Midterm Flashcards
What does Louis Pasteur mean when he writes that “the virus is nothing, the terrain is everything” in light of this course?
- The virus’s ability to spread depends on much more than just its transmissibility infectiousness but rather depends on a variety of socio-economic- political factors in the location where it is afflicting.
- Evident in South Africa where the crumbling government and sudden movement away from apartheid struck at the same time as the AIDS pandemic and as a result it skyrocketed
- Evident in places where the epidemic was compounded with the crack-cocaine epidemic
- Evident in Suzanne Mulligan’s essays about Freedom Place where there was virtually no method of survival for women that wouldn’t put them at risk of contracting the virus
- In South Africa migrants male workers, lack of condom use, high rates of inequality, poor healthcare and low rates of education compounded
What populations are at particular risk for HIV transmission today (new infections, in what regions) and why? What was the 90-90-90 treatment target for 2020? Did the world community meet it?
- Particular risk: Eastern Europe, central Asia, Middle East, North Africa, Latin America
- “the epidemic is globalizing increasingly rapidly, from West Africa to Eastern Europe, from China and India to the Caribbean and Central America.” – Places with high inequality, high rates of poverty, poor healthcare infrastructure
- In contrast there is more prep in Kenya and South Africa and Nigeria is doing well
- 90% know their status, 90% of those are on ARV, and 90% of those experience viral suppression
- 85-88-92 in 2021
Why does Peter Piot claim AIDS is exceptional? What does he outline in terms of the exceptional response needed?
- No plateau in sight, stigma around diagnosis, decimating the labor force – kills young adults, severity and longevity of the virus
- Poses special challenges to effective public action
- Retrovirus – extremely mutagenic and difficult to develop a vaccine or treatment for, long gestation period
- Exceptional Response:
- Responsible guidance/real leadership – activism across sectors, across countries
- Expanding peoples rights and fundamental freedoms and reducing inequalities of all kinds
- Adequate financing – debt relief
- Exceptional implementation- Donors and host countries work together to shape a more effective and coordinated response
What relevant points of similarity and difference can you identify as you compare the HIV/AIDS and COVID-19 pandemics?
Similarities:
* Rampant spread of mis-information
* Disproportionally impacts minority and low income populations
* Heavily politicized, masks and gays
* Stigma – Asians and gays
Differences:
* Immediate response to COVID, affecting everyone from the offset, HIV not as immediate of a response
* Transmission different
* HIV has higher death rate for infected individuals
How has COVID-19 been a “tragedy and teacher,” according to the authors we have read? What social and cultural factors have exacerbated the spread of COVID-19? What ethical assumptions or ideologies have abetted its spread?
Tragedy and Teacher
* More visibility of social/ethical issues: crowded housing, essential workers, health care inequalities, chronic health conditions, education, misinformation, spotlight on mental health, telehealth/online education/ work from home capability
* Zoom
* Women’s issues
* Revealed how individualistic our society is
* Fragile medical system, burden on nurses
Social and Cultural Factors, Ethical Assumptions/Ideologies
* US exceptionalism
* Individualism
* Structural issues – infrastructure
* Resilience in healthcare
* Economic and gender inequalities
Based on his assigned texts and the presentation by Shaun Slusarski, how does the monkeypox epidemic compare with the HIV/AIDS epidemic? In what ways does stigma surrounding HIV/AIDS (both in the early days of the epidemic and today) relate to stigma surrounding monkeypox today?
Monkey pox compared to AIDS
- Not a sexually transmitted disease, but primarily transmitted sexually
- Vaccine in existence, but not available to everyone
- Lots of fear surrounding its spread and transmission
- Painful, scarring lesions produced by both viruses
- Monkeypox is not a lifelong illness, quarantine period is long however
- Monkeypox is not deadly like HIV
Monkeypox – primarily affects gay community, stigma surrounding
- Shaun discussed how discourse on stigma may serve the needs of the LGBTQ community in the case of monkeypox, but I don’t think that this was the same in the HIV epidemic
- Stigma causes isolation, affect who is heard, limits research
- Catholic belief that Monkeypox is retribution for homosexual sin
What is social sin, and what particular social sins are relevant to the ethics HIV/AIDS?
Dimensions of social sin
- Unjust structures – structures of ideology (patriarchy)
- Harmful ideologies – attitudes/ideologies (androcentrism, sexism)
Particular Social Sins
- homophobia, racism, sins of omission (failure to love)
What interdisciplinary dimensions of stigma are relevant to HIV/AIDS in Gillian Patterson’s view, and how?
- Medical Perspective – as long as it remains untreatable stigma remains entrenched
- Goffman’s Stigma – attributes are what is physically present, stereotypes are socially constructed
- Sectarianism – demonizing an outside group so there is an ingroup and outgroup
- Meaning of Purity – contagion as taboo and pollutes the group
- Stigma and Power – groups with power more likely to put others down
What physiological, social, cultural and economic factors heighten women’s susceptibility to HIV contraction and how? Which factors would you classify as social sins and why?
- Less agency to demand protection
- Less access to education
- <18 denied access/age of consent
- Stigma surrounding testing
- Receiving partner more likely to receive transmission of the virus
- Caretaking role
- Survival sex, sex work, sugar daddies
- Gender based violence
- Women have less economic power/resources
- Harmful social norms, needing permission from partner – irrationality, double standards about appearance, high expectations of purity
Social Sins:
Patriarchy (ruling of the father), androcentrism (male-centered), misogyny
Are you convinced by the claims in the Higuera case analysis that some circumstances (exceptional) warrant disclosing HIV status or violating confidentiality? Why/why not? What arguments and criteria are given? What might be unintended consequences?
Yes, I do agree that some exceptional circumstances warrant disclosing HIV status to one’s partner. Prevents the suffering and death of a large number of people that would result from maintaining the confidentiality of persons who refuse to disclose their HIV status.
Unintended consequences are it is a slippery slope: people may be less likely to go to doctors. Fewer people would be willing to present themselves for HIV testing, and therefore fewer people would receive crucial guidance about reducing the risk of transmission.
Fundamental problem of the conflict between the respect of the liberty and the autonomy of the patient and the professional duty to defend the health of third parties (the partner) and of the community
Confidentiality is not an absolute which imposes law without exceptions but instead it imposes limits that stem from the fact that there is a social dimension to health which is no less important than the personal dimension
Constantino vs Pastoral agent
How is poverty both a cause and a consequence of AIDS in African contexts, in particular?
- Cause – mining town, survival sex work, don’t have the ability to use condoms, women in situations where they are at risk of being sexually abused, reduced access to healthcare and ARVs
- Once infected with AIDS – stigma, discrimination, poverty, fewer economic opportunities
- Aid industries – how are resources even provided, problematic dimensions for international aid
What does “The Body of Christ has AIDS” (or the church has AIDS) signify? How have Christian churches been part of both the problem and the solution (according to Farley, Dowling, Hinga)?
– It is a metaphor , calling on the church as body of Christ to follow the example of Jesus’s mission towards those who were suffering, sick and marginalized.
– powerful tool from which to call upon churches to engage in a Christian response to people whose lifes are infected and affected by HIV.
– the Catholic Church in Southern Africa is doing more to combat the spread of AIDS and help HIV-positive people and AIDS sufferers than any nongovernmental organization.
The Church continues to condemn advocating the use of condoms as a prevention of the spread of AIDS.
- Aggregious and creative interpretation of Christianity
- Not completely inclusive
- Church has historically been a source of strength in the past but in recent years certain sterotypes, attitudes and gay stigma created a culture of silence with destructive effects
- The woman in the documentary who contracted HIV from her husband was supported by the church, but her husband was likely encouraged to maintain his silence by the church
What U.S. law had the single greatest impact on the HIV epidemic’s spread and why? How did US “incarcerate its social problems” in the late 1980s? How did changes in nature of mating game increase straight/heterosexual women’s vulnerability to HIV?
- Drug Paraphernalia Law – caused people to share needles
- Incarcerated its social problems: arrested people rather than helping them get treatment
- Incarceration changed the dating pool, women less agency
- Treating an addiction as a criminal issue rather than a health concern
- Because of social issues of poverty and inequality African Americans did not have a general sense of agency to set the circumstances in their life, Coercive effect
What does Amartya Sen mean by “basic freedom” (as cited by Mulligan), and what is its relevance for HIV susceptibility?
A really purely individual perspective on freedom – where to eat lunch
Basic freedom is freedom from coercion, in many cases people don’t have basic freedom
Musa Dube characterizes the nature of Jesus’ public ministry as “prophetic.” What evidence does she offer from his practices and from scriptural texts to describe the scope of his prophetic ministry? What does she suggest are concrete implications for a prophetic Christian response to HIV/AIDS?
Jesus stood against social injustice
- Stood with the outliers in society, relates to HIV/AIDS
- Must stand in solidarity with
- Healing examples in the gospel
- Marginalized groups – lepers, poor women and children
- Need to question authorities and structures that put these individuals in, able and welcome to question oppressive structures
- Jesus flipping over the tables at the temples
- Prophetic traditions
- Jesus sided with marginalized groups, there are consequences for disruptive stances
