exam 1 HIV

why america so susceptible at first

Clustering of high risk populations is what explained larger scale of HIV epidemic. US has more people than any western country, more mobility ie sheer concentration of gay people in San fran. Clusters also engaged in riskier behavior ie higher rates of stds, IDUs etc even before aids arrived. In germany ie east berlins, guys still hu but low labor mobility, logistical barriers to partiicpating in gay life and getting drugs, kept clusters from forming. When the Berlin Wall came down west germany about 35k people infected with HIV, east germany fewer than 500. We do know that the virus spreads faster through U.S. cities than European ones, but we don't know, may never know precisely why.

UNAIDS compared incidence 2001 to 2011 but what groups are still expanding?

-UNAIDS compared incidence 2001 to 2011, period of ARV antiviral therapy treatment in most developing countries and reported decline of 20% infections globally, mostly sub saharan africa and caribbean HIV remains dominant in africa though, only global region with female predominance in HIV infections and uniquely high rates of new infection in young women/adolescents -middle east and north africa, eastern europe, central asia, HIV incidence keeps increasing. -MSM, sex workers, transgender women, IDUs, HIV rates are either stable or expanding globally

The Changing epidemiology of HIV in 2013 evidence that HIV epidemics in decline but excpetions in...?6

-identified epidemiology of HIV-1 and challenges of ie epidemic control -evidence that HIV epidemics in decline among general populations worldwide but exceptions in eastern europe/central asia injecting drug populations, young women and girls in sub-saharan africa, MSM in america, asia , africa

Box 4: the HDI and MDGs HDI is a summary measure of average achievement in key dimensions of human development; long and healthy life, being knowledgeable, and a decent standard of living. Calculations based on : 3

1 . health dimension assessed by life expectancy. Min 20 max 85 years 2. Education component- mean years of schooling 3. Standard of living dimension by gross national income per capita

our historical waves public health development and new wave in making discovered 2014.

1. 1830-1900 structural- physical/env conditions addressed, clean water food safety etc, decreased cholera outbreak. 2. 1890-1950 biomedical and scientific advance- first vaccine smallpox foundation for this, uk's 1853 vaccination act made immunization compulsory by the age of 3 months. Many further vaccinations. 3. 1940-1980 clinical- growing understanding of disease causes→ lifestyle interventions ie diet and diabetes, smoking and cancer. 4. Starting 1960, examination of social determinants of health, ill health roots in economic and social factors. 5. Should be "culture for health". Health should be the norm, valued, healthy choices default. Involves involvement of individuals, comm, gov, etc HIV still major threat to public health, more new infection than # ppl starting ARV , will not treat selves out of epidemic- need prevention

dif in race vs class, intro of HAART uneducated black women

2012 Aids dropped off the list of NYCs top ten causes of death. Also diff with race/class ie uneducated black men AIDS mortality rate 30x higher than educated whites. Introduction of HAART barely dropped mortality rates at all for uneducated black women. All due to higher levels of stigma, poor infrastructure, lack of education, no insurance. Disease burden in south high for other diseases too ie institutionalized racism, poverty, lack of trust in health care etc that is not present in the north. difference between the United States and Western Europe, he says, is that "we're a much bigger, much more complex, and much more unjust country.

what percentage of aids cases 13-29 years old are AA what t cell count is AIDS diagnosis

68% under 200- some people don't go on meds until that point and then it is too late

AA social economic vulnerability higher ie , do incarceration rates x why is it easier to get HIV in prison?

AA socio economic vulnerability higher ie poverty, incarceration rate 6x higher than whites, black women 2-5x higher than white women, twice rate of hispanics. IDUS and sex workers often end up in prison --. HIV 3-5 X higher in prisons/ jails than in general population , harm-reduction programs ie clean needles, condoms to high risk pops etc, almost nonexistent in incarceration facilities in US. sooo all of this linked together. Many prisons also high violence ie sexual assaults, 4. Incarceration can limit person's access to health care and ie HIV services for testing prevention treatment absent in these facilities

what does AIDS stand for, when first cases, and how did it start?

Acquired Immunodeficiency Syndrome (AIDS)-caused by HIV which crossed from primates into humans -first cases 1920s or earlier but rapid spread began in 1970s

Living with HIV part 2 - after acceptance open communication, how it affected attitudes, prevention

After acceptance, came to HIV/AIDS service organization as a positive first step , help meet other people by distracting them from problems. Also legal emotional and psychological counseling for patients and families, job placement, financial assistance etc "Because the men have it, and they know that they have it,they're just spreading it. They're not letting anybody know about it. So what we need to do is get together, make groups. I mean let the children know. Specially the teenagers" Also comment about open communication bw parents and children, that families should provide foundation for learning appropriate gender relations-differences in culture w/in latino communities, families ought to teach daughters how to succeed Many women in the study embrace positive attitude, stated would no longer tolerate domestic violence, that HIV made them braver, more self sufficient claimed, strength in spite of circumstances.

how many people infected with HIV/how many died from AIDS by 2015

By 2015 more than 82 million had been infected with HIV and 41 m died from AIDs related No part of the world is untouched

when is it time to tell someone this secret? chris vs austin vs rakiya

Chris brooks says puts it up there as soon as meets a new guy so that knows person is ok with it before gets self involved with it Austin was struggling with dating because of it so came up with the idea of website company works for- "positively frisky" creating website for HIV positive men- safe, stigma free place, everyone on the same place Rakiya says her HIV positive boyfriend is one of the best things that has happened to her, she will be careful , a lot of her friends did not understand why she would put herself in that position, tells her friends to educate themselves Chris brooks says his relationships have failed not because of HIV+ status but because of other things

The Relationship Between Culture, Gender, Structural Factors, Abuse, Trauma, and HIV/AIDS for Latinas data emerged into 4 themes:

Data emerged into four themes: histories of trauma, living with HIV, vulnerability, and luck (la suerte). Women also talked about structural and cultural factors that involved risk of HIV and IPV, women in study reconceptualized IPV to denote form of situational abuse ie threats of deportation exacerbated by their status

theme 3: vulnerability - talk about risky childhood, poverty and immigration status

Easy to see stereotypes among these HIV+ women ie poor uneducated illiterate immigrants drug addicts IPV victims etc. 1-Risky childhood: many believe vulnerability to IPV and HIV began with childhood expierences, early sexual assault, idea of respeto where prohibited to chlaenge elders, marriage became an escape but husband abuser too sometimes 2-Poverty: poverty leads to vulnerability, women sent money to families abroad which depleted money further. Sometimes leads to prostitution, drug abuse etc. some stated HIV status inhibited ability to get legitimate employment, medications weaked them etc 3-immigration status- complicated lives, dependency on others for sponsorship. At risk for abuse and poverty as a result.

framework of HIV related stigma

Framework of HIV related stigma 3 components of stigma framework=stigma sources, effects, stigma reduction interventions Cultural community and healthcare sector two main areas which women encounter stigma- perceptions due to lack of education (fear of infection from casual contact), moral shame, high religiosity → more stigma too sometimes

Why did AIDS Ravage the US more than any other developed country? germany vs US in peoples deaths, today per year,

Germany 27 k people have died of AIDS but germany has 80m people. In Us CDC say sUS 636k . 23 x higher than germany. Makes no sense bc germany has big cities, gay men, sex workers, drug users. AIDS has claimed more people in nyc then spain italy netherlands and switzer combined. Even today US loses +15k a year, germany and UK fewer than 800 Virus hit US early and hard. 1982 first year of nationwide CDC surveillance, 451 died US, just 5 in berlin. 1985 US 7k, germany 170 aids deaths.

golden age of aids goals ie 2, 2002, WHO and UNAIDS goals and initiative

Golden age of AIDS goals- 2000 Aids discussed in UN security council→ resolution 1308 recognizing spread of HIV and AIDS devastating on all sectors/levels society Two months before this creation global war chest to finance MDG 6. 2002 global fund to fight AIDS tuberculosis and malaria opened for business "raise it, spend it, prove it", WHO and UNAIDS launched 3x5 campaign to provide antiretroviral treatment to 3 m people in developing nations by 2005, target is not achieved by groundwork for expanding treatment done More page 86 UNAIDS fast track ending aids epidemic by 2030 sets targets 2020- that 90% HIV infected people know status, 90% of these treatment, 90% of these suppressed viral load. 2030 95% three

Heteroseuxality and vulnerability emerged when

Heteroseuxality and vulnerability emerged when AIDs case definition expanded 1993 and following this veritable explosion, reported cases increasing from 6k '92 to 17k '93

where was highest national prevelance? international dimension

Highest national prevalence was 2004 in swaziland- 42.6 percent there is also an international dimension regarding HIV/AIDS. Potential sources of infections originating in sub-saharan africa spread out through the world include refugee flows, and also nationals who travelled to source countries

chapter 2 what is the problem on when AIDS appeared

How HIV and AIDS work and scientific responses -AIDS appeared when the world was becoming interconnected which is one of the reasons spread rapidly, also during time where lots of scientific discoveries that raised expectations Preventing HIV transmission and treating patients had no scientific silver bullet- more than lab work, epidemic lodged into areas of poverty in the world, needed to understand the diseases science etc

intersectionality

Intersectionality theme-intersection of factors like race gender class stigma which determine health status and access to quality health care. Women whose lifestyles arelready considered shameful by society ie IDUs sex workers, single mothers, experince layering of social stigmas Stigma may be intensified by racial discrim or socioeconomic disparities, main purpose of understanding effects of stigma is to implement intervention to mitigate these effects

what is IPV a risk factor for? 4

Ipv risk factor for unprotected sex, higher incidence of SITIS, increased violence when discosing HIV status, abused when negotiating condom use etc

key populations

Key populations=people at greater risk, including sex workers, men who have sex with men MSM, intravenous drug users IDUS.. these activities often crimilalized

last pepfar news on ie babies, declines, 5 countries

Latest pepfar shown declines in new HIV diagnoses among young women. 65% highest HIV burden communities greater than a 25-40% decline in new HIV diagnoses and declines in nearly all dREAMS intervention districts, >2.2M babies born HIV free due to pepfar, assist 6.4m orphans. Pepfar's population based health impact assessments how 5 african countries approaching control of their epidemics. Goal to control in up to 14 high hiv burden countries by 2020. PEPFAR is led and managed by the U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy and implemented by seven U.S. government departments and agencies.

percentage of US population hat is latina, what percentage IPV

Latinos are a diverse group in socio demographic terms, dif immigration histoires family structures etc. 13.3% US population, 40% foreign born, 34% IPV (intimate partner violence ) in the US so one of the highest rates of partner abuse, 54% greater than nonhispaic whites but hispaics 9x also more likely to report male to female abuse than any other type of partner abuse HIV/AIDS and IPV share risk factors, links risk behaviors of HIV with IPV and other violent traumas of poor urban women especially of color.

HIV OUtbreak in Massachusetts linked to injection drug use

MA cities, bw 2015 and 2019 , 129 new HIV cases linked to drug use Fentanyl use driving HIV outbreak - two cities lawrence lowell MA , could result in national public health crisis 2015 opioid injection linked to HIV outbreak rural indiana Pervasive fentanyl have shorter half life than heroin so users inject more often, more exposure to dirty needles High rates of homelessness compound health risks and doctors also don't routinely screen for HIV, most new cases white men ages 20-39, people do not disclose their status even when using together bc stigma around hIV.

malawi

Malawi famine 2001-03 bc drought, famine had rapid effect on HIV prevelance through migration and increased transactional sex. 2015 malawi floods, drought 2016, author speculates malwi might provide example of aids as cause of state failure but this has not been case as the society has been resilience

Where information comes from

Most consistent prevalence data came from women in ANC surveys originally chosen bc blood routinely taken- women sexually active and data could be anonymous Men were excluded, younger women overrepresented bc more likely to fall pregnant, HIV positive and older women underrepresented as HIV infection and age reduces fertility Increasingly the best data come from population based surveys- representative HIV prevalence and provide information on characteristics associated with infection and risk. Most have been part of demographic and health surveys

what remains priority

Prevention must remain priority, treatment a lot more costly bc take for life, sima attached Risk includes anti gay legilslation in some african countries and russia, forcing them underground. Treatment as effective prevention tool

Natural and human disasters what results in being 3x more likely death from infection? resources ie doctors rural africa,

Real political impact from ensuring treatment affordable, increased risk of illness and death among poor shown in south africa, if obtain <80% prescription, 3x more likely to die Inconsistent drug supplies in some developing countries , evidence suggests patients just as adherent in developing and developed nations. South africa three sphere governance at national provincial and local . human resources for health generally constrained bc doctors seek practice in urban areas. Ie liberia 2 doctors for 100k people. US has 245 doctors for the same number.

thailand program microbicide, vertical transmission

Thailand 100% condom programme- required use of condoms in brothels and worked. Male condoms reduce heterosexual transmission by 80% and anal sex 60%. Sterilize needles, discourage needle sharing.community mobilization/leadership crucial to behavior change. Prevention of vertical transmission began 1994, drugs and treatment advances, pregnant women taking ARV. medical male circumcision reduces chances of infection. Ned for female controlled HIv prevention→ microbicide. Work in some trials but challenge in using gels constantly in the real world.

is future of aids predictable? why? what is not predictible about aids/hiv

The future of HIV/AIDS is reasonably predictable- unless mutates, will be contained -technology is advancing,prevention methods ie vaccines coming and also circumcision proven to reduce transmission impacts of HIV/AIDS is less certain

chapter 7- treatment and prevention dilemmas best way for healthy society

The public health context-best way for healthy society is to ensure people don't fall ill or have accidents.successful prevention and public health programmes most cost effective way to health. Medical interventions essential when disease, natural disaster etc. role of public health to keep people healthy at population level.

what percentage of prison population do women represent, what percentage women infected through heterosexual sex? incarceration rates in past few decades?

Women represent ,10% prison population in USa so that does not explain sharp increase in HIV among the group, one study claimed this is explained by hyper incarceration of black men- increased risk of infected partner-CDC estimates 87% women infected through heterosexual sex Incarceration rates quadrupled in past few decades→ available partners decrease for black women, overlapping partners, AA women more likely to have partner previously incarcerated Heterosexual AA women 2x rate of HIV infection compared to AA men, bc of women biological vulnerability higher, partners of heterosxual black men gorups of lower HIV risk,

down low theory & what must be focused on to reduce HIV/AIDS among AA

down low theory puts spotlight on wrong contributing factors- posits high numbers of bisexuals in AA community and focuses on sexual orientation rather than history of incarceration To reduce HIV/AIDS rates among AA must focus on structural factors ie reduce incarceration, improve healthcare access, HIV testing initiated in prisons, needle exchange, condom distribution

when was the name AIDS agreed on, how was it spread?

name AIDS agreed in washington 1982- results in deficiency within the immune system and not a single disease -in french portuguese and spanish known as SIDA -at this time, news of cases in ie europe, australia, african countries, mexico etc, uganda -not immediately clear cause of it /how spread - first thought unidentified virus

stigma and sexuality- percentage disclose to all sexual partners what was the confounding variable? stigma reduction and positive coping

perceived and internalized stigma rural HIV+ women related to depression, inversely to social support and quality of life quantitative studies relationship bw stigma and sexuality, 69%disclose status to all sexual partners CONFOUNDING VARIABLE=racial discriination 3 quantitative studies evaluated effectiveness of support groups,65% participants reduced risk behaviors as a result of attending women only support groups , 48% improved medical adherence 67% less shame felt 70% increased socialization outside the group. Women only as safer environment since they have different needs then hiv+ men

positive youth documentary how fast is HIV test

prick finger and find out blood test results of if HIV positive within 15 minutes

challenge after identifying how HIV was spread was to... early responses 3 but realized...

reduce transmission -early responses to improve blood safety, provide condoms, clean syringes and needles but soon realized that was not enough and needed to change behaviors -drugs to treat infected people- took fifteen years to develop effective antiretroviral therapies ART

Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review social stigmatization of HIV/AIDS due to ... how mitigate this?

social stigmatization of HIV/AIDs due to assumptions on transmission and behaviors→ well being of people living with chronic illness ie southern US holds highest incidence HIV rate in US -dialogue about moral implications of stigma is needed to mitigate the destructive effects of the stigma for women in the southern US

stigma define and relate to HIV stigma can be (3)

"attribute that is deeply discrediting" which reduces individual who possesses it "from a whole and usual person to a discounted one" This relates to psychosocial integrity of people who have HIV -shame attached to disease→ negative social reactions towards those people Stigma can be perceived (expectation of negative perceptions before experienced so limited disclosure) experienced (that which actually happens so racial discimination and rejection) or internalized (affects a person's own psycho self image and value). Women especially impacted by stigma, partially due to gender expectations

is this approach working? and what does he ask readers for help with?

-approach seems to be working based of preliminary findings from pilot program- black MSM valued it and felt empowered through education programs offered . Asks for readers help- funding that supports HIV prevention and treatment moved to biomedical model that relies on health system. Solutes will only accelerate if dismantle stigmas, inequalities built into health care system that make it untrustworthy and unreliable for black men

the realities of ie MSM sex workers transgenders IDUs underscore what? past two years...

-these realities underscore importance for response that is more inclusive of marginalized populations who have limited access to services -past 2 years=most successful for HIV epidemic, antiviral treatment advances, public health investments, vertical transmission reduction however this overshadowed by challenges of preventing infection -vaccine development efforts ie RV144 trial, CAPRISA 003, IPREX etc trials -use of antivirals etc have altered discourse in epidemic responses but these treatment programs must have indicator to identify populations who benefit most from such interventions -greater demands on surveillance systems Advances have introduced possibility of AIDS free generation

Soooo to sum up women at risk for IPV share similarities to at risk for HIV transmission 5 mechanisms involved in intersection of HIV and IPV condom use %

1. Childhood trauma associated with sexual risk behaviors 2. Traumatic forced seuxal activities 3. Violence limits womans ability to negotiate safer sex 4. HIV+ women who disclose status to partner at risk for IPV, 5. Pattern of violence against HIV+ women can interfere with health care Some studies examining IPV HIV include latinas, but recints hispanic 93% women experienced psychological abuse and 40% reported physical abuse 18-36 years old- found 61% did not use condoms and 13% fearful consequences if tried to use condoms. About 21% sample reported IPV

Across the world pressure caused by aids needs to be seen in the context of other stressors. 2

1. Climate change. Vulnerability to this - poor most exposed. Window of opportunity decreased, if someone sick at this crucial time can be catastrophic for crops harvested for a year 2.malnutrition huge impacts in high HIV areas, nutritional status as risk, undernourished more likely infection and if already infected dangers health, replicates more rapidly bc greater nutrition requirements. Art without food side effects.

Aids does not unite people politically. Social scientists identify three key factors for sustaining democratic rule

1. Contracting economies and growing inequality threaten 2. Need strong political institutions 3. Attitudes- people must want democracy. Aids could affect all 3 factors Where state cannot guarantee rights international community must assume some responsibility

results -Moneyham et al identified 4 predominant stigmatizing reactions by HIV+ women examples of health care provider stigmas and what was cited as reason

1. Physical distancing for fear of contagion b)overgeneralized stereotype of women as bad c)social discomfort of others when women discuss HIV diagnosis d)pity for the women Often judged as prostitutes, drug abuses, negatively at risk behaviors → shame Ie women HIV + claimed friends feared eating with them, touching them -older women in alabama reported not disclosing status to family bc fear of losing closeness Lack of education cited as reason, distancing common by healthcare providers ie refused surgery bc touching them bodily or used multiple gloves for any touching procedures

whiteside chapter 5 - production and people tracking social and economic impact of AIDS more complex than measuring demographic consequences bc 4

1.epidemic does not have long history and measuring what has happened , 2. research may not ask the right questions 3. Tension bw intensive ethnographic research at individual level and national survey instruments 4. People communities and economies have coping strategies→ adaptations so some predictions wrong

what named in 1987 and what is a zoonose

1987 name "human immunodeficiency virus" confirmed by international committee on taxonomy of viruses. Current accepted terminology is HIV/ AIDS -zoonoses-diseases that spread from animals to humans ie SARS -HIV is so far the most deadly pathogen that is a zoonose

1990s model- negative relationship bw HIV/AIDS and growth.however

1990s model- negative relationship bw HIV/AIDS and growth.however aids did not hurt economic growth in uganda botswana or south africa. Uganda has the worst epidemic in world had constant gdp growth and so did the other two countries. However may have grown faster w/o AIDS.extent not clear in macroeconomic terms so arguments about those effects of HIV weak.

heterosexuality as main route of transmission women, explain, why? studies suggest... why so vulnerable

1994 heterosexual trans passed IDU as route of tranmission US women→ aIDS Today is 60% of identifiable risk in women, trend expected to continue mostly bc heterosexual women are more likely to encounter an infected man. Biological and social susceptibility factors Studies suggest male to female trasnmissibilty is 2x that of the reverse, strong evidence for common sexual double standard, unequal econmic/social staus, power differentials that affect safer sex negotiations, women taught to put interests aside to please others Women espeically vulnerable with current long term male partner ie desires for trust and pleasure, assumption that is safe, also vulnaerable most in sex work, and rape

why southern women hiv/aids rates higher

2014 south US 37% of popuolation but 44% of HIV diagnosis and 52% new AIDS- bc lack of education, awareness, insurance, poverty, STIs, rurual settings, MSM majority but over ¼ new cases in US women (usually heterosexual intercourse and IDUs), sexual abuse south, perception of sexual promiscuity attached to hiv infection for women

SDG and critiques

2015 nations adopted sustainable development goals to replace MDGs. 17 goals, 169 targets, aim to wipe out extreme hunger/poverty by 2030, protect planet from env catastrophe Box 5- the health SDG. one health goal- ensure healthy lives and promote the wellbeing of all ages Critiques of SDG ie watered down MDGS, price tag 3t is unachievable

Austin Head

27 years old- gay- appeals to both sexes his friends say- has a weave , dresses very eccentric (ie christmas lights woven into his hair) Says everyone thinks his name is fake but he was actually born with this name Has been working in the club scene since 17 years old , gets out of quiet self and becomes loud when in this scene -says based on timing knows how he became positive- when 18 years old had someone worked with, decided to move to NY together, found apartmnet in Chelsea (gay mecca of NY) In chelsea highly populated gay parts, probobly one of two gay men have HIV -If get diagnosed with HIV probably will have full life today but will have health issues -different medications for different people- different strains have - unique to you Austin is on clinical trial (not everyone has ie insurance and clinical trials they will pay for the blood tests , medications etc and the one he is doing the medication would be 1500 a month) - studying hiv medication, monitoring you every step of the way, Side effects he has had ie lucid dreams, joint pain Your reputation if tell people is that you are the guy whose HIV positive, that's why must tell people who you trust

AZT vs today pricing , co infections, horizontal

AZT approved 1987, effective preventing HIV transmission mother to child. Virus quickly mutated and resistant to azt.1996 using three drugs in combinations, but drugs expensive 10k per year,so only rich. Action and advocacy about prices of these drugs, prices begin to fall, single daily dtablet. Drugs have side effects from nausea/diarrhoea/headaches to nerve damage, liver/kidney damage, fat redistribution,cardiovascular etc. if patients do not adhere to drug virus will develop , viral load up, fall ill. Adherence requires taking at least 80% drugs. Before can start treatment must be identified HIV+, counseled, viral load monitored. Co infections ie tb may need treatment. Initially treatment in vertical programmes where facilities focused on HIV, as HIV is seen as chronic, done in horizontal programs via standard public clinics. Costs to this ie less personal attention.

Findings Theme 1: Abuse- histories of traumas who did abusers inclulde why stay in relationships? threatas? did men who were spreading it know they had HIV

Abusers included close family members, spouses, through physical acts and neglect included beatings sexual assault rape emotional deprivation. Women rationalized the abuse called it "normal" and maintained that they somehow deserved it, traits of obedience Many reasoned stayed in such relationships bc nowhere else to go, many as both children and adults. A few reported fathers/steps molested or raped them.most mothers did not come to their aid, helpless. Some also forced to marry people they didn't want to or become prostitutes Also treat of deportion- being ie undocumented immigrants, many of their loved ones threatened to report them to authroities if they didn't keep quiet. Returning to home country might mean death giving lack of high quality.free medical care for HIV/AIDS in latin america and the caribbean -another type of abuse being infected by HIV men who knowingly spread it "There are certain men out there that figure you're positive, you're not going to find nobody. "Another woman in the group faced a similar situation, saying that she was too embarrassed to call her family and had to rely on her abusive boyfriend for assistance" "When I was being abused, I thought that was life; because my mother did it to me, my uncle and aunts did it to me, so what made me think that my husband wasn't going to do it to me?

community meetings explain, demographics ie high school education? emplowed? born in Us? HIV?

Also in addition to focus groups and interviews, two community meetings with 30 participants HIV+ Latinas. Audiotaped meetings and used data in final analysis. Technique used modeled action research approach of inquiry and participatory research. Helped author achieve accuracy of understanding themes from data. Demographics-29-60 years , mean age 43. 85% <high school education, 90% unemployed. 65% foreign born . all women HIV+, 40% no symptoms, 25% living with aids. 40% hetero sex, 55% sex with drug user, 10% IDUs, 5%blood transf.

result of project implications for future intervention

As a result of this project support group for women with HIV and victims of trauma established with one of agencies where data was collected prevention and research for both HIV infection and IPV should address the way LAtinos live and include structural factors that address context of poverty discimination racism etc HIV and IPV programs should include trauma informed prevention. Prevention efforts must derive from sociocultural definition of risk, power differentials, sociocultural context of relationship ie machismo and marianismo Themes emerged from study lay out a foundation on which to develop future research interventions prevention programs for latinas with histories of trauma Important to understand cultural construction of risk reduction ie how condom use cane be negotiated in power differentiated relationships Behavioral interventions not the only solution bc ipv and hiv not strictly related to individuals risky conditions. Need to be able to intervene with structural factors too ie many latinas economically dependent on men for support.

politics of HIV early 1980s

At first highly political late 1980s. Ie south africa reported 120, zimbabwe reported 119 so didn't exceed other country- no one wanted to be the country that had it ie india refused unaids to publish anything. Number of people infected matters for funding and support, on targeting the best place to put resources so accurate numbers are important. =numbers game

families and households ie effect when someone is sick if not enough resources through gov , who bears burden of care

Consequence of infection is stress Often identified if infant sick, can lead to family break up.illness affects individuals, can't engage in productive work. Labour lost but sick also need care. Sometimes from care and community where not enough resources through government. Household members care for one another. Expenditures reduced, people eat fewer meals, sell possessions. Hard to cope and support over time bc long periods of illness. Burden on grandparents (usually women) to care for them lots of the time, economic burden on them Household impact worst impacts of AIDS are visible **- burden of care. Medicine is not the only burden but also nutritious food and lost days of work

chapter 6-development, numbers and politics development what is it, why aids impact developing countreis more

Development and targets Development is more than macro econ growth. Real wealth of nation is its people so purpose of development to create an enabling environment for people to enjoy long healthy lives -aids impacts developing countries more. Adds burden to debt, structural adj,other disease When factored in rankings, changed immediately and significantly ie botswana

development of .... has gotten lots of atention and progress in calde b populations algorithmic approaches... HIV testing now regarded as...

Development of cost effective diagnostic tools for incidence assessment based on combinations of biomarkers has gotten lots of attention and progress in clade b populations -algorithmic approaches based on natural history of disease progression, virus evolution and immune responses- validated in non clade B populations for diagnostic and surveillance use -HIV testing now regarded as gateway to prevention/treatment where in past could lose job/social inclusion etc if tested HIV status.stigma and simran still barrier to access , have started ie home testing, provider initiated testing etc and rights of individuals to know HIV status in response

AIDS, conflict and security early advocacy platform what was hiv presented as? what is true though? miliatry populations and HIV epidemic leading to crises

Early advocacy platform, present HIV/AIDS as presenting a security risk. Time of conflict may be less spread of communicable disease, trade decreases borders close, mobility apart from refugees and armies is diminished. It is peace that poses bigger risk. Accepted idea before/suggestions that Military populations had high prevalence of hiv, but he concluded this was not the case, primarily young men, low levels. Hiv + usually includes person from recruitment, may result in termination . Little data that supports why epidemic might lead to crises 1990s, greater concern should be the impact of conflict and political instability on prevention and treatment

8 MDGS first international development targets. Set by UN 2000 run to 2015. Goals:

Eradicating extreme poverty and hunger Achieving universal primary education Promoting gender equality and empowering women Reducing child mortality Improving maternal health Combating HIv/AIDS malaria etc Ensuring environmental sustainability Developing a global partnership for development When mdgs were set not fully appreciated that AIDS would make achieving some difficult. Child mortality target worst affected. Goal 6 still remains the primary cause of death in some countries Still little appreciation of what hiv means for development targets

focus groups- what happened, what questions asked, were women paid? in depth interviews

Focus groups -demographic questionnaire given to each participant, info on age education level income HIV transmission mode, asked to describe selves in focus groups, questions ie how found out infected, does your partner know how to react, condoms?, forced to have unprotected sex? Were you ever abused as a child etc. became evident testimonies on these sensitive subjects empowered other women to tell their stories and fostered disclosure. Collective empowering , unique to latinas bc nurtures concept of familialism. Each woman paid 15$ to participate In depth interviews-5 women key informants from focus groups as having diverse experiences with IPV and HIV and particularly knowledgable.1.5 hour face to face interviews, each women 20$

how many genes HIV, what is its genetic material? conversion, what types dominant in US, southern africa, east africa, mutation

HIV converts viral RNA→ DNA before reproducing many RNA copies through reverse transcriptase. Conversion makes combating HIV difficult -each time occurs, chance of mutation which could enable sub types/clades of virus or evolve. Type B is the primary clade in the US, type C dominates southern africa, east africa types A and D most common, variety in west central africa Mutation is reason why cure not yet been found. HIV undermines human immune systems ability to fight infections bw HIV targets cells of the immune system- CD4 cells, primarily CD4 T cells which organize immune response to foreign bodies and infections, also attacks macrophages-immune cells which engulf foreign invaders in the body and recognize/instruct Some virus particles dormant in cells until replication activated- trigger could be infection ie TAB, or deterioration of immune system

HIV epidemic US with IDUS how did US react vs european countries to IDUS

HIV epidemic has gotten so severe in US got so severe due to IDUs, and policies trying to prevent it. Up through '96, 124k IDUs diagnosed in US whereas UK just 3.4k Arrived earlier in the US than it did in Europe. No one knew how severe epidemic was among IDUS until 1984 when antibody test found 50% drug users NYC and Edinburgh and 30% Amsterdam already infected→ germany needle vending machines, west europe needle exchange programs. Free syringes. US however refused to provide federal funds for needle exchanges, established in a few cities later but never coverage of countrywide programs unlike western europe. US stigmatized drug users in mid 80s a lot ie america in crack epidemic that was trying to stop. The ban on federal funding for needle exchanges wasn't lifted until 2009—and then got banned again in 2011.

HIV related stigma reduction interventions 3

HIV related stigma reduction interventions- interpersonal , interpersonal and structural. Intrapersonal- decreasing internalized stigma and effects on HIV pos women ie counseling. Interpersonal level-reduce external stigma through personal interactions/relationships including HIV education programs/care initiatives

what does IHME do? three broad categories of cause? when is it believed global incidence peaked? what are sustaining issues then?

HME produces data on burden of disease, looks at disability adjusted life years DALYs lost form three broad categories of cause: communicable, newborn, nutritional, and maternal causes; non communicable disease; and injuries in the 1990s HIV/AIDs ranked 33rd on global list, by 2010 ranked 5th. And in subsaharan africa went from 9th to 2nd during this period -is believed global HIV incidence might have peaked late 1990s, number of new infections falling. Issues are providing treatment, ensuring trends maintained, and reaching key populations

health care professionals with stigmas especially for HIV+ women who are pregnant

Healthcare providers being subset of this community influenced by moral assumptions about HIV but lack of education about transmission also widespread among healthcare professionals May also associate health changes in person infected solely to this Women become defined by their infection due to stigma, depression , internalization also with pregnancy- negative self image and personalized stigma increase pregnancy odds, high levels of disclosure related stigma and public attitude sigma decrease these odds HIV positive women who decide to carry to term also receive stigma during and after pregnancy regardless of medication to reduce transmission to the fetus.

Aids and the private sector effect of aids on private sector? zimbabwe law productivity of workforce due to illness

Impact of AIDS private sector depends on scale of epidemic in the country, role of gov regulations, capital/labour mix, some countries death results in rising costs and falling productivity, aids increases cost of doing business, 2000 zimbabwe law employed persons pay 3% taxable income towards hiv interventions Decreased productivity of workforce due to illness more complex, hard to measure except when workers paid according to output

importance o aids over time public sector majrity of people in high prevelence countries ...

Importance of aids has declined, private sector orgs that focused on aids before redefined their mandates, broadened them to include more health concerns H for HIV→ H for health Pharmaceutical companies benefit from epidemic (but pressure has caused them to bring down prices), non profit orgs, consultants . Majority of people in high prevalence countries dependent on subsistence agriculture (except for botswana and south africa). Rural pops in general less health facilities, illness more severe AIDS adverse effect on agriculture through impact on labor=evidence. Staff illness and death, declines morale , reduced area planted, changed crop mix to easier crops to cultivate, animal husbandry so livestock ie animals less attention=evidence.

natural disasters health concerns

In natural disasters, health concerns dominated by sanitary problems, overcrowding in camps, increased risk of cholera, diarrhoeal diseases, malaria, measles. Immediate need clean water and food. Also health worker strikes and drug stock outs ie month long strike south africa 2007 Political and economic failure also implications for health system, provision more difficult bc lack of drugs, insufficient workers. Ie result may be have to close hospital.. Enabling nurses to prescribe ART would help problem.

The US president's emergency plan for AIDS relief PEPFAR how many countries, how many people support, when initiatied

Inception in 2003, PEPFAR received strong bipartisan support in congress and admins, reauthorizations with majorities. The US is unquestionably the world's leader in responding to global hiv crisis. Through PEPFAR US supported safer world, strengthened global capacity to prevent, detect, respond to risks. Originally conceived as effort for services in countries hit hardest by hiv aids but now undertaking controlling the pandemic. Working in over 50 countries, has transformed global response, support more than 14 million people with ARV (just 50k on treatment in africa when pepfar began)

conclusion- main themes of this study showed.... fatalism.... findings suggested (bw HIV and IPV)

Main themes of this study reveal interwoven relationships among culture, gender, structural factors abuse and HIV Fatalism (external locus of control) emerged as a theme in latino culture that disempowers both women and men from taking action and changing risky behaviors/abusive situations Most women who had childhood/adult abuse faced, did not report or seek help Findings suggest HIV and IPV intersection variables and reality for many latinas. IPV histories of trauma and poverty, risk factors for STIS and HIV Cultural factors such as marianismo and machismo increase risk for HIV and beleifs like fatalism hamper latinas efforts to protect selves from sexual abuse Some women in the study were resilient, some left partners attributed to being HIV+ or support groups that empowered them

method for research, what a theory, what kind of research, participant eligibility

Method Grounded theory allows for the emergence of themes and development of questions for focus group Action research used as cooperative inquiry and involved females as informants in the process of evaluation of the themes found and putting them into action. Final layer of action research enlisted members from HIV+ latino community, providers, consumers in dialogue on HIV and IPV. direct result of study one of the involved agencies initiated support groups for hIv+ women who are victims of partner abuse Participant recruitment and eligibility Participants in this study were selected from 2 latino community based agents Nyc area that deal with IPV and services for HIV/AIDS. Participants qualified if reported some type of abuse being latina/hispanice, HIV+ and between 18-60 years old. 32 women participated in focus groups and 5 women as key informants for individual in depth interviews

statistics in africa ie which part of africa highest, women rate, how many people, 21st century has this decreased?

Nearly 26 million people in subsaharan africa with HIV- just over 70 percent of the global total Main mode transmission through heterosexual intercourse. Femals 58% infected. Africa has recent discriminatory actions against MSM -epidemic sub saharan africa divided into 4 geographical areas Southern africa has the highest HIV prevalence. Main story for HIV and AIDS in middle of the second decade of the 21st century is in africa. Prevalence reaching at unprecedented levels according to data from antenatal clinic surveys Death rates fall as prevalence rises as treatment improves and more ppl have access

next major advances HIV for treatment ? when should ART be initiated

Next major advance probably weekly pill injection, eventually one implant for months HIV drugs relatively expensive, also toxic so not all patients can tolerate ART should be initiated in all HIV+ people regardless of CD4 cell count, WHO suggests prioritizing stage 3&4 where not resources to do this or CD4 count<=350

activism in gay community US

One clear result of epidemic was activism began in gay community in US, ie ACT UP in the US created, in recoruse poor world TAC launched in south africa 1998 . uganda TASO 1987 Led to numerous ngos, social movements ie orphan support

Physical capital accumulation through what destroys human capital

Physical capital accumulation through savings and investment (individual company international levels) ie if have aids deplete savings to cope. High mortality destroys human capital /investments in education and skills

where find best data about info on hiv? politicians and treatment ,

Potential political impact is limited, best data from DARU, through national public attitude surveys with university of michigan. Political fallout through loss of leaders and voters, disengagement/disillusionment with the political process at all levels. ART changed ie deaths of politicians and politicians were among the first to access treatment. In elections, peoples primary concerns unemployment and poverty over hiv. Is not mentioned as one of the top 3 problems even in ie batswana south africans

PrEP assumes... future studies should provide 3

PrEP assumes people are comfortable discussing sexual behavior with health providers where this is not always true, only performed one study which included sufficient amount of trans people called iPrEx and suggested that those people that participated did not even take drug to prevent Future studies should provide medical and primary care services and integrate ie hormonal/surgical care with antiviral management, depression, substance abuse, housing instability etc Drugs transgender people are on also could interact with ie PrEP, not studied enough

prevalnce and incidence

Prevalence =absolute number of people infected- prevalence rate is the proportion of the population which has a disease at a particular time. With HIV, prevalence rates are given as percentage of specific segment of the population ie ages bw x and y , ANC patients, blood donors, or the at risk populations Incidence refers to the number of new infections over a given period of time. Incidence rate is the number per specified unit of population ie per 1000 or per 1 million, and time ie per day or weak. Measuring HIV incidence was complex and expensive People infected with HIV remain so for the rest of their lives, the only way they leave pool of infections is by dying so prevalence can keep rising even after incidence has peaked ART bottom page 15 Introduction of ART in year 9 means prevalence rises more rapidly but bc treatment reduces viral load and likelihood of transmission, decline in incidence is faster

prevention western countries ie activism 1980s when did number aids deaths peak

Prevention efforts different among countries ie lots of awareness efforts made in western countries including US, especially gay community group activists in US. IDUs in us were also educating each other, fewer partners share needles with, exchanges. By the mid-'80s, gay men and drug users knew about HIV, they knew about their risks, and they were making changes to reduce them. In all three countries, HIV incidence—the number of people contracting HIV each year—peaked in the mid-'80s, then started to drop as people de-risked their sex and drug use. But by this point many already infected, the number of deaths rose through early '90s *number of AIDs deaths per 100k people peaked around 1995 in US, UK, and germany

Public health believed for years that.... is this effective?

Public health believed for years education on avoiding HIV/AIDS, avoiding sex, using condoms etc to reduce incidence and this has worked more for gay/bsexuals minorities more than whites but prevalanee among blacks remain, so approach this way is ineffective, ignores systematic

Rakiya

Rakiya went to summer camp and met boy, did not think about the fact he was positive, she has it vicariously through her mother, (18 years old), started working at fifteen years old to help support family. Her mother was very anemic when brother was born so Rakya helps take care of him. Mom didn't know what to do because didn't want to pass her virus on to her child but she kept it Rakiya has been publicly speaking about HIV and AIDS for a long time - Mom started HIV meds when became pregnant with son, knew there would be side effects and quality of life would be affected but over the last ten years has been on medications- side effects ie bone marrow stops making red blood cells so became very anemic and tired all the time from first medication went on Huge stigma of HIV is really stigma of sexuality, socio-economic status, etc Rakiya says sometimes thinks about her mom not being there, it will be a struggle

Ryan White HIV/AIDS Program HRSA

Ryan white diagnosed with AIDS age 13 following blood transfusion Given 6 months to live, fought aids related discimination, rallied for the right to attend school , became the face of education for disease. the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people living with HIV who are uninsured and underserved. More than half of people living with diagnosed HIV in the United States receive services through the Ryan White HIV/AIDS Program each year. That means more than half a million people received services through the Program. Hrsa funds hundreds of grantees across the country without sufficient resources to cope with it Has def made a difference in terms of transmission during pregnancy. Uva New orleans- lots of ignorance about hiv disease, how its transmission, why it is so important to have other programs ie therapies to help people stay in treatment, helping with transportation, mental health, paying for medical bills. Support system huge. Able to regroup after katrina- at very sites where there was housing availability bc very limited University of nebraska-serve great number minorities, large population from southern sudan, latinos, asians. Rural population hard group bc lots of stigma, people are afraid to go because don't want to be seen so will travel further distances to go. Ryan white helps them with transportation.

stages of infection- WHO recognizes 4 disease stages

Stages of infection- WHO recognizes 4 disease stages. Developed in 1990, revised 2007 . do not require cd4 count Stage 1. Asymptomatic infection sage 4. Aids- occurs when a person is seriously ill with diseases like extrapulmonary TB, pneumocystis carinii , parasitic disease toxoplasmosis, meningitis

treatment exploits weaknesses of US healthcare system

Treatment exploits weaknesses of US healthcare system. Undiagnosed HIV infection ticking time bomb for those carrying it- chips away at immune systems, dec life expectancies, remain more infectious ie 50% transmissions by people who don't know they have it. If in UK and germany if test positive for HIV will immediately be referred to HIV clinic for tests to measure how much virus is in your blood, if skip viral load test will get call from clinic. 97% brits care within 3 months. US only 65% people, so more likely to die and pass it on. If you stop taking pills then start again, or forget to take them a lot , could develop a resistance to the drugs. Britain and germany ⅔ HIV+ HAART prescription. Only ⅓ america.most obvious reason is cost- in UK HIV treatment completely free, germany is 5 euros. US could be 2k a month. Unless poor, then medicaid covers it, Ryan white program with 2.4billion annual federal funding provides it for poor. The US has put huge efforts into this. Deep south is a lot worse than up north.

State of aRT so two standards, guidelines in poorer countries, lines of treatment, US, why so costly

Two standards of treatment. Virus strain identified in rich world, appropriate mix drugs prescribed, progress monitored. Ie by medicare/medicaid in US or private sector, national health services in most countries. Resource poor world therapies more limited. Target population used to be cd4 count <200. 2013 guidelines raised to 500. 2015 soon as HIV+. if develop resistance to first line treatment → 2nd-->3rd line treatment, costs a lot more. Immediate ARV doubles chances of staying healthy and surviving. Still, issue in many settings is cost especially bc need to take it for the rest of one's life, transportation to clinic, time off work etc, treated disrespectfully by staff -getting and taking drugs leads to stigma 59% adults and 68% of children eligible for treatment not getting it.

African americans, HIV, and mass incarceration US 2014 % infections AA in US vs % US AA and what x that of white and black men/women why are AA rates higher

US 2014 44% new HIV infections 48% AIDS diagnoses were AA even though only 12% pop 2016- CDC said HIV incidence black men 6x white men, black women 20x that of white women and 2x hispanic -HIV/AIDS prevention and treatment focussed on high risk individuals ie IDUs AA higher rates isn't bc of condom use, its bc of structural factors like health care access, disease prevalence in communities

methods/study for stigma

Understanding nature of stigma crucial to providing appropriate care to HIV positive women in south US- HIV related stigma among women in south understudied. . purpose of this study to analyze state of science regarding this, identify prominent gaps in literature, suggestions for future research among women in southern US

what are female risk categories considered to be what are the effects of this?/results in...

Unlike men, womens risk said to be IDU, heterosexual, and undefinable ie women who get HIV from haivng sex with men IDUs classified as under categoires of heterosexual transmission, results in bias for consitution of heterosexual transmission and erases possiblity of lesbian trasnmission. Woman who has long sesisons of oral sex w mulitple women but one heterosxexual contact counted as heterosxual risk→ need for greater intersectionality in surveillance categoires , reviews rescently found large amount female IDUS women are WSW but they are classfied as IDUS in terms of HIV and sexuality plays little prevention role Also WSW found to have more oral=penile and more anale intervource and less vaginal intercourse than hetreosexual women, will be counted as hetrosual trans risks though lesbians/bisexuals may not htink they are at risk but first case Female to female transmission ofHIV now documented due to use of sex toys, woman said told by physician to use protection only w her male partners

viral load testing over time transmission, what % transmission through sexual intercourse? vertical transmission?

Viral load testing increasingly available and less expensive- routine measurement recommended to diagnose treatment failure Transmission -hiv found in all body fluids of an infected person, minimall in sweat/saliva/tears. Exposure to blood heightened risk. Sexual intercourse most commmon source trasnmission 75%, heterosexual predominates, second most common spreading through drug injecting equipment- eastern eruope and asia especially. Passed from infected mothers to infants possible too.=vertical trans But can be prevented through drugs Women on treatment who do ART have little chance of transmitting HIV through breast milk Routes of exposure and risk of infection table page 27

what is unusual about the virus? what is most common transmission, then, then, then ?

Virus itself is unusual, comes from retrovirus and slow acting . most common transmission sexual intercourse followed by mother to child infection, sharing drug injecting equip, contaminated blood HIV and AIds is long-wave event-waves of spread and impact ie pg 5. First curve steadily rising and levelling off, second curve number of people cumulative who required treatment. Third curve=into the future, harder to forecast

another stigma reduction intervention/positive coping ... already named the first , name the other two

Visual media intervention- videos of hiv+ women and how they coped, improvement in NC women who viewed it, reduced internalized stigma, also helped women who lived in rural neighborhoods without transportation access since via online Discussion Knowledge on this subject far from comprehensive but study found pieces in the universal stigma framework

Theme 4: La Suerte

Vulnerability closely related to la suerte. Suerta aka luck and can either mean good or bad luck. Latino culture embraces idea that no ability to alter fate. Language itself in discussion is passive ie powerless. Powerlessness sense had a domino effect on them- that since did not have suerte in the beginning ie childhood, destined to lead poor and desperate lives. They also look to external source to redeem them. According to some participants- one either has or does not have good luck, that person's past is influential. Upbringing family culture all contribute to la suerte, as an immutable external force. That one person falls into bad luck cannot reverse.

what is not considered in this discourse? analysis of gender in relation to HIV must consider men and women made up of 3

What is not considered in the discourse is that in reality, men are also poisitioned in quite variable positions within social structures, involved in migration, also raped, sex work Ommitting discourse of heterosxual men's builnerability is alarming epidemiologically Analyses of gender in relation to HIV/AIDS must consider women and men privileges and inequalities made up of 1. Dif groups of women 2. Dominant male groups 3. Subordinated men ie marginalized racialized classes sexualized

where did women report stigmas and what is the effects of such stigma

Women most frequently reported stigma from family and friends, quanti study showed younger women more afraid of losing friends, AA women afraid family rejection, rejection of partners too in older women especially Women reported stigma in the workplace and neighborhoods too, even some lost jobs over status lack of disclosure and self isolation commonly reported manifestations of stigma, secrecy, to avoid stigma (phillips et al) rural women physically hide ie avoid family gatherings

affordability and access as issues why? ie what does ART cost per year in the three lines vs per capita health care per year

affordability and access remain life/death issue despite some price reductions by western pharmaceutical companies who are the main source of new drugs (cheaper ones in ie india) 2015 avg cost ART 115$ per patient per year second line 330 PPY, 3rd line 1500 PPy, but uganda spending on health care only 59$ per capita per year, malawi 26, south africa $593. Without treatment from ie state then would only be accessible to wealthy Poor people may also have no ability to clinics , right nutrition, etc

Jesse brown

apparently the longer he can prolong not going on them now, the longer his health will be in the long run by waiting now, his immune system goes up and down and up and down , fear of side effects of the drugs. Most of the new drugs don't tend to cause these effects though. Specialist tells him his immune system is already shut down, is having opportunistic infection , which will make his treatment much more difficult. That is important to know that the more people who get treated, the less transmission there is of HIV. if taking treatment and that treatment keeps viral low, definitely decreases chances.ne guy- 20 years old, gay, gets tested bc other people are, HIV+ and came out to paretns about both -not a death sentence- just because have HIV doesn't mean you will have aids, but is a chronic disease- manageable, but still have to deal with every day =family members afraid he'll get sick, or that he'll meet someone who won't be accepting of the fact he has HIV Met partner and told him on second or third date but he was ok with it, if take the right steps and careful the risks are almost non existent- have to use condom etc If someone is HIV positive but is on therapy/meds and virus suppressed, risk of transmission is much much lower

circumcision role in HIV contraction ie south africa studies the role of ART in prevention

circumcised men less likely to contract and pass on STIS as well as HIV, patterns (caldwell) South africa studies- circumcision 60% protective against HIV infection for men so that is recommended, HIV+ people taking ARVS more than 20x less likely to infect partners . gave rise to advocacy for treatment as prevention, reinforced by START study 2009-2015 in 35 countries, concluded early initiation of ART beneficial to all HIV infected individuals If a person is at risk ie needle stick injury, ART should be taken as soon as possible (PEP post exposure prophylaxis). Two drug remimen for four weeks, PEP can also be used for non occupaitional exposure ie unprotected sex HIV- people taking drugs to reduce the risk of infection While new infections fall, the number of infected people continues to rise

cultural factors implicated in IPV , what does this result in? machismo and marianista

cultural factors implicated in IPV ie demarcated gender roles/power differentials, gender norms This influences ie ability to stay in treatment, leave abusive relationships also additional structural factors like limited knowledge of US healthcare system, immigration status,financial hardships. Poverty unemployment, limited job skills, substance abuse risk factors and also cultural factors like stigma against condom use/lack of education on HIV, marianismo which requires submissiveness and obedience of women, passive in sexual interactions Traditional gender roles like machismo- encourages male duration and dictates sexual behavior like having multiple sexual partners. Both embedded in culture , can act as eithe risk of protection with HIV.AIDS. marinanista - women cannot know about sexual matters or negotiate safe sex, may have to bear abuse.

Potential of macroeconomic consequences and feedback loops gave rise for growth determined by... formula

early advocacy for allocation of resources for AIDS. answers to questions had ie economic returns to investments in HIV response magnify positive effects of investments? Etc- answers were not clear Growth determined by capital accumulation and total factor productivity. TFP variable - output not caused by inputs of labor and capital. AIDS assumed to affect growth through reduced savings and investment , cutting the size of labour force, efficiency/productivity losses

Theme 2: Living with HIV how did it affect relationships, what did HIV deprive them of? reactions to diagnoses

describes how participants health status influenced daily lives, at times defined everyday struggles, quality of relationships, giving men an excuse to be controlling. HIV also played a role in who they dated, felt trapped into adhering to traditional gender roles "It's not a latina's place to talk openly about sex", put them at risk for STIs and HIV, did not even consdier asking a partner about status or sexual practices -most women reported being HIV+ negatively affected relationships, infecting partner left relationship shortly after disclosure. -latinas struggling to find a partner who was willing to use condoms OR they won't wear one knowing female has it to "demonstrate his love"-He already knows I am HIV. He ain't scared to have HIV 'cause he loves me too much. -HIV robbed these women of dream of prosperity and happy future, some would prefer to return to homeland but believe cannot bc don't have home, health care might be unavilable in their native country too, being undocumented added tho their worries in US, poverty has driven many of their lives for years Many reactions to diagnosis =denial, fear, depression, loneliness, stress. Some suggested emotional losses worst HIV effects, that thought about suicide in the past, at some point accepted their status as a process.part of living with HIV is disclosing HIV status to others which came with fear of abandenment. One who got it from baby's father did not tell him and continued to have sex with im throughout ther pregnancy. Some latinas concerned would be labelled as prostitutes, scared to tell family

How do theories of gender address butch women if have sex w femme women w multiple boyfriends, or risks who embrace female masculinity across sexuality categories? theories of intersectionality

e do not know. Theories of intersectionality may not provide total solution but this could begin to place some populations/behaviors into existence while allowing for much needed contextual understandings and conceptions of at risk and vulnerable The US CDC is moving in this direction in terms of men's categories but not women Examining intersectionality and simultaneity of race class and shifting gender relations for women and men remains vital

kenya tea plantation private vs public sector options

ea plantation in kenya output amounts decreased pg 72 when infected. Once established on ART medication productivity recovered (plummeted immediately after initiating aRt then recover) Used more sick days though if HIV+ Private sector has a range of options for dealing with HIV from prevention to treatment of workers . today hiv included in broader wellness programmes, less clear how epidemic affects environment where company operates. Costs of public sector benefits borne by gov, costs of declining efficiency borne by society.public sector limited in capacity to respond, private sector many options is the difference

for many years what was flawed in trans studies

for many years studies did not differentiate trans women from cis men in studies but trans women have structural factors that increase % ie many settings transgenders rely on sexx work to survive bc poverty rates higher Trans men- limited studies , some sues lower HIV risks and others suggest elevated risk compared w cis men in same communities

politics what need

health responses to epidemic outbreaks focuses on technical and scientific., biomedical attitude of infectious disease. Aids become endemic and well understood but the politics of this are complex Needs political engagement on treatment prevention who gets what etc

widener university interdisciplinary sexuality research -2 parts

hifts to first person when talks about widener university interdisciplinary sexuality research- "our team" etc- team got grant in 2017 to take dual approach to problem in baltimore and jackson miss (two cities in top 10 HIV): 1. Sex education tools to empore blak gay and bisexual 2. Targeting ie doctors, specialists, mental health providers to make sure they know how to serve black gay men and aware of importance of viral suppression drugs. Claims they are taking holistic approach , addressing systemic barriers etc help them every step of journey

paper examines statment that

his paper examines the statement that women are especially vulnerable to HIV.AIDS in USA and worldwide, goal to exam nature of epidemiological classifications and discourse Also how these classifications limit meanings, fathomability of gendered and sexualized vulnerability to hiv (fathomability here=way social formations constituted as identifiable risky vulnerable etc)

HIV may not discriminate but structural inequalities do what is december considered? 1 in ___ black MSM have HIV, hb latino and whites? and why

ie december AIDS awareness month but stigma discrimination still there especially marginalized groups 1 in 2 black MSM HIV, 1 in four latino MSM, and in in 11 white MSM→ all bc structural inequality bc already facing negative cultural/structural problems oppression based on race, sexual orientation class, etc affect every aspect of person's life This is why black men who need access to medications such as truvada for PrEP, and TasP, facing most barriers to access, only 24% black gay and bi men with HIV stay in car compared to 43% white men (according to the Lancet)

The HIV life cycle elaborate on HIV mutates and affect virologists super infections

irus mutates and becomes resistant to drugs -drug combination should be tailored to variant of virus which infected=patient must do costly tests and drug combos from sophisticated labs HIV mutation could make the virus less or more deadly Virologists monitor virus/changes to warn of new developments HIV infected person could be re-infected with new strains of virus→ super infections

holistic framework gist- 5 doctors and goal

journal supplement was developed to provide info on HIV among trans individuals , includes dr tonia poteat, reviews global HIV epidemiology among transgender individuals. Then dr peter anderson discusses info about interaction of hormones and antiretroviral drugs. Dr robert grant what has been learned from iPrEX study, new directions. Dr reisner -holistic framework for optimal health needs of transgender people so if infected still live lifes. Dr garofalo discusses behavior interventions to optimize protection . DR Siskind- efforts at NIH ton clinical trials. Dr Hughes statistical considerations on populations not highly represented in general population but risk for HIV high. Dr Singh ethical considerations Goal of this supplement is to provide more holistic development on HIV prevention intervention for transgenders and on addressing social /structural issues civic equality etc

have hiv incidence and prevalence peaked yet? UNAIDS and WHO 4 epidemiological scenarios:

key features of the epidemic- HIV incidence and HIV prevalence have peaked. UNAIDS and WHO categorize four epidemiological scenairos: 1. Low level (here HIV has not spread to significant levels in any subpopulation bc networks of risk are diffuse 2. Concentrated- prevalence is high enough in one or more subpopulations ie MSM, IDUs, or sex workers and their clients- to maintian epidemic there, but virus is not circulating in gerneral population. 3. Generatlized- HIV prevalence is bw 1 and 5 percent in pregnant women. Presenese of HIV among general population is sufficient for sexual netowrking to drive the epidemic ie multiple partner relationships accounts fo rnew infections 4. Hyper-endemic- HIV is above 15 percent in adults in general population thorugh extensive heterosexual multiple concnerruent partner relations with low and inconcsisstent condom use. May be high levels of HIV stigma, gender based violence ie sexual coercion and gender inequality

Chris brooks

left home when 17 years old because mom was not accepting that he was gay, had to go back though bc got fired from job, evicted, etc. et a guy - says he wasn't being smart about using protection . around time decided to get HIV test was sick a lot, skin was blotchy, throwing up at work,diarrhea- called ex and said let's go get tested at 21 years old found out HIV+ Says he currently is not on meds, immune system is still strong has not gone on them yet but what happens when the immune system isn't working like it used to? He doesn't have a job, no income, etc says he feels like he is going through a midlife crisis at the age of 23, youtube ting, out in his community, talks to people about his experience- telling people to get tested,but at the same time he still has not told his mother= feels that his mother is not ready emotionally to hear this Stigma in A community- no one wants to talk about it, instead psychological phenomenon where sort of will separate self from person with HIV

TB and HIV- what % HIV related deaths does TB account for. what is their nickname together, one disease does what to the other? drugs

most diseases that affect HIV+ people not threat to others, but TB is! -TB accounts for 25% of all HIV related deaths, ⅓ worlds population harbours latent TB (people exposed to bacteria but not ill and do not infect others, HIV+ people over ¼ likely to develop TB. africa greatest proportion of new TB cases, generally treatable with four antimicrobial drugs over 6 month period , however without proper supervision could fail, also concern over multidrug resistant TB which when bacteria do not respond to first line drugs , costs up to 100x more 2006 report in South africa of extensively drug resistant TB XDR TB, few drugs effective, those patients tested for HIV and all positive HIV/AIDS and TB closely connected- co-epidemic- "terrible twins" , one disease speeds progress of others. TB shortens the survival of those with HIV and HIV+ increased likelihood of acquired TB, potential to make HIV broader public health issue

HIV tests-antibodies vs virus indirect tests vs direct tests

most hIV tests look for antibodies not the virus- if have antibodies, they are infected -most common test is the ELISA. Used to only be able to detect with blood samples but tests through saliva and others developed and easier -indirect tests such as ELISA cheap and quick, testing for the virus instead of antibodies sometimes preferable . direct testing involves a PCR using technique by which dna from cell can be replicated unit can be measured. indow period when an infected person may not be detectable by ELISA tests - should have 2 tests, three months apart to be sure Pg 25 viral load and CD4 cell counts over time Window period followed by long incubation sage- viruses and cells are reproducing rapidly and wiped out by each other- up to 5% of bodys cd4 cells may be destroyed by 10 billion new virus particles each day- eventually virus destroys immune cells more quickly than can be replaced

impacts are less certain but are confined to... what percentage of global total HIV in africa global average %

mpacts are less certain but confined to worst affected countries/marginal groups- mostly african- over 70% of the global total. Also some eastern europe countries may be impacted bc decline and ageing populations/HIV in young groups Greatest numbers consistently in Africa ie 1980 18k HIV US, 1keurope, 1k latin am, 41k sub saharan africa Global average of people 15 to 49 years old living with HIV has remained at 0.8% since 1999 .variation within countries

what is it important to uncover in relation to power /economies? identities ?

mportant to uncover the ways in which women and men gain or lo;se ground in given economies and what impact this has on power negotiations and risk in relationships 3. Individuals do not have singular identities within social structures but interacting. Ie evident epidemic in US disproportionate impact on the poorest and most marginalized women ie women in color in inner cities, young people ages 13-19 greater infections HIV women- so linkages with intersectionality with social and economic relations of inequality pg 6

second wave of feminism notion of sex/gender system what was recognized and how are men able to exert dominance? what two assumptions support this system?

notion of sex/gender system introduced during second wave of feminism, heterosexuality conceptualized as gendered and unequal material and social arrangeement. Basis for women's oppression as transformation of biological needs into system of social relations (gender) through kinship system were women treated as gifts in institution of marriage in exchange for men, who are the beneficiaries . this enables men to exert dominance over women, constraints women sexuality etc Two main assumptions support this system 1. Heterosxual women categorically oppressed and vulnerable where men powerful 2. sex/gender system is consituted by biological women who have one gender role known as feminiity while bioligcal men have one gender role aka masculinity.

Commentary: Who Is Epidemiologically Fathomable in the HIV/AIDS Epidemic? Gender, Sexuality, and Intersectionality in Public Health Author(s): Shari L. Dworkin what does this paper ask

paper examines nature of contemprary epidemiological classifications in HIV/AIDS epidemic, assumptiosn that guide vulnerabiity discourse, examines emphasis in public helath on frame of "vulnerable women" who aquire HIV through heterosexual trasnmission -paper asks why discourse of vulnerability is infusioned into discussions on heterosexualy active women's HIV risk but not heterosexually active men Surveillance categories applied to womens and mens risks in epidemic, theories of intersectionality , suggest future more productive options

transgender People and HIV Prevention: What We Know and What We Need to Know, a Call to Action explain biological, epidemiological and stuctural factors and individualized factors

ransgenders disproportionately affected by HIV particularly trans women, includes including biological (eg, increased efficiency of HIV transmission through receptive anal sex), epidemiological (eg, increased likelihood of having HIV-infected partners), structural (eg, social stigma limiting employment options),and individual factors (eg, internalized stigma leading to depression and substance use and risk-taking behaviors).

surveillance key populations

surveillance , access to hiv services , inclusion in programs etc has not yet begun ie MSM HIV incidence data only available for one african country (kenya ) and only thailand and china in east and must address these issues Expansion of HIV in EECA region in 2013 very challenging especially IDUs especially kazakhstan and kyrgyzstan, particularly by heroin Sub saharan africa young women acquire HIV in early teens, 5-7 years earlier than men, must prevent HIV infection in adolescent girls to break chain of transmission here

surveillance challenges 2013-

temporal trends of HIV prevalence data in populations monitor epidemic, identify priorities, target interventions and monitor impact , as HIV survival has increased prevalence much reliable indicator of HIV epidemic status at population levels -must include key populations, understand transmission dynamics, phylogenetic mapping, motion drug resistant strains, etc recognized as future HIV surveillance increasingly but lack of available diagnostic tools -growing recognition that need to measure incidence rates but ethical/financial implications so can't

Per capita income =

total country output/number people, US dollars expressed and then purchasing power. If people die contributing little then per capita income will increase. US=54370, qatar 137k, central af repub 607 $. In society where high unemployment , deaths will not have the same economic impact as deaths among skilled when skills shortage. -Oxford economists moral duty to rescue infected even if the cost of maintaining lives is low.

percentage of transgender popuolation, factors that increase HIV acquisition (3)

transgenders <1% Us population but epidemic prevalence in double digit % for trans women -factors that increase HIV acquisition include anal intercourse, high likelihood of partners with increased HIV risk , also internalized stigma-->depression/subs abuse→ risk increase

how does the virus work? source of HIV-1? when and where was earliest plasma sample of HIV found?when did HIv-2 cross into humans

two main types of the virus- HIV-1 and HIV-2. HIV-2 is harder to transmit and slower acting -both originate in simian (monkey) immunodeficiency viruses found in africa. Source of HIV-1 was chimps in central africa where HIV-2 derived in west africa from sooty mangabey monkeys -When virus crosses species barrier is still speculated, prob during butchering of bush meat tho -earlies plasma sample found to have HIV taken in democratic republic of congo 1960- scientists calculated HIV-1 originated bw 1884 and 1924 , HIV-2 crossed into humans in the 1940s

what would be the ultimate solution ? what was first worldwide disease to be eradicated? vaccine development, will money and science be enough?

ultimate solution to HIV would be scientific breaththrough providing cheap effective vaccine -first disease to be eradicated worldwide smallpox 1977, since then vaccines the move -progress towards HIV /AIDS vaccine is slow, only one vaccine has been found , reduced infections by 31% in thai military recruits and that's it -1995 AIDS vaccine advocacy coalition founded to develop HIV vaccines, estimates program providing 70% protection could reduce infections by 40% in the first 10 years and half 25 yrs Vaccine development is resource intensive , risks are high market limited Another option microbicide- substance inserted into vagina prior to intercourse that will kill viruses and bacteria but development has also been slow , numerous trials underway, uncertain when will be successful -money and science will not be enough to provide solutions to epidemic, even when vaccines do become available

Concept of AIDS transition- HIV prevention- UNAIDS goal

until # new infections falls below number deaths HIV infected people numbers needing treatment will rise. See page 97. If two lines don't cross, number continues to grow. When do cross→ economic transition HIV prevention UNAIDS seeks to end aids by 2030. 2001-2013 new infections declines by 38% and the trend continues. Today blood safety generally not an issue except emergencies, bc test donations. Social interventions ie behaviour change, advising condom use etc.

in absense of treatment what is consequence, how long is period from infection to ilness and what is linked to HIV? ie caloric needs, ass CD4 count falls... when ART becomes vital lazarus syndrome women more at risk then more or no?

yes women are more at risk In absence of treatment infections increase in frequency severity duration until person dies Period from infection to illness about 8 years-can be extended with lifestyle changes Nutrition diet and HIV linked, HIV can lead to malnutrition- patients with mild malnutrition twice as likely to die in the first three months of treatment -in severe malnutrition risk 6X greater Hungry individuals may feel taking ART leads to bad side effects so may skip treatment Infected ppl have greater calorie needs, 10% more energy in child, 20-30% if adult , sick children 50%-100% more As CD4 cell count falls and immune system compromised, infected person experiences opportunistic infections that rarely affect healthy people, most infections can be treated Eventually ART is vital- reduce viral activity, allow the immune system to recover and improve quality of life. 1991 in US Aids leading cause of death ages 25-44, into of ART 1996 caused mortality to plummet "lazarus syndrome" First effective drug was azidothymidine aka AZT trade name REtrovir- offered only ST benefits as resistance, found different combos of drugs on different stages of viral rep cycle most effective