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Health Studies
Rhan- Ju Song

HLTC05: Social Determinants of Health Lecture 9 –HIV/AIDS and the Global System (Baer et al. 2003a; O’Neil 2006a and Case Study TBA) Tuesday, November 6, 2012 HIV/AIDS  Caused by 3 types of RNA retrovirus of lentivirus family called HIV (HIV-0, HIV-1 [global] and HIV-2 [localized 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 WHO 2012  60 million people infected with HIV since early 1980s  30 million have died  high mortality rate o We have been able to control the rates of infections since the late 1990s Figures  stabilizing maintain the disease due to retrovirals  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 Future of HIV  Africa has over 14 million AIDS orphans  Social consequence: grandparents take care of grandchildren  Diseases of poverty: TB and HIV o Causes the most morbidity, mortality o Can become pandemic The Syndemic of HIV-AIDS 1) Syndemical co-infection with TB  Two diseases 2) Syndemical relationship of infectious disease with social environment and social relationships: the interaction of microparasitism (HIV virus) and macroparasitism (preying on humans by other humans) (Baer et al. 2003) o Interaction with social factors can maintain itself o Praying on marginalized and vulnerable group  Social stratification has brought us unequal risk for exposure to, and infection by, various microparasites like HIV Anthropogenesis of Disease Emergence  Emergent  HIV  Recent due to human cultures/ human made  Re-emergence  TB Behavioural Factors  Sexual practices and attitudes  Beliefs re: contraception (condom use)  Intravenous drug use  contamination of material (such as needles)  Medical incompetence (misuse of needles, contaminated blood products, poor screening)  Ultimate Factors? AIDS, the US and the World System (O’Nell, 2006)  Early spread of AIDS in US: due to government indifference/ obstructionism, delayed and paltry funding, media disinterest, failed leadership at all levels of government and public health (see Shilts 1987)  Reagan Revolution: budget cuts to National Institutes of Health, CDC, other public health agencies  Also: infighting within multilateral agencies (esp. UN), early silence of AIDS activists, priority spending (incl. African countries) on arms rather than HIV prevention, global racist views of Africa (as beyond help)  Indifference to a disease perceived as “gay plague”  Widespread Ignorance, fear, prejudice, rejection Stemming the Tide: Key Events  Growing awareness as disease associated with blood transfusions (not sexual behaviours)  Death of Rock Hudson in 1985  1986: J. Mann, WHO and Global Program on AIDS  1996-introduction of HAART (highly active antiretroviral therapy) helped to expose the inequity of the disease  By 1998: US assumed greater global leadership in tackling HIV-AIDS, including research funding  With Bush: greater funding and public visibility of the disease; was first to pledge major grant to the Global Fund (global AIDS research) and increased US foreign aid by 50% through Millennium Challenge Account; PEPFAR, 5 year, $15 billion pledge to combat AIDS in Africa and Caribbean (prevention, treatment) – aided by reduced price of drugs  Role of musician Bono important in guaranteeing US’ greater foreign aid and debt relief for poor countries AIDS: “Acquired Income Deficiency Syndrome” o Disease of low income  Lack of socio-pol-economic voice Impoverishment  One of the most significant factors in maintaining infectious disease rates among humans  Impacts nutrition (and immunological integrity), shelter (protection from elements), access to health care, sanitation, soc-pol-econ power  Overall: increased susceptibility to environmental (physical, cultural) stressors  THUS: one of the greatest determinants of human adaptability and health today HIV and Poverty  Structural Violence: gender inequality, racism, poverty  Differences in distribution of disease and outcome SAPs, National Impoverishment and HIV  Structural Adjustment Programs (SAPs) refer back to previous lecture for more detail  Imposed by the international financial institutions (IMF, World Bank) as a condition for further borrowing & development  SAP measures included devaluation, debt reimbursement, market “liberalization”, privatization, government cutbacks  Cutbacks: agricultural and health services, education and social programs ….social support safety net  Urban unemployment and impoverishment increased  Many poor people lost their land to transnational firms that paid very low wages  Deepening poverty brought mass social dislocations, hunger, disease, and further suffering HIV, Urbanization, and Poverty (Baer et al., 2003)  Risk factor for HIV: inner city environment –poverty  urban city with low SES: o Overpopulation o Crowding o Poor infrastructure o Crime, violence o Drug/alcohol use o Prostitution / sex trafficking o Limited education
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