HIV prevention: it’s not that easy Flashcards
why is prevention not so easy?
Many social, biological and economic factors converge to cause barriers and challenges that complicate HIV/AIDS treatment and prevention in rural areas. Some crucial factors such as poverty and lack of HIV prevention infrastructure result in lower outreach and access to these services.
quick question before we go further, is treatment and testing a part of prevention?
yes it is! here’s why:
We must understand that when dealing with HIV, treatment and testing are themselves forms of prevention. Since HIV positive people take quite some time to recognise their disease as the symptoms also take a while to develop, they can be disease carriers and can potentially transmit the infection to other people. Therefore, we also need to look into factors that prevent people from getting adequate access to antiretroviral treatments, testing venues etc..
social factors pt 1
here’s the clue:
multiple partners
based on prior knowledge, how do you think this^ can be a barrier to HIV prevention?
- Multiple sexual partnerships are characterized by early sexual activities, greater lifetime partners, more frequent coitus (sexual intercourse), and unprotected coitus.
- Having multiple partners, both homosexual and heterosexual, allows the virus to spread more widely.
- This is because you don’t know whether or not your partner is HIV-positive, because they could be. The more sexual partners you have, the more your odds of catching HIV go up.
- Recent studies have found a very strong relationship between people who have had more than one sexual partner and those living with HIV. Individuals with multiple sexual partners are more likely to be HIV positive.
social factors pt 2
this one’s interesting…
the clue is: concurrency
let’s start by understanding what this term refers to in this context
Concurrent sexual partnerships describe situations in which an individual has overlapping sexual relationships with more than one person.
They can be contrasted with serial monogamy, when an individual has a sexual relationship with only one partner, with no overlap in time with subsequent partners.
social factors pt 2.1
so how does this affect HIV prevention?
Researchers suggested that concurrent relationships can increase the size of an HIV epidemic, the speed at which it infects a population and its persistence within a population.
In other words, as soon as one person in the network of concurrent relationship contracts HIV, then other people in the network are at risk (the chances are only low if condoms are used).
social factors pt 3
the thing with HIV is, intervention at various levels is required in order to maximise the effects of prevention and cure.
and this means, intervention in people’s personal lives is also necessary; so that we understand what keeps driving this seemingly never ending epidemic/pandemic.
basically, let’s talk relationships.
Relationship instability caused by economic stress, stigma, discrimination, domestic violence, migration, and incarceration also contribute to sexual partner mixing patterns that foster HIV transmission.
social factors pt 4.1
the clue for this one is:
pride month! 🌈
how simply being a part of the LGBTQIA+ community excludes you from having access to preventive services?
- Dealing with the potential consequences of bias and discrimination – job loss, homelessness, lack of healthcare insurance – often results in LGBTQ people engaging in behaviors that facilitate the spread of HIV.
- For example, in the face of persistent employment discrimination, many transgender women are left with few other options but to engage in survival sex work in order to meet their most basic needs. According to a 2015 survey of more than 27,000 transgender people, “The rate of HIV [diagnosis] was…five times higher! among those who have participated in sex work at any point in their lifetime than among those who have not.”
to be continued…(having too much info on one thing can overwhelm the mind)
social factors pt 4.2
how does simply being a part of the LGBTQIA+ community exclude you from access to preventive services? pt 2
- Anti-LGBTQ bias further enables the spread of HIV by discouraging many in our community from getting tested or treated for HIV for fear of harassment. A 2014 Kaiser Family Foundation survey of gay and bisexual men in the U.S. found that 15% of them had received poor treatment from a medical professional as a result of their sexual orientation, and least 30% did not feel comfortable discussing their sexual behaviors with a healthcare provider.
this is a big deal, here’s why:
- Simply put, if they are discouraged from getting tested or treated for HIV, they will act as disease carriers and potentially reduce the effectiveness of other prevention strategies by unknowningly transmitting HIV to quite a few people in the process.
- Moreover, if they continue to face discrimination and are victims of violence they may turn to usage of drugs and alcohol consumption for not only earning some sort of income but also as a coping mechanism, this in turn would increase the likelihood of contracting HIV as explained earlier.
social factors pt 4.3
how does simply being a part of the LGBTQIA+ community exclude you from access to preventive services? pt 3
hang in there, we’re at the climax!
- On a macroeconomic level, in countries wherein homophobia, transphobia, biphobia and anti-LGBTQIA+ behavior prevails, it is often seen that prevention infrastructure is underfunded and thus the quality of these services falls which further reduces the effectiveness of these strategies.
- Yet the percentage of young men who have sex with men who are able to access cheap condoms, information about how to prevent HIV and other sexually transmitted infections (STIs), HIV and STI treatment is extremely low.
these conditions are similar for people of colour, migrant workers and below subsistence income people.
social factors pt 5
someone once said, “HIV/AIDS is an epidemic of the underprivileged, marginalised, and discriminated” and this couldn’t have been more true
despite the progression of time, we’ve struggled to progress in reducing the gender disparities in the healthcare system.
Gender differences also exist in access to quality HIV care.
Studies show that women with HIV are more likely to attend outpatient appointments than are men (National Health Disparities Report, 2007).
Conversely, women living with HIV were found to be less likely to receive antiretroviral therapy. This discrepancy may reflect men entering into care earlier in the HIV disease process and therefore being afforded more opportunities for early treatment.
The observed gender differences also intersect with race and ethnicity. Women of color suffer disproportionately from poverty in America, with lower literacy and lack of economic opportunities manifesting in delayed entry to care and poorer adherence to health improving behaviors.
social factors pt 6
next up is…alcoholism!
we sure do have a lot to talk on for this one ^^
fun fact: amethyst and dionise (named after the greek god of wine “Dionysus”) were sobering stones which meant they were thought to help prevent intoxication from alcohol.
Alcohol consumption is not only a social, but also a biological factor that reduces the effectiveness of prevention strategies. Let’s look at a few ways it does this:
- Acute and chronic alcohol use, as well as consumption of alcohol in venues such as bars/nightclubs and shebeens (for adolescent drinking) leads to increased chances of risky sexual behaviour, like unprotected sex with multiple partners which influence the incidence of the infection.
- People who indulge in consumption of alcohol may also be involved in taking drugs for example heroin that’s injected in order to be consumed and thus it directly increases risk of exposure to HIV.
- Alcohol like other drugs is a tool for sexual coercion which also increases risk of HIV infection. For example, Stockman and colleagues (2009) reported that women who had been sexually coerced by use of alcohol and other drugs had a 1.5 times higher risk of having multiple sex partners than women who had not been coerced using drugs.
biological factors pt 1
we’re starting this segment with the very factor we ended the previous one: alcoholism
so how does alcoholism act as a biological factor?
clue: vaccination
As mentioned earlier, alcohol is also a biological factor as it hinders the success of emerging biomedical prevention strategies.
💉 One such approach is vaccination, and many researchers are looking for an HIV vaccine. Should such a vaccine prove effective, however, alcohol use may interfere with the person’s immunological response to the vaccination. A similar effect of alcohol abuse already has been reported in response to vaccination against the hepatitis B virus (HBV) (Hagedorn et al. 2010).
💉 Moreover, drinkers often are less connected to the health care system and therefore may be less likely to initiate vaccination.
🔬Alcohol use may delay willingness to be tested for HIV, increasing the likelihood that infection will only be detected after serious HIV-related disease develops or when it progresses to AIDS and therefore the chances of them being disease carriers increases.
biological factors pt 2
this one’s literally on our minds all day recently.
clue: quarantine
* yep it’s the one and hopefully only COVID-19*
fun fact: a new word was coined called ‘blursday’ which basically refers to the weakening sense of time when so many days bleed into each other.
People living with HIV are at greater risk of developing more severe disease if infected with COVID-19. Lockdowns and other social distancing measures are affecting the ability of those with HIV to access vital health services services. As of the end of October, nearly 20% of countries were still experiencing high levels of disruption in services that deliver prevention, testing, and treatment support for people living with HIV.
In terms of statistics, it’s beyond deadly the consequences:
if health systems collapse or treatment and prevention services are interrupted, the death toll from HIV, TB, malaria, and other diseases could exceed deaths from COVID-19 itself. A six-month disruption of antiretroviral therapy due to COVID-19 could lead to more than 500,000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa.
biological factors pt 3
STIs, genital ulcers and male circumcision
how do these help or worsen HIV susceptibility?
Co-occurring sexually transmitted infections (STI), especially those that degrade mucous linings and cause genital ulcers, are also critical determinants of both HIV infectiousness and susceptibility.
Studies show that the probability of HIV transmission during a single act of vaginal intercourse increases more than five times when there is a co-occurring genital ulcer disease (Boily et al., 2009).
Conversely, male circumcision removes infectable cells in the penile foreskin and reduces HIV transmission by as much as half.
economic factors pt 1
when we consider barriers that reduce effectiveness of prevention strategies, not only is accessibility a problem, but also affordability.
let’s see how poverty, high cost and sparse finances act as barriers
- Economic status has long been recognized as an important structural driver of the HIV epidemic . Although the relationship between poverty and HIV is not linear, economic factors are linked to HIV risk behaviors, as well as outcomes at all stages of the HIV care and treatment.
- Simply put, cost of HIV treatment can be unaffordable for people who live on low incomes, especially if they are uninsured and unable to qualify for Medicaid. Rural communities may not be able to sustain important services, such as public transportation and homeless shelters, due to sparse finances.
lastly, the very important one:
………..
anyway credits to brainspace for this relatively less boring platform, and…..for sharing HIV
