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Health Studies
R Song

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) 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? • 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 • Women infected with HIV may have more difficulty accessing health care, due to lack of $$, lack of transportation, or the added responsibility of caring for family members or • ♀ frequently stigmatized as vectors of HIV transmission, despite overwhelming evidence to the contrary • In Malawi, the term for a sexually transmitted disease, regardless of its origin, is "woman's disease“ • In many parts of Africa, men call STDs 'battle scars‘ (an honour for men, but stigmatizing for women) • In several countries, “free women,” living without male protection, have been scapegoated, rounded up and deported to rural areas where they were unable to make a living or were even imprisoned and raped • Women whose HIV/AIDS was known or suspected have been evicted from homes & deprived of livelihoods & kids • Some, accused as witches in deaths of husband or kids, have been killed …. thus fear of testing 6. What is “pharmaceutical colonialism”? • • Questions from class discussions during Week 10: Gendered Health Disparity 1. Why is higher education a risk factor for greater violence among Aboriginal women in Canada? • • 2. What has been implemented in Canada to address gender equality? • • 3. Is Canada gender equal? Yes, or no, what is the evidence? • • 4. Who is responsible for perpetuating gender stereotypes? (re: roles of males/females)? • • 5. What core components need to be implemented to achieve gender equity? • Education, training, skills development • Empowering women politically • Community-based projects Educating women and girls about their rights • • Educating men and boys about the contributions and roles of women and girls in society, their role in female subordination, the overall societal benefits of gender equity, and how they can • Gender “mainstreaming” in governments and institutions: integration of a gender perspective at all levels, e.g., Division of Gender Equality (Sweden), Gender Unit (WHO), UNIFEM (UN) • Correcting gender bias in family law (re: divorce, support, property) • Laws re: equal opportunity, pay equity, reproductive rights, domestic violence, harassment • Including women’s economic contribution (re: household work, care, voluntary work) in national accounts – to make women’s economic contribution more visible 6. Could we consider gender inequality a cultural construction (considering it is usually defined according to economic roles/contributions)? • • 7. In what ways does employment equity lead to gender equity? • Safe, secure and fairly paid work (accounting for real and current cost of healthy living) for men and women, year-round work opportunities, healthy work-life balance • benefits: • financial security (eradicate poverty), social status (alleviate social inequities), • • personal development, social relations and self-esteem, • protection from physical and psychosocial (work-related stress) hazards... enhance opportunities for health and well-being Extra Questions from Lecture/Reading material: 1. Why should we be concerned that women today represent approximately half of the global burden of HIV/AIDS (and slightly higher rates in some parts, i.e., sub-Saharan Africa)? Consider the historical pattern of the pandemic. a. 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 with HIV b. This was a result of patriarchal societies where 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 (e.g. 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 c. Women infected with HIV may have more difficulty accessing health care, due to lack of $ $, lack of transportation, or the added responsibility of caring for family members 2. Outline the various ways gender can be an important determinant of health. • is interlinked with biological and other social determinants (access to social and economic capital, geopolitical environment, cultural values, racism, ageism) (Spitzer 2005) • Relationship b/w health outcomes and social hierarchy (wealth-health gradient) is more linear in predicting men’s health, while association to women’s health is more complex (Matthews et al. 1999) • “Relationship b/w gender inequities and health is seldom static and intersects with factors such as ethnicity, sexuality, age and disability in dynamic and complex ways” (Spitzer 2005: S78) - gender roles are historically contingent, and the roles and relations can change throughout one’s lifetime and can influence access to health resources • biological perspective • Variation in growth and development • Variation in nutritional requirements • Different reproductive changes / health conditions • Maternal requirements as childbearers: nutrition, health, etc. • Differences with aging (hormonal, menopause, etc.), e.g., later adult bone mineral density (biology & social factors) Sex differences in treatment success, morbidity (severity, progression, symptom • manifestation) and mortality risk • sociological perspective • Patriarchy : a social system in which males are the primary authority figure in social organization; power is held by adult men; fathers hold authority over women, children, and all property. It entails female subordination: being in a lower position or social status, with less power and rights. Property and title are inherited by males only. Patriarchy is manifest in the social, legal, political, and economic organization of many different cultures 3. What is the “gender paradox”? • Females will, on average, live longer than males (by approx. 5 yrs), but females more likely to experience those years as unhealthy ones (Spitzer 2005) • 11% women vs. 4% men suffer from chronic conditions • Diagnosed more often with conditions like MS, lupus, migraines, hypothyroidism and chronic pain (Spitzer 2005) • Life expectancy disparity is mostly due to higher rates of accidents and injuries leading to excess mortality among men (masculinity, risk-taking, valour) 4. Which proximate, ultimate and historical factors can explain the rate of female Aboriginal HIV (compared to other groups) in Canada? • women: 50% of newly diagnosed HIV cases among Aboriginal people vs. 20% of newly diagnosed non-Aboriginal HIV cases • proximate: women: IDU, heterosexual sex 5. Consider the various solutions to reduce gender inequality worldwide. • Affordable housing • Employment equity (pay and opportunities) • Family friendly policies (childcare, flexible hours, parental leave) • Assistance for rural women, new immigrants • Programs re: sexual and reproductive health, partner violence • Better access to nutrition education/programs • Gender-sensitive health care • Address inequities that lead male partners to resort to substance abuse, depression & violence • Having a legislative environment that protects and promotes gender equity: legislative reforms, repealing discriminatory laws, developing and implementing laws and regulations that protect and promote equity, harmonizing legislation with human rights treaties (WHO 2005, 2008) • Legislature regarding equal property and inheritanc
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