HLTB02_Lecture_10.docx

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Department
Health Studies
Course Code
HLTC23H3
Professor
R Song

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HIV/AIDS and Health March 25, 2012 Global Under 5 Mortality in 2008 (WHO, 2011) HIV/AIDS  Caused by RNA retrovirus of lentivirus family called HIV-1 (global, while 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)  Thought to be some genetic protection, resistance to infection (3 genes)  “Risk” Groups: homosexual men, intravenous drug users, prostitutes, heterosexual women (and children), TB patients, prisoners, impoverished Transmission  Vertical transmission: during pregnancy, labour and delivery, breastfeeding  Blood transfusions  Drug use (contaminated needles)  Sexual transmission (unprotected consensual sex, child rape) Symptoms in kids vary based on phase of infection and age  HIV disease progression more rapid in children*  Failure to thrive (poor weight gain & bone growth)/delayed growth  Failure to reach developmental milestones on time  Fatigue, weight loss  Enlarged lymph nodes, liver and spleen  Mental and motor developmental delays  Opportunistic infections (ear infections, pneumonia, tonsillitis, sinus and throat infections, dermatitis, yeast infections, GI infections / diarrhea, colds, TB)  Nervous system impairments (also, seizures, difficulty walking) HIV leads to: 1. Increased susceptibility to TB 2. Reactivation of latent TB 3. Acceleration of active TB  12-14 million people co-infected with HIV and TB today  250,000 people died with HIV associated with TB in 2006  1% or less people living with HIV were screened for TB in 2006  NOTE: extensively drug-resistant TB increasing globally  Major burden of TB in HIV-infected kids occurs where both diseases are common in adults  African data suggest children comprise 50% of the adult TB incidence  Children reflect recent transmission  High disease rates among HIV-infected kids explained by 2 mechanisms: 1. Increased Mycobacterium TB exposure (esp. parents), and/or 2. Increased vulnerability to develop active TB following infection  IMP of anti-retrovirals (HAART) and TB detection Anti-Retrovirals  Medications for retroviral infections  Different classes of drugs that act on different stages of HIV infection cycle, i.e., protease inhibitors, entry inhibitors, AZT  Highly Active Antiretroviral Therapy (HAART): combination of several (3 or 4) ARVs  Cost is prohibitive for most people and nations  Issue of patented vs. generic drugs  Brazil (Abadia-Barrero & Castro 2006): o High pricing of life-saving anti-retrovirals set by private pharmaceutical companies is the greatest threat to successful local and global responses to AIDS Children under 16 years living with HIV globally, 2010 AIDS: “Acquired Income Deficiency Syndrome” Proximate and Ultimate Factors  Behavioural: sexual practices, attitudes, contraception beliefs, IV drug use and needle misuse, contamination, prostitution and trafficking, leisure and economic travel  Medical incompetence and drug research: poor blood screening, contamination; pharmaceutical patents and drug costs  War and violence: rape as weapon of war, child soldiers; links to poverty – homelessness, displacement, mass migration  Global impoverishment (SAPs, structural inequality) HIV and Poverty  Structural Violence: gender inequality, racism, poverty  Distribution (risk) of disease, treatment, and outcome The Future of HIV  Africa has over 15million children orphaned by AIDS Aids and Orphaned Child Survivors  Depression  Anxiety and worry  Social isolation  Higher internalising of problems  Bullying  Reduced concentration  Shame  Greater self-reporting of somatic illnesses  Less friends  Recurrent nightmares  Unhappiness  Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder  3 main types of symptoms: 1. Re-experiencing the traumatic event 2. Avoiding reminders of the trauma 3. Increased anxiety and emotional arousal Children with Post-Traumatic Stress Disorder exhibit:  Fear of being separated from parent(s)  Losing previously-acquired skills (such as toilet training)  Sleep problems and nightmares without recognizable content  Somber, compulsive play in which themes or aspects of the trauma are repeated  New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)  Acting out the trauma through play, stories, or drawings  Aches and pains with no apparent cause  Irritability and aggression Stigma and HIV  Extreme social disapproval that is “a contextual, historical, and strategically deployed social process that produces and reproduces social inequalities and functions at the point of intersection between culture, power, and difference o (Parker & Aggleton, 2003)” (see Abadia-Barrero and Castro 2006: 1221)  Stigmatization: arises from the perception that there has been a violation of a set of shared attitudes, beliefs, and values o It can lead to prejudicial thoughts, behaviours, and/or actions on the part of governments, communities, employers, health care providers, coworkers, friends and families to the stigmatized  The social construction of AIDS-related stigma has been nurtured by historical components including social fear, ignorance, anxiety, lack of knowledge, denial, shame, taboo, racism, xenophobia, and moral judgments HIV-AIDS and the “Other”  Homosexual men  IV-drug users  Haitians
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