SOC 2101 CASE STUDY
University of Ottawa
Illness communities have changed the way people view diseases and also helped significantly in addressing misconceptions as well as stigma. Illness communities act as support groups, available both offline and online with the aim of providing necessary support to victims of chronic illnesses. The illness community that will be studied in this case study was the community of people living with HIV. People who are infected with HIV (human immunodeficiency virus) are more susceptible to infections and other disorders because the virus affects the cells that assist the body fight infection. Most typically, it is shared via unprotected sexual contact or by sharing injection equipment with someone who has HIV. AIDS may develop if HIV is not treated (acquired immunodeficiency syndrome). The current paper focuses on several discussion points, including the biological and social characteristics of the community of people living with HIV , and how these characteristics process and influence the treatment of the community, as well as exploring the labelling and identity of the group members. This paper claims that disease characteristics and social characteristics can have an both positive and negative impacts on the treatment of disease groups, including non-optimal medication compliance, poorer visit compliance, increased depression, and a worse overall quality of life in general, requiring that more stakeholders in the healthcare sector work towards educating the public, and not just the community of people living with HIV.
Characteristics of the community of people living with HIV The characteristics of the community of people living with HIV necessitate mentioning of the ways and means of transmission of HIV and the management of this condition. First, HIV is transmitted through three main routes: sexual transmission, blood transmission, and mother-to-child transmission. The primary cause of patient infection through sexual transmission is unprotected sex, a route of transmission that is common in both the heterosexual and LGBTQ communities. In fact, reports from Nelson et al., (2019) indicate that more than 32044 gay, bisexual, and other men who have sex with men (gbMSM) were infected with HIV in 2018, representing about 51.7 percent of individuals living with HIV in Canada. There is also a high risk of contracting HIV during unprotected heterosexual sex, according to the American Centers for Disease Control and prevention (CDC). Having vaginal intercourse with someone who has HIV without the proper use of protection (like condoms or medicine to treat or prevent HIV), can lead to contraction of HIV (Haddad et al., 2019) . The second route of transmission is blood transmission, such as through sharing the same syringe or other drug injection equipment. According to Kapila (2016），HIV can be transferred by intravenous, intramuscular, or subcutaneous injection of contaminated blood. This blood-to-blood transfer can happen through transfusion of infected blood and blood products as well (Kapila, 2016). The third mode of HIV transmission is mother-to-child transmission, which, as the name implies, occurs from mother to baby. According to HIV gov，during pregnancy, delivery, or nursing, an HIV-positive woman might pass the virus to her child (Logie et al., 2018).Next, the treatment of HIV is one of the characteristics that affects the community of people living with HIV, and antiretroviral therapy (ARTs) is the most common treatment for the condition today. According to Okunola (2017), due to the fact that this treatment has significantly decreased the mortality and morbidity associated with this illness, antiretroviral therapy (ART) has become the mainstay in the care of HIV globally.（Okunola，2017）. In summary, the way of transmission and treatment of HIV are the important characteristics that affect the treatment of community of people living with HIV.
Social characteristics of the community of people living with HIV：
Social characteristics can affect the treatment of community of people living with HIV. As I learned in class SOC2101, which focused on the social determinants of health (SDH), the community of people living with HIV is influenced by these very social determinants of health in terms of education, social status, gender, and access to healthcare. The awareness of the community of people living with HIV regarding HIV/AIDS mainly comes from the health knowledge education provided by both governmental and non-governmental institutions. According to international technical guidance on sexuality education, the protective impact of education in lowering vulnerability to poor sexual health outcomes such as HIV, and other sexually transmitted infections, is critical (Kalichman et al., 2009). Education can help prevent uninformed, high-risk behaviors and reduce the risk of HIV transmission, as well as make it possible for those already infected to start treatment.
In addition, the social status of the community of people living with HIV is a major factor influencing their access to treatment. Some people in poor areas do not have enough financial resources to support the expensive treatment costs and therefore give up treatment. According to Tsafack，（2009）in the developing nations, the pandemic spread the fastest. This negative relationship between national wealth and HIV prevalence shows the role that better infrastructure, access to health care, and nutrition appear to play in the disease’s spread. Poverty also has an influence on HIV transmission because it restricts access to health care (Tsafack, 2009).
Furthermore, income is an important factor in the patient’s acceptance of treatment, which is somewhat related to the conflict theory I learned in SOC2101. By Conflict theory emphasizes the inequality of social and health systems, where social resources are limited, but most of the resources are held in the upper social classes, and the upper and lower classes receive and are provided with different levels and types of healthcare. People in the lower income brackets often do not receive adequate attention and treatment when they need medical resources, so inequality in social resources and health systems is one of the social characteristics that affects the access of the community of people living with HIV to treatment. Not only that, but the reasons that influence the community of people living with HIV to accept treatment vary across different social stages. Poverty may hinder access to health care and subsequent treatment in resource-poor nations, whereas issues correlated with poverty, such as addiction or depression, may prevent persons living with HIV from adhering to treatment in resource-rich countries (Jonsen & Stryker, 1993).The next meaningful social characteristic is gender. HIV continues to afflict women and young girls disproportionately over the world, but notably in Sub-Saharan Africa (Temah, 2009.). The unequal social status of men and women also makes it more difficult for women to protect themselves from HIV. Women’s capacity to negotiate condom usage and protect themselves from HIV is often hampered by financial inequities and intimate partner violence in partnerships. Lower access to sexual health services, including HIV testing and treatment, is closely connected to gender inequality in education and social autonomy among women. Despite worldwide agreements to minimize the impacts of gender inequality, there is a need to considerably scale up efforts since social inequalities and violence against women continue to exist across the world (Women, U. N. & UNICEF, 2018).
Finally, the environment and location in which the community of people living with HIV lives are also influential factors in determining their ability to receive effective treatment. The kinds of treatment available to the community of people living with HIV differ from region to region. The developed world has a more comprehensive medical facility system and a more universal medical policy, which allows people to have easy access to medical resources for timely and effective treatment, but people in poor areas are unable to receive effective treatment due to the lack of supporting medical facilities and medical policy, which negatively affects their health. According to Jonsen and Stryker (1993) the first shock of the AIDS pandemic was absorbed by the country’s public health systems—federal, state, and municipal. Since the pandemic has become more concentrated in low-income and minority groups in Canada, however, the public health system has become the major service provider for a significant number of persons living with HIV or AIDS at the local level. Drawing on from the above, the improvement of public facilities has a certain impact on the treatment of the community of people living with HIV. In summary, the discussion demonstrates that social characteristics affect access to treatment in the community of people living with HIV in terms of education, social status, gender, and medical infrastructure.
Labeling/stigmatization/identity of the community of people living with HIVAs time goes by and knowledge becomes more widespread, increasing numbers of people can gain a basic understanding of HIV/AIDS, and the community of people living with HIV and gradually eliminate their prejudices. In a time when knowledge was scarce, people often thought that suffering from AIDS implied gay sex and drug addiction (Garenne, Lydié, & Garenne, 2001). Nevertheless, a phenomenon that has been noticed all around the world： minorities that are marginalized, racially, ethnically, or sexually are all linked to HIV transmission（Kontomanolis et al.，2017).. In addition, the perception or stigma of the HIV community varies from region to region. In some places, people tend to think that the main means of transmission of HIV is the lifestyle of the community of people living with HIV, such as experimenting with risky sexual behaviors or using drugs, so in some areas, even with the knowledge, there is still a deep prejudice against the community of people living with HIV. In South Asia and Sub-Saharan Africa, health-care workers and the general public have similar attitudes against AIDS patients, according to research revealing that 80% of nurses and 90% of doctors discriminate against AIDS patients (Logie et al., 2018). When they talk to the patient or provide treatment, they will physically distance themselves from a them and medical workers’spouses will put pressure on healthcare workers, asking them to stop providing care to their patients. Among them, there is a widespread belief that HIV is only transmitted through sexual activity. Interestingly, while knowing the transmission channels well, the physicians do not appear to truly believe the facts (Ullah, 2011).
In order to quantify how the stigmatization of the community of people living with HIV is nearly uniform across cultures, the AIDS stigma scale was developed based on data collected from HIV patients in Cape Town, Swaziland, South Africa, and Atlanta, USA. Experimental analysis found that these data had some internal consistency and time stability（Kalichman et al.，2009）. These data demonstrate that people with AIDS experience different levels of prejudice and discrimination regardless of their cultural background and location.
Nevertheless, this stigma is completely unfounded. It is often assumed that people with HIV are infected because of homosexual sex or drug use, and such statements undoubtedly label the community of people living with HIV inappropriately. In some areas of severe gender inequality, women have extremely low social status, so they have little right to demand that men take protective measures when they have sex and thus become infected with HIV. In addition, there is more than just sharing syringes as the only method of blood transmission of HIV (Logie et al., 2019). For example, if a patient receives a blood transfusion from a person with HIV/AIDS who has not been properly tested, that patient can also develop HIV, often in areas with poor medical care, and not only that, but according to HIV.gov (2022), HIV can also be transmitted through broken skin, wounds or mucous membranes, so the blood-borne route of HIV does not represent all of the inappropriate behaviors such as drug use. Therefore, those who discriminate against or try to stigmatize the community of people living with HIV are simply applying a perverse label on them and labeling them as abnormal, which is inappropriate and absurd.
The impact of the stigma and discrimination on the treatment for the community of people living with HIV is stark. According to the American Psychological Association (APA), 2010), people living with HIV have emotional and mental health issues as a result of HIV stigma and discrimination. People living with HIV frequently internalise their stigma and develop a bad self-image as a result. Internalized stigma associated with HIV can result in emotions of shame, fear of revelation, loneliness, and despair. People may be hesitant to get tested or treated for HIV as a result of these sentiments (UNAIDS, 2000). Thus, it is clear that stigma and discrimination have severely impacted access to treatment for the community of people living with HIV. Stigma has a negative impact on people’s lives. For persons with HIV, stigma has a detrimental impact on health outcomes including non-optimal medication compliance, poorer visit compliance, increased depression, and a worse overall quality of life in generalStigmatization should therefore be avoided. According to the CDC, we can act in several ways to avoid stigmatizing community of people living with HIV. First, we need to know how to talk about HIV to avoid stigmatization, and people should converse about HIV using supportive words, instead of stigmatizing language. Furthermore, positive and positive actions should be taken towards people with HIV/AIDS, including physical contact such as hugging or shaking hands, thereby correcting the stigmatization of people with HIV/AIDS. Third, the basic knowledge of HIV should be shared as widely as possible, including the facts on how the infection spreads. To sum up, I believe that stigmatization and discrimination have a great impact on the treatment of AIDS patients, and these stigmatization and discrimination views are not correct. We should stop stigmatization and discrimination against AIDS patients through various means.
This paper has analyzed the disease characteristics and social characteristics of community of people living with HIV, as well as how social characteristics affect the treatment of community of people living with HIV. Finally, the harm of stigma and discrimination and its impact on treatment were analyzed, as well as ways to avoid them. The discussion has shown that disease characteristics and social characteristics can have an impact on the treatment of disease groups. The paper has shown that disease characteristics and social characteristics can have an both positive and negative impacts on the treatment of disease groups, including non-optimal medication compliance, poorer visit compliance, increased depression, and a worse overall quality of life in general, requiring that more stakeholders in the healthcare sector work towards educating the public, and not just the community of people living with HIV.
Ahsan Ullah, A. K. M. (2011). HIV/AIDS-related stigma and discrimination: A study of health care providers in Bangladesh. Journal of the International Association of Physicians in AIDS Care, 10(2), 97-104.
American Psychological Association (APA). (2010). HIV/AIDS and Socioeconomic Status. HYPERLINK “https://www.apa.org/pi/ses/resources/publications/hiv-aids” https://www.apa.org/pi/ses/resources/publications/hiv-aids
Centers for disease control and prevention (CDC). (2022). HIV: Ways HIV can be transmitted. HYPERLINK “https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html” https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html
Garenne, M., Lydié, N., & Garenne, M. M. (2001). Gender and AIDS. WHO monograph on Gender Analysis of Health. HYPERLINK “https://www.who.int/gender/documents/GenderAIDS.pdf” https://www.who.int/gender/documents/GenderAIDS.pdf
Haddad, N., Robert, A., Weeks, A., Popovic, N., Siu, W., & Archibald, C. (2019). HIV: HIV in Canada—Surveillance report, 2018. Canada Communicable Disease Report, 45(12), 304.
HIV.GOV. (2022). Preventing Mother-to-Child Transmission of HIV. HYPERLINK “https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-mother-to-child-risk/preventing-mother-to-child-transmission-of-hiv” Preventing Mother-to-Child Transmission of HIV | HIV.gov
Jonsen, A. R., & Stryker, J. E. (1993). The social impact of AIDS in the United States. National Academy Press.
Kalichman, S. C., Simbayi, L. C., Cloete, A., Mthembu, P. P., Mkhonta, R. N., & Ginindza, T. (2009). Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS care, 21(1), 87-93.
Kapila, A., Chaudhary, S., Sharma, R. B., Vashist, H., Sisodia, S. S., & Gupta, A. (2016). A review on: Hiv aids. Indian Journal of Pharmaceutical and Biological Research, 4(3), 69-73.
Kontomanolis, E. N., Michalopoulos, S., Gkasdaris, G., & Fasoulakis, Z. (2017). The social stigma of HIV–AIDS: society’s role. Hiv/aids (Auckland, NZ), 9, 111.
Logie, C. H., Lacombe-Duncan, A., Wang, Y., Kaida, A., Conway, T., Webster, K., … & Loutfy, M. R. (2018). Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada. Journal of acquired immune deficiency syndromes (1999), 77(2), 144.
Logie, C. H., Marcus, N., Wang, Y., Kaida, A., O’Campo, P., Ahmed, U., … & Ogunnaike‐Cooke, S. (2019). A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study. Journal of the international AIDS society, 22(7), e25341.
Nelson, L. E., Tharao, W., Husbands, W., Sa, T., Zhang, N., Kushwaha, S., … & Kaul, R. (2019). The epidemiology of HIV and other sexually transmitted infections in African, Caribbean and Black men in Toronto, Canada. BMC infectious diseases, 19(1), 1-10.
Okunola, O. A. (2017). Antiretroviral Therapy (ART): Evaluation of Art’s Perception among People Living with HIV/AIDS in South Western Nigeria. J AIDS Clin Res, 8(650), 2.
Temah, C. T. (2009). What drives HIV/AIDS epidemic in sub-Saharan Africa?. Revue d’économie du développement, 17(5), 41-70.
UNAIDS. (2000). AIDS and HIV Infection: Information for United Nations Employees and Their Families. HYPERLINK “https://data.unaids.org/publications/irc-pub01/jc306-un-staff-rev1_en.pdf” https://data.unaids.org/publications/irc-pub01/jc306-un-staff-rev1_en.pdf
Women, U. N., & UNICEF. (2018). International technical guidance on sexuality education: an evidence-informed approach. UNESCO Publishing. HYPERLINK “https://www.unfpa.org/sites/default/files/pub-pdf/ITGSE.pdf” https://www.unfpa.org/sites/default/files/pub-pdf/ITGSE.pdf