of HIV/AIDS vulnerability
• HIV incidence in 2014 (89% non-aboriginal and 11% indigenous) → Canadian Pop. (96% non-aboriginal and 4% aboriginal)
o Aboriginals are isolated and have fewer opportunities to seek health care
o Intergenerational trauma with severe mental health consequences (high rate of substance and drug abuse) → range of
health inequities (need culturally safe methods to implement)
o Need deeper understanding of history, culture and context to change risk of HIV in a population.
2. fosters interventions focused solely on individual-level yet individual behaviour change is known to be insufficient for long-term,
sustainable improvements
• Paternalistic approach → change individual behaviour (continues in individual-level clinical interactions) but it is not
sufficient as an approach to the HIV epidemic
• Be sensitive as a health care provider to environment, history, culture etc.
SOCIAL EPIDEMIOLOGY OF HIV
Social factors:
• Social capital
• Cultural context
• Neighborhood effect (social/physical environment, socioeconomic factors)
• Social networks (network dynamics, sexual network)
Individual factors:
• Behaviour (partner selection, condom use, sexual practice)
find more resources at oneclass.com
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Document Summary
Risk behaviours involved taught to stay safe to avoid risk of hiv. Paternalistic approach change individual behaviour (continues in individual-level clinical interactions) but it is not sufficient as an approach to the hiv epidemic: be sensitive as a health care provider to environment, history, culture etc. Cultural context: neighborhood effect (social/physical environment, socioeconomic factors) Individual factors: behaviour (partner selection, condom use, sexual practice) Legal structures (laws, law enforcement) hiv disclosure of status. Cultural context: war and militarization, demographic change, neighborhood effect (social/physical environment, socioeconomic factors, behaviour (partner selection, condom use, sexual practice) Socioeconomic position (income, education, occupation) *social and structural factor. Broken windows and t he risk of gonorrhea. Poverty, discrimination, lack of access to social supports where disease is clustering: researchers aimed at using indicators of disadvantaged (broken windows symbolic for disadvantaged) Idea that certain populations have overlapping epidemics that cluster in certain areas of high disadvantage. Social disadvantage leads to disease and health disparities.
