The history of HIV/AIDs in Haiti and the US are linked. In June 1981, the Centers for Disease Control published a report about cases of pneumocystis pneumonia among homosexual men living in the US. Soon, other cases of rare and opportunistic diseases such as mucosa-associated malignant disease, and Kaposi’s sarcoma were identified in Haitian immigrants (Fuchs & Leven, 2021). The new disease was named Acquired Immune Deficiency Syndrome, with the Human Immunodeficiency Virus (HIV) identified as the causative agent. Scientists suggested that there was a possibility that the virus spread from Haiti to the US, or vice versa (Fuchs & Leven, 2021). As the prevalence of the disease increased, it would become a serious long term health challenge for the two countries, posing serious long term psychological, social and economic consequences. In this paper, the writer will examine HIV/AIDs in the two countries, consequences of not addressing the health challenge, and the social determinants of health that impact HIV/AIDs.
HIV/AIDs in Haiti
Haiti, which is located in the Caribbean, has one of the highest prevalence of HIV/AIDs in the region. The prevalence of the disease is estimated to be around 2% in the general population. The number of infected people has remained stable over the past 15 years (Louis, et al., 2020). However, there are differences in distribution of infections. High risks groups such female sex workers (FSWs), and men who have sex with other men (MSM) have higher infection rates. It is estimated that the prevalence is 8.7% and 12.9% for FSWs and MSM populations respectively (Louis, et al., 2020). Commercial sex and unprotected transactional sex activities are the main drivers of new infections in the country. it is estimated that HIV/AIDs accounts for 1,7023 years of life lost in the country (Fene, et al., 2020). The dominant variant of HIV virus in Haiti is the HIV-1 subtype, and has been circulating in the island since the 1960s (Bello, et al., 2019).
Prevention and treatment of HIV/AIDs is critical for the welfare of the Haitians. Higher rates of infection contribute to social, and economic challenges that have the potential to impact the long-term stability of the country. At the family level, HIV.AIDs can have three key consequences. First, HIV-related illnesses lead to the lost of income, if the person who gets infected is the breadwinner. Second, it increases healthcare expenditure, forcing families to divert their resources to healthcare. Third, absenteeism associated with the death of the family member (Dona et al., 2021). When a person is sick, or dies, they can no longer go to work or school. The magnitude of the effect of the disease on family outcomes is dependent on whether a family has community support. In countries such as Haiti, where people living with HIV/AIDs are stigmatized, the likelihood of families receiving such support is low, meaning that most families become more impoverished when one of their members gets infected (Dona et al., 2021). At the community, and country level, death and absenteeism associated with the disease robs the nation the necessary labor force, and collective intelligence it needs to develop.
There are multiple SODH that influence the risk of contracting HIV/AIDs in the country. One of the most important determinants is poverty. Poverty has consistently been identified as a key driver of STI and HIV transmission among vulnerable groups such as women and FSWs. Over 60% of people in Haiti live below the poverty line (Rosenberg, et al., 2019). The prevalence rates of HIV/AIDs tend to be higher among people with low income, relative to those with high incomes. There are two plausible explanations for this phenomenon. First, low income means that people who live in poverty lack sufficient financial resources to access HIV/AIDs treatment and prevention programs, HIV testing, and condoms (Rosenberg, et al., 2019). The second explanation is that partners who are overdependent on their own partners lack the power to negotiate for safe sex, as they fear of losing the economic stability provided by their partners (Rosenberg, et al., 2019).
The second determinant is education, or education attainment. People who have lower educational attainment are at a higher risk of contracting HIV/AIDs. Individuals who are educated are likely to be aware of transmission pathways of HIV/AIDs and take preventive measures. Additionally, education increases empathy and tolerance to individuals who contract the disease, reducing stigma and discrimination, which are the main reasons why people fail to seek education. Education also reduces economic vulnerability especially in vulnerable communities such as women and children. low educational attainment is correlated with poverty, and low incomes, which increase vulnerability, and risk of HIV infection. People with low incomes are less likely to access preventive care relative to those with high incomes.
HIV/AIDS in the US
The prevalence of HIV/AIDs is lower in the US relative to Haiti. Recent estimates suggests that 1.1 million people in the US are living with HIV/AIDs -which represents only 0.4 percent of the population. In comparison, the prevalence rate in Haiti is 2.0%. While the most vulnerable groups in Haiti are MSM and FSWs, the most vulnerable groups in the US are African Americans and MSM (Laurencin et al., 2018). It is estimated that while African Americans make up only 12% of the US population, they accounted for 44% of the new HIV diagnoses in 2016 alone. The diagnosis rate for African American males was 38.8 per 100,000 people compared to a diagnosis rate of 10.6 per 100,000 people for male whites (Laurencin et al., 2018). MSM population accounted for 66% of all infections in 2016, despite making up less than 2% of the population (Avert, 2019). It is important to note that MSM population includes African Americans, whites, and other racial and ethnic minorities.
The low prevalence of HIV/AIDs in the US relative to Haiti can be attributed to multiple factors. First, the US has a better and more responsive healthcare system compared to Haiti. There is better access to care in the US, which means that people can be able to access preventive and curative care for HIV/AIDs. For example, the drop in incidence of perinatal HIV infections since 1992 can be attributed to routine prenatal HIV screening, and use of effective therapies to prevent perinatal HIV transmission (USPSTF, 2019). Second, higher awareness levels, due to higher educational attainment. Third, people in the US have more disposable incomes, which means that they are more capable of paying for HIV/AIDs testing, condoms, and antiretroviral drugs. Lastly, the US government is one of the most important financiers of HIV prevention programs, meaning that access to these awareness programs is higher in the US than in Haiti (Avert, 2019).
The two most important SODHs in relation to HIV/AIDs risk in the US are racial discrimination, and socioeconomic status. Racism is simply the assignment of differential access to resources, opportunities and power, which advantages one group to the detriment of others (Stanley et al., 2019). Racial discrimination in the US is highly correlated with high HIV infection rates in racial minorities, as it impedes their access to healthcare, and financial resources that could reduce the risk of infection (Laurencin et al., 2018). For example, African Americans tend to live in residential segregated areas, which are characterized by poor access to healthcare services. Racial minorities in these segregated areas are less likely to receive any HIV testing and treatment, which contributes to high community viral load, and consequently higher transmission rates (Laurencin et al., 2018). Socioeconomic status also correlates with HIV diagnosis. Without sufficient financial resources, people from low-income households are unlikely to access the preventive care they need to reduce their risk of infection (Laurencin et al., 2018). Furthermore, the concentration of low-income households in specific geographical areas contributes to high community viral load that makes these communities infection hotbeds.
The proposed interventions comprise of an education component, and distribution of HIV/AID self-testing kits in community centers in the two countries. The education component will comprise of education sessions with community leaders in respective countries on how HIV is transmitted, ways of preventing infection (condom used, and Pre-exposure prophylaxis), and some of the strategies they can use to reduce risky sexual behavior. These local leaders will be tasked with raising awareness in their respective communities. Using national data, the researcher will identify communities, or residential areas with higher prevalence rates and target these areas. The intervention team will also develop leaflets and other educational materials, such as brochures to be distributed to the target communities.
The second component of the intervention is distribution of HIV/AIDs self-testing kits. In areas with high HIV/AIDs prevalence, testing is a critical entry point for antiretroviral based HIV prevention and management (Dehne et al., 2016). These kits will be distributed by community agencies in the two countries, including hospitals and pharmacies. Systematic reviews of the efficacy and safety of self-testing kits show that the kits are not only safe, but also increase testing levels in communities (Jamil, et al., 2021; Johnson, et al., 2017). The key differences in distribution of these kits in the two countries is that in the US, the distribution will be conducted through pharmacies, and hospital facilities, while in Haiti, they will be distributed through community health centers, and non-governmental agencies operating in the country.
HIV/AIDs remain a significant challenge for both Haiti and the US. However, the prevalence of the disease in Haiti is higher, with poverty, stigma, and low access to healthcare increasing the vulnerability of Haitians to the health, social, and economic implications of the disease. The two most important SODH for HIV/AIDs in Haiti are educational attainment, and poverty. We hypothesized that poverty reduces available financial resources for preventive and curative HIV/AID care. On the other hand, low educational attainment decreases awareness of HIV prevention, and increases economic vulnerability. In the US, poverty, and racial discrimination are the major contributing factors for high prevalence of HIV/AIDs among racial minorities in the country. Since prevention is critical, the paper proposes educational of people in communities with high prevalence of the condition, and distribution of self-testing kits as a pathway to antiretroviral prevention and treatment.
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