Category: HIV

The following essay will define global health, identity, and examine the global health challenge of Human Immunodeficiency Virus (HIV) and Acquire Immunodeficiency Syndrome in South African (S/A) and the impact globally. Furthermore, it will analyse relevant health data of total death and the Disability-Adjusted life years (DALYs) due to HIV and AIDS globally, S/A and the United Kingdom (UK). Moreover, the present outstanding global policies and initiatives established to address HIV and AIDS within the two countries will be discussed and evaluated. The collaborative public health services, organisations and charities that worked in partnership to address HIV and AIDS, health inequalities, the determinant of health globally S/A and UK will be identified, discussed, and analysed. Finally, the role of the future nurse, health promotion models applied to tackle this challenge will be critically analysed and discussed using an evidence-based guideline and the overall conclusion.

Global health is a study that prioritises people’s health, to promotes health equity, minimise the spread of diseases and illness and ensure that individual has access to resources that will improve health and well-being (Crips, 2016). The importance of global health to the future nurse is to acquire effective knowledge that is required to deliver a culturally competent standard care and promote individual health and well-being in a globalised world.

South African is a developing country located in Sub-Sahara African with an estimated population of 56,668.602. HIV and AIDS is the leading cause of death in South Africa. It is a virus that weakens the white blood cells of the immune system to become vulnerable to sexually infected diseases (STI) and when proper medical treatment is not provided it will be developed to AIDS. ( HIV.Org, 2020). According to the Institute of Health Metric and Evaluation (2018), there is an estimation of total DALYs of 2.18% and death of 1.71% caused by HIV and AIDS across all aged group globally. DALYs is the total number of years an individual lived with disability from a specific disease and the total number of years lost in death in relates to the diseases (Hagell & Cheung, 2019).

In South African total DALYS of 30.6% and death of 28.46% was due to HIV and AIDS in the overall population. However, young adult between age 15 to 49 years is at most risk of HIV transmission because of a total DALYs of 46. 34% and death of 58.95%. Whilst total DALYs of 50.26% and death of 67.19% was recorded on females in the same age group (WHO, 2020; IHME, 2018). These statistics indicated that South Africa suffered from the global burden of diseases and the trend on the prevalence of HIV and AIDS remains high because of health inequalities, unequal right and intimate partner violence against women (Frade & De Wet-Billings, 2019). However, the UK is a developed country with an estimated population of 66.7 million (ONS, 2019). In 2017, there was a total DALYs of 0.1% and death of 0.043% of male and female due to HIV and AIDS. Though, the ages of 15 to 49 were total DALYs of 0.23% and 0.56% death (IHME,2018). According to Public Health England (2018), an estimation of 92% of 102,000 people living with HIV in the UK in 2017 was diagnosed, 98% of people diagnosed received treatment while 97% of those treated was virally suppressed. This reveals that the UK has attained above the UNAIDS 90:90:90 targets.

HIV and AIDS Policies are a legal framework established to improve the success of treatment and minimise HIV and STI transmission (CDC, 2020). Prevention of Mother to Child Transmission (PMTCT) is a global policy Fast-Track- Target 90-90-90 by United Nation for AIDS (UNAIDS) to minimise infection and eradicate HIV and AIDS by 2030. This meas=ns that if the target is achieved HIV and AIDS will no longer be a global threat. PMTCT policy aims were to encourage HIV infected mothers to use contraceptive pills and prevent unwanted pregnancy. Also, to provide immediate ART to pregnant and breastfeeding mothers that will prevent HIV transmission during childbearing and support them throughout the antenatal and postnatal period (WHO, 2010). The policy was target mostly at Sub-Sahara African countries because of the high mortality rate of the women and infants in a result of HIV transmission. In 2014, 90% of HIV testing was delivered to women in the southern and eastern part of Sub- Sahara Africa. Whilst above 80% of them living in the 21 global plan countries receives ART from the first antenatal check. This was to improve the health of an estimated 1.2 million babies that are vulnerable to HIV infection. Moreover, 51% of babies received HIV testing at 2 months old (WHO, 2015).

Nevertheless, PMTCT encountered several challenges during its achievement as many women withdraw from the ART after childbirth. Thus was because of the distance between health facilities and insufficient finance. Another reason was out of stigma and fear of disclosing sexual status to their partners (Knettel et al., 2018). Alhough, Van Lettow et al (2014), suggested that Women that was referred from antenatal check to ART clinics programmes with follow up are more likely to have greater postnatal care to compare to those that enrolled on ART from the first antenatal check. Therefore, utilising a standard approach to monitor and report patient’s continuation in treatment is very effective to identify unauthorised move of a patient within the health care settings (Jones et al., 2019). Hence, scarcity of HIV test kits, Antiretroviral drugs (ARV), the death of women in care and poor infant care services in Africa countries are more likely to increase the risk of HIV transmission to babies and patient’s inconsistency in care. However, an up to date record of stock in and stock out of HIV diagnosis materials will facilitate supply. While quick adoption of the orphans is effective measures to solve these challenges (Cawley et al., 2017 ).

HIV testing is the first important step to access treatment and prevent transmission of HIV infection. For this reason, the Department of Health South Africa introduced National HIV Testing Services Policy and Guidelines (2015). The policy goals are to utilise a comprehensive approach by working in collaboration with various health care services such as hospitals, local clinics, community centres, home visit and reached to target population. Thereby, reduce 50% of HIV transmission through HIV testing, deliver 80% of ARV, provide 70% continuous treatment and minimise 50% of stigma and discrimination among those living with HIV and AIDS (SDPH, 2015). Young adult leaners were educated to use a condo and avoid unprotected sex, early sexual activity, uptake HIV testing and treatment services (NDH, 2015). In 2017, 90% of people living with HIV in South Africa were aware of their HIV status (UNAIDS). However, Strauss et al., (2015) research, discovered that ignorance of HIV testing, stigma, discrimination from peers and families and fear of been HIV positive tested were the barriers encountered in the uptake of HIV testing. Secondly, lack of financial support, far distance to health facilities, long waiting in the queue and operating hours could affect classroom lessons and individual desire to attend HIV testing. Although to increase demand for HIV testing, people need to be enlightening about HIV testing and provided with emotional support to speak out of HIV status to their sexual partner. Moreover, delivering free HIV testing at mobile station facilities and introducing a multi-tasked strategy that could address the shortage of health care workers, promote confidentiality, high performance and flexible operating hours of health facilities could increase the number of HIV testing (Simukai, 2019).

Introduction

Diseases that are known to be communicable are infectious diseases that results from growth of pathogenic agents Communicable diseases are those diseases that can be spread from one person to another such as spread through contact, airborne or can be spread through, mosquito bites, droplet, body fluids or blood products. There are several examples of communicable diseases, some require reporting to the appropriate health departments or local agencies. Examples of communicable diseases include HIV, Hepatitis A, B and C, Measles, TB, Flu, Salmonella and blood-borne illnesses.

Definition of HIV

Human immunodeficiency virus (HIV) is a virus that weakens a person’s immune system by destroying important immune system that fight disease and infection. There is no cure for the disease, if it is not treated early, it may lead to AIDS. This disease affects the immune system and it kills CD4 Helper cell or T cell. After destroying CD4 Helper cell o T cell, it becomes hard for the body to fight off other inections easily. The number of CD4 counts represents how well the immune system is working. The CD4 must be within certain ranges for the immune system to function well. The normal range for CD4 cells is between five hundred to one thousand five hundred . Since there is no known effective cure for HIV, anyone diagnosed with the disease must be on medication and treatment compliant for proper medical care.

Stages, Symptoms, and Complications of HIV

The acute stage of Human Immunodeficiency virus is usually within two to four weeks after contracting the infection. The symptoms at this stage are as follows: When people have acute HIV infection, they have a large amount of virus in their blood and are very contagious. People with acute infection are often unaware that they’re infected because they may not feel sick right away or at all (CDC, 2019). People may experience flu-like symptoms after they have been infected and this may last for a few weeks. People with acute infection are mostly unaware that they are infected because they may not feel sick right away. The second stage of HIV infection is called the clinical latency, which also means HIV inactivity or dormancy. This stage is also called asymptomatic HIV infection because at this stage, HIV is active but it reproduces at a very low level. People may not have any symptoms during this time. It is also possible to transmit HIV to others during this stage. People who follow a treatment program may remain in this stage for many decades, or for the rest of their lives, as drug therapy reduces viral activity. Without treatment, the clinical latency stage lasts around 10 years.

Stage three is the most severe phase of HIV infection. “Acquired immunodeficiency syndrome (AIDS) is a term which applies to the most advanced stages of HIV infection. It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers” (WHO, 2018). People with AIDS have damaged immune system and they get a number of severe illnesses. Without treatment, people with AIDS survive for about three years. The common symptoms of AIDS include fever, chills, sweats, weakness, weight loss and swollen lymph glands. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells. People with AIDS can be very infectious. Opportunistic infections are infections that occur more frequently, they are more seen in people with weakened immune systems, especially people living with HIV. Examples of oppurtunistic infections are Candidiasis of bronchi, trachea, esophagus or lungs, invasive cervical cancer, coccidiodomycosis, cryptococcosis, cryptosporidiosis, herpes simples and Histoplasomosis (CDC, 2019)

Methods of Transmission

HIV can be transmitted from infected individual to uninfected person through specific activities. Certain body fluids -blood, serum, rectal fluids, and breast milk from a person who has HIV can transmit HIV. In the United states, HIV is spread mainly by having anal or vaginal sex with someone who has HIV, without using condom. The use of the unclean needle is another common method of HIV transmission among illicit drug users. Sharing needles, syringes or other equipments used to prepare drugs for injections for an infected person can transmit the disease. HIV can live in a used needle for up to 42 dyas, depending on the temperature and other living factors. According to CDC, there are less common way HIV may spread from mother to child during pregnancy, being stuck with an HIV contaminated needle or other sharp object. In extremely rare cases, HIV can be transmitted by oral sex, receiving blood transfussions, organ /tissue transplants that are contaminated with HIV, eating food by a person with HIV and deep open-mouth kissing if both partners have sores and blood from the HIV positive partner (CDC, 2019).

Prevalence of HIV

HIV is a virus that causes AIDS and it is one of the world’s serious public health challenges. HIV affects people regardless of age, gender and race, but they mostly affect gay, Africans-Americans and bisexual men. There were approximately 37.9 million people across the globe with HIV/AIDS in 2018. Among these people, 1.6 million were 15 years and older while 160, 000 infections were among children ages 0-14. African Americans account for a higher propotion of HIV. In 2018, 42% of African Americans accounted for the new HIV diagnosis in the United States and dependent areas (CDC, 2020). Approximately 1.1 million of people in the United States live with HIV. It has an impact on certain populations, especially on ethnic minorities, gay and bisexual men. In 2018, 37, 832 people received an HIV diagnosis in the United States. In the United States, ga and bisexual men are the population most affected by HIV. In 2017, adult and adolescent gay and bisexual men accounted for 70% of the HIV in the United States and dependent areas. The HIV epidemic affected households, communities and development and economic growths of nations.

Social Determinants of Healths

According to Green, Social Determinants Of Health are “conditions of living, such as housing, socioeconomics, transportation needs, quality of education, that directly impact health and access to health care needs.” (2018). SDOH are conditions that contribute or hamper a person’s well-being. Evidence has shown that poverty and low income adds enormously in a high prevalence of HIV. The extreme poverty drives most of the young women to get into risky behavior to simply make money for survival. Sub-Saharan African has sixty-two percent of the world population of people living with HIV and also home to seventy percent of the world’s poorest people (Mbirimtengerenji, 2007). A better standard of living means that people can have proper medication, good nutrition, and social amenities, but it is the opposite for the people of Sub-Saharan Africa where people lack basic life amenities like water and food. Poverty acts as an underlying driver of human immunodeficiency virus infection in Sub-Saharan Africa.

In the United States, blacks or African Americans have a higher percentage of new cases of HIV and the number of people infected with HIV compared to other races. sixty percent of African Americans that were diagnosed with HIV in 2017 were gay or bisexual men. In 2018, 42% of African Americans accounted for the new HIV diagnosis in the United States and dependent areas. There are several social determinants of health that contributed to the prevalence of HIV among African Americans. Some of the challenges include lack of HIV awareness, poverty, limited access to healthcare and a higher rate of crime.

HIV Epidemiologic Triangle

HIV has no cure but there are available treatments. Stricts adherence to anti-retroviral therapy can dramatically slow down the disease’s progress and prevent secondary infections and also prolong life. According to World Health Organization, standard antiretroviral therapy(ART) consists of the combination of antiretroviral (ARV) drugs to suppress and stop the progression of the HIV diseases. WHO recommends ART for people with HIV as soon they have been diagnosed (WHO, 2020).

Apart from using ART or ARV, there are other preventive ways to stop HIV from spreading. People having sex should use condoms right away everytime before having sex. Reducing numbers of sexual partners can lower the chances of having a sex partner who will transmit HIV. The more partner one has, the more chances of having a partner with HIV. Gay and bisexual men are more at risk. It is recommended that gay or bisexual men who has had anal sex without a condom should test for a HIV. Receptive anal sex and Vaginal sex are risky type of sex for getting HIV, even though receptive anal sex is riskier than vaginal sex. It is also important to talk to one’s health care provider about pre-exposure prophylaxis (PrEP). PrEP is an HIV prevention option for people who are HIV negative but are at the risk of getting infected with HIV.

Role of Community Health Nurses

Community health nurses played a major role to play during the worldwide public effort in response to the HIV pandemic. Community health nurses perform various function in HIV programmes, which inlcudes reporting cases, testing, linking patients to care, accompanying them to clinic appointments, advocate, health educator, program coordinator and providing psychosocial supports as well as making referrals (Busza, 2018). Community health nurses contributed positively to the HIVcase in midwestern U.S suburban comminuty. The community health nurses involved developed HIV programs which were implemented to help the patients in need. The initiatives used by the community health nurses resulted in positive feelings about the health department and enhanced the image of community health nurses as facilitators of change.

National Agency or organization

National Institute of Health (NIH) is a primary federal aganecy for conducting and supporting medical research and also the lead federal agency for biomedical research on HIV and AIDS. NIH also researched opportunistic infections, co-infections and malignances. The research made led to a better understanding of the basic biology of HIV/AIDS. The NIH supports an international research and training portfolio that encompasses more than 90 countries. In 1989, NIH researchers made several discoveries about how the Human immunodeficiency virus destroys the immune system and leads to AIDS. In 1996, NIH funded scientists discovered a new drug known as protease inhibitors. In combination of other AIDS drugs, these medications attack HIV in several ways and extends the lives of HIV infected patients. This discovery turned HIV from a death sentence into a chronic disease. The NIH continues their research on HIV/AIDS, complications, and as well as develop test drugs (NIH, 2015)

Global implication of HIV disease

The scale of HV/AIDS epidemic exceeded all expectations 20 years ago. According to world Health organization and Joint United Nations Programme on HIV/AIDS, at the end of 1999, an estimate of 34.3 million of people were living with HIV/AIDS. Most of these people are from developing countries. Africa is the continent that has been mostly affected with HIV/AIDS. Sub-Saharan Africa has the highest infection level, they have the low access to care and least economic stability. Sub-Saharan Africa has the most population with 70% of people infected with HIV/AIDS. Out of the 6000 new cases of infection that occurs globally, two out of three are sub-saharan women (Kharsany & Karim, 2016).

Conclusion

HIV was once an epidemic that raged through the world in the 1980s, killing millions of people. HIV is still a threat to humans regardless of age, gender or ethnic group. Even though there are no known cure for HIV/AIDS,with the help of national agencies like NIH and other agencies around the world, there are preventive measures to make diagnosed people live longer.

References

1. Busza, Dauya, Bandason, Simms, Chikwari, Makamba, Mchugh, Munyati, Chonzi, & Ferrand, (2018). The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe, Health Policy and Planning, Volume 33, Issue 3, April 2018, Pages 328–334, https://doi.org/10.1093/heapol/czx187. Retrieved March 29, 2020 from https://academic.oup.com/heapol/article/33/3/328/4788356
2. CDC. (2019). How does a person get diagnosed with AIDS?. AIDS and Oppurtunistic Infections. Retrieved March, 27, 2020 from https://www.cdc.gov/hiv/basics/whatishiv.html
3. CDC. (2020). HIV and African Americans. The Numbers, HIV Diagnosis. Retrieved March 28, 2020 from https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html
4. CDC. (2017 May 06). The National Institute for Occupational Safety and Health. Communicable diseases. Retrieved March 28, 2020 from https://www.cdc.gov/niosh/topics/aircrew/communicablediseases.html.
5. Dean, H. D., & Fenton, K. A. (2010). Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis. Doi: 10.1177/00333549101250S401Public Health Rep. 2010; 125(Suppl 4): 1–5. Retrieved March 29, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882967/#__ffn_sectitle.
6. Kharsany, A. B. M., & Karim, Q. A. (2016, April 8). HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. Retrieved March 29, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893541/
7. Mbirimtengerenji N. D. (2007). Is HIV/AIDS epidemic outcome of poverty in sub-saharan Africa?. Croatian medical journal, 48(5), 605–617.
8. National Institute of Health., 2015. HIV/AIDS. (2015, October 7). Retrieved March 29, 2020, from https://www.nih.gov/about-nih/what-we-do/nih-turning-discovery-into-health/hiv/aids
9. U.S. Department of Veterans Affairs. (2018). HIV/AIDS. Retrieved March 29, 2020 from https://www.hiv.va.gov/patient/diagnosis/labs-CD4-count.asp
10. World Health Organization. (2018). Treatment and Care Retrieved March 29, 2020 from https://www.who.int/hiv/topics/treatments/

Human immune-deficiency virus

HIV (human immuno-deficiency virus) is a virus which damages a person’s immune system and weakens the ability of a person’s body to be able to fight infections (Haas, 1993). Segregation of HIV positive prisoners was a common practice during the first discovery of the disease, due to added pressure on prison officials to reduce the growing spread of HIV in prisons. The lack of education and understanding of the disease led to segregation and stigma of prisoners with this disease. General stigma of HIV positive prisoners occurs not only in prison but also amongst the public. This could be due to the media’s portrayal of HIV, creating fear amongst the population. Also, there was no cure for the disease at the time, people believed once you were infected with the disease then it meant certain death. The ethical implications of segregation of prisoners also have to be considered as some would argue it’s a violation of human rights. Through research that was carried out into the cause, unjust punishment and treatment of prisoners with HIV, a better understanding has been developed on the issue.

Segregation

To begin with, the spread of HIV is possible in many different ways from sexual intercourse to vertical transmission. However, statistics shows that around ‘74% of HIV infections have been spread from unprotected homosexual intercourse while 17% is from sharing of contaminated needles’ (Haas, 1993). This could therefore provide the basis for why many believe that compulsory segregation of HIV positive prisoners is necessary to avoid the spread of the disease. There has also been a steady growth in the spread of HIV by use of intravenous injections, this is due to there being a scarcity of needles therefore this results in the rapid spread of the disease. HIV is a disease that a person could have without knowing they are infected therefore it also poses a threat to the general public. This is because once an infected inmate is released, they could then go on into the population and spread the disease. This provides an issue for prison officials and has led to increasing pressure for changes to be made and policies put into place leading to the introduction of mandatory HIV testing for all prisoners and the segregation of HIV positive prisoners. However, these policies have faced fierce opposition from not only inmates but also from other in the public due it’s breach of human rights and constitutional rights (Haas, 1993). Prisoners also feel that there is a lack of privacy and by immediately being forced to submit to a blood test, their rights are being violated. Although, prison officials will argue that due to the increasing cases of infections mandatory testing is required to help reduce the spread of HIV and help control the infections. This is thought to be achieved by segregating the inmates (which was the only act done before the introduction of HAART) or now also administering treatments for the inmates in the form of HAART (Highly Active Anti-Retroviral Therapy) for example. The key issues that still exist is the breach of confidentiality of prisoners, by segregating HIV positive prisoners their condition is highlighted to all other inmates and prison guards. Segregation of inmates could also create the stigma towards the disease as other occupants in the prison might not understand the disease and how it’s spread. Prison officials also considered providing condoms for prisoners in order to help promote safe sexual relationships as well as providing bleach to help sterilise needles that were used by prisoners (Robinette et al., 1999). However, after 1985 there was large reduction in the number of prisons which still used segregation as an effective method to curtail the spread of HIV. This in part was due to the decrease in stigmatisation and hysteria surrounding the disease (Robinette et al., 1999). There are also perhaps four other factors as to why segregation of inmates has fallen out of favour; ‘avoiding stigmatisation, hazards of mass screening, problems with segregated housing and small chance of transmission through casual contact.’ (Robinette et al., 1999).

Stigmatisation

In addition, looking through the stigmatisation of seropositive inmates, it is clear that through segregated housing the inevitability of inferior health care for these inmates has occurred. This stems from the fact that healthcare professionals do not view them as adequate patients. Health care providers immediately place prisoners into two groups with there being the ‘good patients’ (patients who are HIV negative) and the so called ‘rubbish patients’(those who are HIV positive)( Robinette et al., 1999). This is because health care specialities want to deal with life threatening issues or acute illnesses which can lead to them using key skills learnt and putting it into practice. Thus, ensuring that they can improve the health of the individual and save lives. However, with a disease such as HIV death is inevitable therefore the medical professional will feel like their attributes aren’t being used efficiently as there is nothing they can do to save the life of the individual hence why HIV positive patients are seen as ‘rubbish patients’. The ‘good patients’ are those who have exhibit these acute illnesses ensuring the medical personnel can help bring the person back to full health. From this it’s clear to see that segregation of inmates can only further increase this stigmatisation from health care professionals and this is therefore detrimental to the infected prisoners as it leads to inadequate care for these prisoners. To add to this, mass segregation of inmates requires mass testing of all prisoners. The issue with this is that sometimes the test could produce a false positive or negative result which could have detrimental effects. Individuals who are deemed to be seropositive will immediately be isolated, however due to a false positive result these people may not be infected. This is the same for those who are shown to be seronegative while in fact they are infected. This leads to those infected being put into the general population creating an inaccurate and false sense of security for the prisoners who aren’t infected as they may now be more likely to partake in high HIV risk activities such as unprotected sexual intercourse and Intravenous injections. It is clear as to how hugely detrimental this can be as it can lead to the rapid spread of the HIV disease in those or are uninfected. The results of these tests are also affected by the time taken between the first exposure to HIV and the presence of antibodies as sufficient time has not been given for the specific virus to be detected (Robinette et al., 1999). There are also two other issues related to mass testing of all prisoners, these being the costs as well as underappreciation of the education of HIV to inmates and the dangers of HIV. This is because only those who are infected with HIV and have been isolated, or those who are known homosexuals or intravenous injection users are more likely to be targeted when it comes to the education on the disease. This therefore ignores the belief that all prisoners should be informed and have a good knowledge on the issue to curtail the spread of the disease. As previously stated segregation of seropositive prisoners is also spreading the false belief that HIV is a disease that can be contracted by casual contact and as we know this is not the case.

Conclusion

To conclude, in order to help tackle the issue of HIV in prisons several changes can be made. A key change being the huge importance of the education of prisoners as knowledge is power and it can help reduce stigma towards HIV whilst also helping to reduce its spread as if people know what causes the disease they can be more cautious. It is also evident that sexual intercourse will occur in prisons so therefore condoms could be provided for prisoners. This is already being used in countries such as Canada and France and there have been no negative effects. For example, in Canada prison officers were surveyed to see if the use of condoms in prisons has caused any issues. Out of these people, ‘82% of prison officers surveyed said that condom availability caused no problems at their prisons’ (Robinette et al., 1999). However, there are prison rules against sexual intercourse it is argued that this is inhumane, and prisoners are bound to break the rules so is it is a better choice to provide inmates with the tools to practice safe sexual intercourse. Correctional officers may see condoms as a way to promote sexual intercourse with inmates or a way to move contraband into prisons but the protection of people from the spread of a deadly virus should outweigh these negative aspects. In future, more can be done to not only tackle segregation of inmates but to also challenge the stigma of HIV that it creates.

(RED), an organization founded in 2006 by celebrity humanitarian Bono and activist Bobby Shriver has exploded all over the world with its partnerships with popular global brands, including Apple, Converse, Gap, Armani, and Starbucks. This brand, commonly known as (Product)RED, markets products in an attempt to raise funds and awareness for those living with HIV and AIDS in Africa. (RED) incentivizes customers to step up by providing individuals with the opportunity to make a positive impact, as a portion of all donations generated from (RED) campaigns go directly to the Global Fund to fight AIDS, Tuberculosis, and Malaria. Product(RED) claims that they are fighting to solve the issue at hand, but they do so in ways that perpetuate the causes of the epidemic. The citizen-consumer, mobilized through celebrity humanitarianism, drives commodity fetishism which allows businesses to capitalize on humanitarianism.

In 2008, Starbucks, one of the largest coffee companies in the world, began its partnership with (RED), launching its 60-second “What If” advertisement. This advertisement poses a series of hypothetical questions, such as “what if when we help someone else, we help ourselves?” This “someone else” refers to Africans diagnosed with HIV and AIDS. However, interesting enough, the advertisement never mentions that the fund go towards contributing to HIV and AIDS prevention, only mentioning that they will “help save lives in Africa”. Upbeat piano music plays in the background of the advertisement, juxtaposing the seriousness of the issue with the lighthearted tone of the campaign. The thought-provoking promotion asks its viewers “What if we are not separated from everyone else, but connected?… What if just part of our purpose here is not me, but we” in an effort to connect its viewers to the epidemic of HIV and AIDS in Africa. The company encourages its audience to take action through its claim that being a part of the solution is much easier than it’s believed to be. The advertisement, which presents solely words and no images, is straightforward in its message: for every exclusive (Starbucks)RED drink bought during the holiday season, five cents will be contributed to helping save lives in Africa. Proceeds from the sale of hand-crafted beverages and other unique (RED) Starbucks merchandise and menu items are donated directly to the Global Fund to help finance HIV/AIDS prevention, education and treatment programs1. Starbucks leads us to believe that through collective efforts, it becomes possible to make significant progress in the fight against HIV and AIDS in Africa. The Starbucks (RED) campaign, claims “You & Starbucks. It’s bigger than coffee”, putting the focus on the individual and how their consumer behaviors can engage themselves in one of the world’s most pressing global health issues: the HIV and AIDS outbreak in Africa.

The Starbucks (RED) campaign certainly creates a good impression on its viewers, using celebrity humanitarian to integrate business with social concerns and motivate consumers. Celebrity humanitarian, Bono, brought the situation in Africa to the public eye, evoking sympathy and encouraging people who may not have known about the situation otherwise to contribute. Celebrity humanitarians, by involving themselves in urgent matters plaguing society, often play a key role in gathering support towards a particular cause. This technique, though well-intentioned, has unintended consequences. Richey and Pontey explain how the (Product)RED campaign attempts to “bring Africa to the minds of the idle rich… [using] celebrity together with the negotiated representation of a distant ‘Africa’” to address the solutions to the global issue. Despite charitable contributions made, the rich patronize the poor. Through these methods of extracting donations by evoking pity, foreign aid results in the framing of the underlying assumption that poor Africans are helpless and dependent on the charity of the more developed, superior Western powers.

The advertisement succeeds in its purpose of gathering funds, but it convinces citizen-consumers that their efforts will directly address the serious problems, even when they have no knowledge of where these funds are allocated. The citizen-consumer strives to unite the forces of consumerism with humanitarian foreign aid through their purchase decisions. Citizen-consumers experience a sense of pleasure through buying the charity merchandise, believing they can become part of the solution without needing to sacrifice anything significant. Nevertheless, the ways in which these consumers involve themselves are in reality for their own interests and not in the interests of those they are trying to help. Consumers end up contributing because of the conveniency of making a donation, and most of the time, they don’t have a full understanding of the causes they are donating to. This promotes the idea that consumers can “help people in ways that let [them] keep living their lives as is, while shedding some of [their] personal guilt” with the assumption that “positive social consequences will occur automatically, as a happy by-product of selfishness”. Starbucks’s Product(RED) advertisement does not disclose the cause they are supporting, but urges individuals to purchase their goods with the idea that their choice of brands and purchases can alter their engagement in real world issues, making them responsible, and ethically engaged citizens.

Starbucks’s partnership with (RED) is a manifestation of commodity fetishism, a term first used by Marx that describes “the necessary masking of social relations under which commodities are produced from which capitalist commodity production gains much of its legitimacy”. Through its branding of (Product)RED goods, Starbucks attempts to make a profit while addressing a fatal disease that plagues the lives of Africans, promoting the idea of doing well by doing good. Starbucks and its partnership with (Product)RED seems to “promote status, capitalism, and conspicuous consumption in the name of ‘helping’” while not disclosing the specifics of their aid activities. Starbucks engages in this commodity fetishism as its primary motive behind its partnership with (RED) is to maximize profits through selling (RED) branded goods and convince its consumers that buying coffee can save lives. Companies tend to not address the causes that underlie the issues they are focused on while highlighting the severity of the issue and how they plan on going about their solution: through gaining profits. (RED) asserts that they have the capabilities to fix the circumstances, so long as they are provided with sufficient funds for their plan of action, the Global Fund. (RED) explains how the solution is highly conceivable: a 20 cent pill taken everyday can stop mothers from passing HIV to their babies. They urge individuals to question, “why not contribute to such a simple solution?”, but they never question: if the solution is so simple, and the epidemic is so preventable, then why does it exist in the first place? What is the source of this problem that allowed it to grow to be so extensive to the point where it affects so many people? The answer, in this case, is poverty. The extremely unstable economic conditions in Africa prompted this wide-spread epidemic that now requires large funding to fix. This is the real problem that should be addressed, but efforts to combat this problem are insufficient. The (RED) campaign is committed to giving back through their business endeavors, representing a belief of business being the “universal access card for making progress, helping people, and changing the world”. The idea that the market is the most effective mechanism for pursuing social change only maintains the existing power dynamic. How could we possibly be able to change the world by maintaining the same economic status quo between the rich and poor? By not addressing the roots of the disastrous condition, companies only perpetuate the circumstances that gave rise to the problem in the first place, allowing capitalism to prevail.

A critical flaw in the way these humanitarian efforts are carried out is their unrealistic emphasis on simple solutions to complex global issues. The (RED) campaign, focused on the contributions of the citizen-consumer for funding, paves the way for commodity fetishism, in which celebrity humanitarians play a huge role. Commodity fetishism attempts to link humanitarianism and consumerism, allowing the rich to continue to profit off of the suffering of Africans. Consumers should ignore profit-maximizing motives to produce effective solutions to properly assist those living with HIV and AIDS in Africa. Though Starbucks claims that their efforts are producing a great impact with 5 cents from every exclusive drink purchased being donated to the Global Fund, the company certainly profits with the vast majority of their charity merchandise sales going towards their revenue. Consumers, when making purchases in attempts to do good, need to understand the importance of the complexity of making a real difference in the state of affairs in Africa. If the root causes behind the HIV/AIDS epidemic are not addressed, companies will continue to offer inadequate solutions that allow the disease to persist throughout the population.

People who are infected by Human Immunodeficiency Virus and those who are defined to have Acquired Immune Deficiency Syndrome are all eligible. Territories or states need residential, additional finance, and medical criteria to be able to establish eligibility. Individuals who are not infected in situations that are limited are eligible for the services and benefit a person who is infected with HIV indirectly.

Drug assistance program

Assistance programs for drugs for curing AIDS fund medications for treating HIV disease. Each territory and state establish its criteria for eligibility. All these criteria require individuals to document their HIV status and meet all the established criteria for their income. The AIDS drug assistance program operations are under the model of pharmacy reimbursement that is similar to Medicaid and purchase drugs directly and distribute them to the patients. Clients enroll into the program depending on their enrollment state and apply to the office directly or submit applications through the manager, nurse, physician, or service provider. (Gostin, 1998 pp12-19)

Services offered

There are no restrictions that prohibit the tailoring of health care programs by clients and using various services and providers that are eligible for meeting the health care needs of individuals. Clients can not be denied from enjoying the services and tribal facilities. White programs are separate programs for health care and clients that present their need for care or services have individual programs that prescribe them to the eligibility rules.

Ryan White program is not supposed to replace any of the services that are already available and offered and other fund services are used for supplementing the already available services.

Covering the cost of services

Ryan white programs offer to cover the cost of care given except for the programs that are administered by IHS who are not the payer of the last resort if the patient is considered eligible and has coverage for health service such as Medicaid, the provider or grantee seek payment from the payer and follow established procedures for determining coverage of health care and this is done under last resort program.

Trade-offs

The program of Ryan White covers an array of costs of HIV/AIDS health and supportive services that are related. The health services involved are primary health care, early intervention services, and dental services. Ryan White Program covers support services that are related to critical health for HIV/AIDS individuals for them to achieve medical outcomes. Support services offered are respite care of HIV individuals, linguistic services, health care referrals, and support services. Payment made for these services is from other sources, private insurance, and reimbursement plans from guarantees.

The policy against AIDS that is successful was implemented and adopts intellectual property rules. The government analyzes carefully any trade-off to be able to avoid the mistake of engaging in trade for export dollars. The agreement should not prevent members of the organization from taking public health protection measures. The agreements are not supposed to be interpreted in a manner that supports world Trade organization members and denies them their right to protect their public health and promote access to medicine to all.

The above excerpts were taken from the agreement that was reformulated in November 2001 when members of WHO including the United States of America held a discussion and signed a new agreement that clarified that, there should be predominant of public health over patent protection that give hope to poor economies that struggle to ensure they control spread of AIDS inside the national borders. (Chin, 2007 pp37-40)

Any weak rules

There are weak rules because for the program guidance’s to be released, applicants are supposed to apply electronically through the site. Interested programs must review all the necessary steps for applying for grants and use information that must be provided for one to be a competitive applicant and for one to be an eligible client, one has to be competitive.

Are eligibility rules fair and sufficient?

The eligibility rules are fair and sufficient because they can ban the parallel import of drugs that are used by people who are infected by AIDS, they have data for regulating tests for HIV/AIDS, and offer five-year protection for that test. There is a patent extension that cares for regulatory delays to ensure that there are no unnecessary delays that may affect the HIV/AIDS victims. The obligation for generic drugs ensures that they get marketing approval issues offered by state agencies. (Chin, 2007 pp33-36)

References

Chin J. (2007): The AIDS Pandemic: Radcliff Publishing, pp. 33-40.

Gostin L. (1998): Legal Responses to AIDS in Comparative Perspective: Martinus Nijhoff, pp. 12-19.

AIDS.gov receives funds for activities of HIV/AIDS from the HHS office. This is funds from the minority AIDS initiative which can respond to the impact of the epidemic on ethnic and minority populations. The allocation of funds is gotten from HHS secretary of minority AIDS initiative fund which is based on proposals of multi-agency. These funds are discretionary as opposed to funds that go directly to other HIV/AIDS agencies.

The minority AIDS initiative dollars fund has a link to the HIV/AIDS presidents initiative to fund the organization of AIDS.gov. The global funds for fighting AIDS were started as a non-profit foundation which is a unique public and private partnership that aims at attracting, managing, and disbursing resources to the countries that have been burdened by AIDS. The United States established the global fund and the United States government provided 40% of the total contribution and governs the board. During the six rounds of providing funds, $8.4 billion was committed by the global fund to 136 countries in form of grants. (Seibert, 2000 pp33-34)

How reliable are its funding sources

Health insurance schemes are made more affordable where people who are infected by AIDS purchase the coverage. Employees are encouraged to purchase health insurance on their own rather than getting in through their employer. The people who purchase their health insurance on the individual market are provided with substantial tax benefits in order to lower taxes for all those victims who are not insured for the insurance to be affordable and provide a significant incentive for the people to purchase coverage.

Initiative for affordable choices assists states to help the poor who are not financially stable without creating new federal funding and deduction in health insurance makes private health insurance affordable. Health savings accounts have been expanded in order to help small businesses by use of association health plans, information technology that reduce medical errors, and reducing the costs to ensure there is price transparency and protect doctors from being engaged in predatory lawsuits. (Vicki, 2002 pp15-16)

Do they implement financial accountability measures to ensure that funds are being used properly?

Communities and individuals should know all the costs incurred in relation to treatment to be able to make informed decisions and be able to finance their health care needs. This includes costs of medical consultation, HIV testing, biological tests for CD4 counts and viral loads, pharmaceutical expenses for ARV treatment, and treating opportunistic infections and infections which are sexually transmitted. Costs associated with food security and adequate nutrition in the course of treatment should be accounted for in treatment costs. Transportation costs to go to the clinic and lost wages should be accounted for and records kept acting as evidence of how the funds were used.

Clear information must be provided to show the groups that are supposed to receive free treatment depending on their level of needs and the ones to receive subsidized prices for treatment. Established measures are to be put in place to make sure that the listed prices are paid at the drug disbursement source and provide people with treatment education to get information on services that help them afford regular and long-term basis ARVs. (Vicki, 2002 pp13-14)

The questions I would ask AIDS.gov if I had donated a large sum of money and wanted to know how my money was being used

The first question would be on how many HIV/AIDS victims AIDS.gov supports with the money that I had donated. The organization should be able to give the exact number of victims whom they provide with health care. Next, the number of drugs needed by each patient should be available according to the infections that have been treated as a result of HIV infection, for example, tuberculosis treatment and treatment for sexually transmitted infection.

The cost incurred in testing the victims to know their HIV status and the ARVs treatment given should be kept in proper records after every treatment is given. The organization should be able to show how frequently the AIDS patients require to be attended and the amount of money they spend every time they require attention and the counseling services provided and the amount of money paid to the qualified counselors. Finally, I should be provided with financial records stating how the amount of money that I donated has been used and the remaining balances show is indicated properly. (Seibert, 2000 pp35-36)

References

Vicki S. (2002): AIDS; A communication perspective: Congress library, pp. 13-16.

Seibert J. (2000): Children, Adolescents, and AIDS: American Psychology Association, pp. 33-36.

The high rates of infection and spread of HIV/AIDS is considered as a threat to whole humanity. CDC (Centers for Disease Control and Prevention) is a premier public health agency which undertakes the control and prevention of AIDS in US, and their mission is to promote health and quality of life. It explores the stories of health protection; conducts research works and investigates real cases of AIDS.

CDC undertakes various programs related to employment, education, training and volunteering. Rob Noble in his “United States Statistics Summary” points out. (Noble, 2006). “AIDS surveillance data are less able e to represent trends in the incidence of HIV infection or the impact of the epidemic on the health-care system. In response, more states are now implementing HIV case reporting”. The health protection goals of CDC are the integral part of the present and future plans to improve public health and it is accelerating the health impact and ensures health equality to all. So, by the criteria of social problem analysis, the works undertaken by this agency is most valuable.

The surveys conducted and the mode of awarding grants to the organizations which work for the mission is the best example of problem design and evaluation of the available data. CDC awards 85% of its budget through grants and contracts to help accomplish its mission to promote health and quality of life by preventing and controlling disease, injury and disability. Moreover, CDC awards approximately $7 in over 14,000 separate grant & contract action and the grant is provided to organizations whose works affects the people.

There are certain goals that is aimed and promoted by CDC and they are: healthy people in every stage of life, healthy people in healthy places, people prepared for emerging health threats and healthy people in healthy world. These goals can be considered as the guidelines which help us to eradicate HIV infection from our world.

The technology and methodology developed by CDC shows that the rate of HIV infection in US is higher than previously known. The findings, for example in 2006, new 56,300 HIV infections were detected and it is higher than previously estimated 40,000 annual new infections. The most affected group among ethnic races and minorities in US is the African Americans. In 2006, 53% of gay & bisexual men were infected by HIV, and 13% of African Americans in US were detected as newly infected by HIV.

The findings of CDC, states that there is a reduction in new infections among both ‘injectors’ and heterosexuals. This shows the target efficiency of CIDS to identify and solve social problems like HIV/AIDS. Moreover, it shows an increase in HIV infection since 1990s among the gay and bisexual men and there is an increase in infection of HIV among the black people in US. The news article states the importance of planning to fight HIV/AIDS in US. (Global health advocates warn against complacency in fighting HIV/AIDS pandemic ahead of world AIDS day).

“President Bush To Meet With Faith-Based Groups To Discuss PEPFAR- In related news, President Bush on Friday in Mount Airy, Md., is scheduled to meet with faith-based HIV/AIDS advocacy groups to discuss the President’s Emergency Plan for AIDS Relief in advance of World AIDS Day”. During the late 1990s, the innovations in HIV treatments slowed the progress of HIV infection and it resulted in decrease in deaths among persons with AIDS in the 50 states in US.This shows the effectiveness of CIDS among the HIV infected people in US. The number of AIDS cases in 2006 remained stable and deaths decreased, but this resulted in increased number of people who live with AIDS and are capable to increase the distribution as the carriers of HIV.

The reduced number of infection among the people in US gives further hope for the future sustainability of the works undertaken by CDC and it acts as a lighthouse to all other organizations which fight against HIV/AIDS infection.

References

Noble, Rob. (2006). United states statistics summary. AVERT. Vol. 18. Web.

Global health advocates warn against complacency in fighting HIV/AIDS pandemic ahead of world AIDS day. (2007). Medical News Today. Web.