Class Notes (806,888)
Canada (492,503)
Anthropology (1,560)
ANTC68H3 (58)
R Song (25)


7 Pages
Unlock Document

University of Toronto Scarborough
R Song

ANCT68: Deconstructing Epidemics Lecture 8: HIV/AIDS The Third Epidemiological Transition: Disease Emergence  CDC: Emerging infectious diseases are those infections that appeared recently in a population, or those that already existed but are spreading rapidly, in terms of both incidence and geographical distribution (Grisotti and Avila-Pires 2010)  Grmek (1993) substituted the idea of emergence for that of novelty and proposed five distinct historical instances for the recognition of emergence and novelty 1. It existed before being recognized, but escaped medical attention because it went unrecognized as a nosological (medically classified disease) entity of its own 2. It existed, but was only detected after a qualitative and quantitative alteration of its characteristics made it noticeable (pathogen evolution) 3. It was introduced in a region where it did not occur previously, i.e., due to war, migration, population movements 4. The emergence of a disease acquired from a non-human reservoir (zoonoses) 5. A new disease emerges and spreads, when the causal agent or the necessary environmental conditions for its occurrence did not exist before the first clinical observations identified its presence; also possibly as a result of laboratory manipulation of pathogenic organisms intended for research, biological warfare, or genetic engineering of agricultural products (Grisotti and Avila-Pires 2010) 6. In addition to the categories proposed by the CDC and by Grmek, Grisotti and Avila-Pires (2010) add the role of under-notification of those conditions presented by official lists of diseases subjected to compulsory notification, and also the failure to recognize and notify uncommon diseases o “Under-notification is at the basis of many emergent diseases. These cases occur and are diagnosed, but doctors and health authorities ignore or fail to report them.” (Grisotti and Avila-Pires 2010: 68) Anthropogenesis of Disease Emergence Ultimate Causes of Disease Emergence Social / Political / Economic Factors HIV/AIDS  HIV: lentivirus, member of retrovirus family; 2 main groups composed of 5 different viral “families”: HIV-1 (M – 95% global cases, N, O types) and HIV-2 (A and B), largely confined to West Africa  Producing defects in immune system: loss of lymphocytes, impairment of T cells  Subclinical infection with endemic diseases that tend to activate the immune system (eg, TB, malaria) appear to accelerate its expression  Results in opportunistic infections, pneumocystis pneumonia, Kaposi’s sarcoma, cytomegalovirus, yeast infections, cervical cancer, TB, etc.  Success due to: 1) Virus’ ability to use cell’s protein-synthesizing abilities to generate new viruses 2) Extensive variability in its genetic structure (helping to evade detection and destruction by immune system)  “Risk” Groups: homosexual men, intravenous drug users, prostitutes, women (& children), TB patients, prisoners, the impoverished Anthropogenesis of Disease Emergence  Prolonged contact with humans and other animals such as monkeys  Mutated virus with zoonotic origin  Over time became a virus of HIV and SIV  Emerged due to sustainable “Virgin field” Epidemic  80s virgin field epidemic where low exposure to it  Everyone was potentially affected by it  Disease emerged in area where there was no prior exposure to the disease WHO 2012:  60 million people infected with HIV since early 1980s  30 million have died  Africa is the most affected, where 1.9 million people acquired HIV in 2010  2/3 of 2007 global total of 33 million people w/ HIV  3/4 of all AIDS deaths in 2007  Note: great variation as well: < 2% adult prevalence in several West and Central African countries and horn of Africa; other countries: > 5%, >15%; highest in Swaziland: 26% in 2006  30-50% of Africans dying with AIDS also co-infected with TB (Quinn 2001)  Toll: human health, economic, political, strategic  Has led to life span in some countries < 40 years The HIV/TB Syndemic  HIV leads to: 1) Increased susceptibility to TB 2) Reactivation of latent TB 3) Acceleration of active TB Behavioural Factors (proximate factors listed here)  Sexual practices and attitudes  Beliefs re: contraception (condom use)  Intravenous drug use  Medical incompetence (misuse of needles, contaminated blood products, poor screening)  Ultimate Factors? --> POVERTY HIV, Urbanization and Poverty (Baer et al. 2003)  Risk factor for HIV: inner city environment - poverty  Overpopulation, crowding, poor infrastructure, crime, violence, drug/alcohol use, prostitution / sex trafficking, limited education, poor nutrition, stress, employment instability, lack of social support  Higher risk for “ethnic minorities”  “Inner-city syndemic”: factors not independent of each other but are closely intertwined and collectively enhancing  AIDS itself is an opportunistic disease o Take advantage of socialistic issues War, Violence and HIV  Displacement  Homelessness  Child soldiers  Rape as a weapon of war People on the Move  Transport workers  Miners  Soldiers  Domestic workers  Farm workers  Salesmen  Prostitutes  Job seekers  Other (poor) migrants  International travel & tourism The Blood Industry and Medical Malpractice  Blood donations: US - $$ for blood  Inadequate screening of donated blood for transfusions, hemophiliacs  Re-use of needles for immunization (e.g., Africa, mid 20th century +) Pharmaceutical Development  Drug development and prohibitive costs (until 2001)  1996: ARV/HAART, US$10,000-15,000 per person per yr  2000-2001: generics introduced, changing the playing field The Stigma of Poverty and “Compliance”  “erratic noncompliers”  “live in the present”  Screening for compliance  “wasted efforts”… AIDS: “Acquired Income Deficiency Syndrome” HIV and Poverty • Structural Violence : o Gender Inequality o Racism o Poverty • Differences in distribution of disease and outcome • “Appropriate” therapies, compliance and multi-drug resistance…. access to health care / medicines and the role of pharmaceutical companies, governments HIV and Women • Historically, the HIV/AIDS epidemic has affected more men than women, but the gap has quickly closed • Since 1985 the proportion of estimated AIDS cases diagnosed among women has more than tripled, from 8% in 1985 to 27% in 2005 • At the end of 2008, women accounted for 50% of all adults living with HIV worldwide (UN) • If new infections continue at their current rate worldwide, women with HIV may soon outnumber men w/ HIV HIV-AIDS and Women • Women increasingly vulnerable due to subordinate position in many societies • Low sexual autonomy/control • Higher impoverishment rate • Women, as the more marginalized sex in many societies, may be less likely to seek treatment (NB: important role of stigma) • Biologically: women decline faster than men; are contracting HIV at younger ages; have different opportunistic infections; and not all drugs work equally well for women compared to men • Added burden of preventing vertical transmission to fetus • Face more challenges re: prioritizing their needs vs. family’s Women and HIV • Patriarchal societies: male dominated; much of Africa, Asia, Central/South America, Europe, among other places • Women are a subordinate group who are expected to bear children, care for family members and fulfill the sexual desires of their husbands without question • Forced marriages and child brides • “Patriarchal terrorism”: systematic domestic violence against women by male partners (Johnson 1995); often
More Less

Related notes for ANTC68H3

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.