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Lecture 7

ANT204H1 Lecture 7: ANT110409

Course Code
Leslie Jermyn

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How do populations become vulnerable to HIV in the first place – Social Determinants of
Health as structural determinants of health (infrastructural)
Haiti’s a wonderful example, considering how long people have been intervening with
the country.
So, What causes AIDS?
HIV infection –> immune system is attacked (a regular occurrence), but is less
able to keep up with the lost T-Cells.
AIDS = Infected with HIV, Low CD4 (T-cell) count and you need to have
several other opportunistic infections. Occurs once you reach a certain
tipping point.
With AIDS, your body is unable to fight off any new infections, you become
incredibly sick, and this inevitably leads to death.
In the US the use of antiretrovirals has prevented it from developing into
AIDS. The number of those who have it is
There has been about a 25% increase in Canada of HIV, but the death rate
has remained the same.
In Subsaharan Africa, we find increasing infection and increasing deaths.
So what’s the difference between the two countries, considering
It’s not inevitable to descend to death with HIV here and in the United States. It is, in
Subsaharan Africa.
Access to medicines
Access to health providers
Access to food (you need calories to keep your immune system working)
The same thing exists in going from AIDS to death. All of these other factors
massively increase your vulnerability.
So who is most vulnerable?
Women – why would women be more susceptible than men? Men are more
promiscuous…women are victims of sexual assault.
Mother-to-child transmission
Injection drug users
BUT…why are these populations vulnerable?
oPolitical marginalization (Disempowerment)
oLack of education
oEconomic situation
oSocial status

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oSurvival strategies
o(in Canada, the Aboriginal populations have greatly increased prevalence)
Some of these structures make populations vulnerable to infection.
The fact of being infected with HIV has a reciprocal relationship with the social and
structural factors –
AIDS causes you to become sicker and sicker – you spend an enormous
amount of your resources on the drugs (staying alive takes first priority) ->
you are put into a lower socioeconomic class…as you go further downhill, the
more you are unable to work, the more you enter absolute poverty
Class circumstances (for the increasingly capitalist world)
Age, gender, race, ethnicity
Living Conditions
Socialization experience
3: Life Choices: How you are socialized in these structures provides you different
outcomes on your life choices (agency)
Life Chances: Structural constraints and probabilities for the outcomes that are
5: Dispositions to Act (habitus)
6: Practices (habitus)
7: Alcohol Use, Smoking, Diet, Exercise, Checkups, Seatbelts, etc. (in a
medicalized system, this is where we focus)
It is, however, far more important to think upstream, about the particular
societal structures that define this
8: Health lifestyles
As you reach a certain level of per capita income, life expectancy increases equally
so: note that this is not linear, but tapers off at around $10,000.
One of the conclusions: “Poverty is bad for you”
Haiti has a few structural problems:
High under-five mortality rate (123/1000), high maternal mortality rate
(520/100,000), under 50% have access to improved sanitation, 28% have
access to improved water sources, 50% are undernourished, mean life
expectancy is under 50 years, 75-80% live below the poverty line, and GDP is
1,860 per capita.
Class Circumstances
Age, Gender, Race/Ethnicity
Living Conditions
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