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HLTC05H3 Study Guide - Final Guide: Aids, Syndemic, Millennium Challenge Corporation


Department
Health Studies
Course Code
HLTC05H3
Professor
R Song
Study Guide
Final

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Questions from class discussions during Week 9: HIV/AIDS
1. What are the ultimate factors in HIV infection among Aboriginal Canadian women?
Detail the historical factors - and how they impact health today.
2. Which solutions/interventions can we apply to alleviate the situation?
3. What can we do about the historical "collective trauma" suffered by Aboriginal
communities?
4. How can we make Canadian health inequality (especially regarding Aboriginal
communities) a larger public health priority?
5. How does the geography of Canada play a role in public health measures and
effectiveness?
6. What is "learned helplessness"?
Extra Questions from Lecture/Reading material:
1. Outline the two ways we can view HIV-AIDS from a syndemical perspective.
a. the synergistic interaction of two or more co-existent diseases or health conditions that
result in excess burden of disease
b. •A set of intertwined and mutually enhancing diseases/epidemics involving disease
interactions at the biological level that develop and are sustained in a community because
of harmful social conditions and injurious social connections/relationships (structural
violence)
c. 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)

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d. syndemics at the biological level
i. Co-infection of Hepatitis B virus (HBV) and HIV - a significant example of
biochemical changes produced by one pathogen contributing directly to the harmful
impact of a second pathogen, in this case allowing accelerated replication of the second
agent (see Singer and Clair 2003)
ii. •Recent research indicates that HBV can infect T-lymphocytes, the primary cellular
target of HIV, suggesting that HBV and HIV may come into direct physical contact at
the cellular level in co-infected individuals (see Singer and Clair 2003)
e. syndemics at the sociological level
i. Beyond the notion of disease clustering in a location or population, and processes of
biological synergism among co-dwelling pathogens, the term syndemic points to the
determinant importance of social conditions in the health of individuals and
populations (Singer and Clair 2003)
ii. Impacts of disease co-infection are mediated by individual biology, age, sex, nutritional
status, SES, access to health care
2. Differentiate between proximate and ultimate factors in the spread of HIV.
Behavioural Factors
Sexual practices and attitudes
Beliefs re: contraception (condom use)
Intravenous drug use
Medical incompetence (misuse of needles, contaminated blood products, poor screening)
ultimate factors
structural violence: gender inequality, racism, poverty which creates the differences in the
distribution of disease and outcome
Social stratification has brought us unequal risk for exposure to, and infection by, various
microparasites like HIV
impoverishment: 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
SAPS which led to cutbacks, urban unemployment and impoverishment
Urbanization: Overpopulation, crowding, poor infrastructure, crime, violence, drug/alcohol
use, prostitution / sex trafficking, limited education, poor nutrition, stress, employment
instability, lack of social support
War and Violence: displacement, homelessness, disruption of subsistence patterns, work,
social support systems, child soldiers, rape as a weapon of war
3. According to O’Neil, in what ways did the U.S. facilitate the early spread of HIV?

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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
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
4. What were some key events that led to a slowing of the pandemic?
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
5. Detail the various factors in the spread of HIV among women globally.
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 accompanied by substance abuse (drugs, alcohol); violence is often
primary factor for HIV transmission to
Subordinate role of women can be reinforced by religion
Religious beliefs may also prohibit condom use (birth control) that furthers HIV transmission
from husbands to wives
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