Author: gacevedo

HIV/AIDS: A Highly Stigmatized Illness With the Capacity to Define a Person

In a society where being healthy is a high standard that people strive to attain, it can be very detrimental to a person when they are diagnosed with an illness that has no cure. The society we live in today has always been very individualistic in the sense that people are expected to become healthy and return to doing what they have been doing before they became sick. There is an idea that people who become sick could have avoided it by changing their lifestyle and habits. In this society, having any illness would make one feel like a burden, feel guilty, or have a sense of uselessness. Sadly, we live in a society where people with these illnesses are not treated with respect. As someone with a great family friend that was diagnosed with HIV, it can be heartbreaking to see the many ways that this diagnosis interferes with their self-image and life. As someone who also has hopes of going to medical school and becoming a doctor, the way that shame and disease can impact people is something that I want to keep in mind to provide patients with the best care. I hope to talk about the background of HIV/AIDS, the negative experience of people with illnesses and diseases, the impact of stigma and shame, and disparities in this disease that causes people with it to be an easy target for discrimination along with ways that physicians can slightly improve the experience. 

HIV/AIDS Background

HIV (human immunodeficiency virus) is a virus that attacks cells that help with fighting infections in the human body (“What Are..”). HIV can be contracted by having contact with bodily fluids such as sharing injection drug equipment along with unprotected sex. Leaving HIV untreated leads to AIDS which is acquired immunodeficiency syndrome (“What Are..”). Although there is no final cure for HIV, people can take antiretroviral medications that are used to treat it, helping people live longer lives (“HIV and..”). Although there are many ways to contract HIV/AIDS, with the most common being drug equipment and unprotected sex, casually interacting with people does not put you at risk which is what makes the discrimination people with HIV/AIDS face very disconcerting 

Source: HIVinfo.NIH.gov. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/basics-hiv-prevention

Experience of Illness: Stigma and Shame

My family friend with HIV/AIDS has mentioned to me many times that his friends would stop reaching out to him once they found out he had it and would describe how doctors would keep their distance from him. Illness can be defined by the human experience of having to live with the symptoms of pain and suffering. The definition of illness and disease is summed up well in Illness Narratives. Since illness is an experience one has to go through, people can become demoralized, lose hope, or feel as if they are a burden to the people that are taking care of them (Kleinman, 1988, Chapter 1). Disease refers to the problem from the physician’s perspective meaning the experience of one who lives with the illness is not taken into account. There is great danger in not considering the lived experience of a person with a disease and the many obstacles they encounter. HIV/AIDS is viewed as a major threat to the major values of American society. In today’s society, people with AIDS are blamed for their “promiscuous sexual practices” (Kleinman, 1988, Chapter 1). AIDS in a way brands the person with the idea that they deserved it for the way that they were acting (Kleinman, 1988, Chapter 1). 

In the case of Horacio Grippa, he not only had to deal with the symptoms that HIV/AIDS had on his body but also the way that he was treated because of it. His illness defined him in a way that got him kicked out of his apartment and made him lose his job as a teacher. He also mentioned how his nurses seemed scared to come close to him and how the doctors he would encounter would wear masks and gloves (Kleinman, 1988, Chapter 10). As a person who wants to become a doctor someday and knows someone with HIV/AIDS, reading this was emotionally taxing. For a patient, seeing a doctor should be a relief and someone that they can count on. The fact that some patients are still discriminated against because of having HIV/AIDS is truly concerning. When I become a doctor, I would hope to treat everyone with respect and make them feel safe and welcome because they already come to see you in a very vulnerable position. 

Disparities with HIV/AIDS that Lead to Easy Targets of Shame Along With Ways of Improving as a Medical Provider 

In the early stages of HIV/AIDS, the predominantly affected were homosexual and bisexual men since they made up 63% of AIDS-reported cases (Bosh et. al). In 1986, the CDC began to report the disproportionate effect that HIV/AIDS was having on African Americans and Latinos (“A Timeline”). The prevalence rate of HIV for African Americans is nearly eight times greater than for white people and three times higher than for Latinos (Geary). These statistics show that HIV/AIDS is common in minority communities that are already great targets for discrimination and shame. This can also make it easier to categorize a group of people and make them feel responsible for the high prevalence rates of HIV/AIDS.

Source: CDC Fact Sheet  Today’s HIV/AIDS Epidemic, 2016

There are many ways of improving the experience that patients encounter, especially when it relates to stigma and shame. As people that work in a clinic or are doctors, one can be understanding of the challenges that patients have such as obstacles that could cause them to need more time to make it to appointments in the example of using a wheelchair. Doctors must overcome certain biases that they are taught and always listen to their patients by not disregarding the symptoms that they are having. There must also be a reconceptualization of medical care where the physician shows empathy and takes the patient seriously. Although this will not solve all the problems and biases experienced by the patient, it would be the first major step in making them feel heard and important (Kleinman, 1988, Chapter 2).

References 

“A Timeline of HIV and AIDS.” HIV.gov, www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline.  

Bosh, KA, Hall, HI, Eastham, L, Daskalakis, D.C., Mermin, J.H. Estimated Annual Number of HIV Infections–United States, 1981-2019. MMWR Morb Wkly Rep. 2021 Jun 4;70(22):801-806. Doi 10.15585/mmwr.mm702a1. PMID: 34081686; PMCID: PMC8174674.

​​“CDC Fact Sheet: Today’s HIV/AIDS Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Aug. 2016, https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf

Geary, Adam A. Antiblack Racism and the AIDS Epidemic State Intimacies. Palgrave Macmillan, 2014. Accessed October 8 2022.

“HIV and AIDS: The Basics.” National Institutes of Health, U.S. Department of Health and Human Services, hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-aids-basics.

Kleinman, Arthur. The illness narratives: Suffering, healing, and the human condition. Basic Books, 2020.  https://books.google.com/books?hl=en&lr=&id=tV_ODwAAQBAJ&oi=fnd&pg=PT8&dq=illness+naratives+suffering+healing+and+the+human+condition&ots=vHKpCH05FJ&sig=bEjhFgb8K9POln0DYexQAwdBclA#v=onepage&q=illness%20naratives%20suffering%20healing%20and%20the%20human%20condition&f=false

“What Are HIV and AIDS?” HIV.gov, www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids/. 

Race and Poverty: Non-biological and Non-medical Factors that Greatly Influence Health Outcomes 

Race is a social construct that was created to categorize people and justify the atrocious acts of slavery and oppression. In reality, there is more genetic variation found within a racial group than between racial groups (Wu et al., 2005). Although race is not biological, the lack of healthcare access and significantly worse healthcare outcomes present in communities that suffer from poverty, oppression, and racism are staggering when compared to the outcomes found for the wealthiest Americans. Social determinants of health, racial domination, and racism in medicine are the root causes of this disparity found in the United States today. As someone who has parents that were born and raised in Mexico, I have seen firsthand the impact that poverty and lack of healthcare can have on racial minorities, especially with the recent COVID-19 pandemic. 

Defining Social Determinants of Health

I grew up in a very small town in west Omaha, Nebraska, which is a predominantly white community. I was the only person of color in my elementary school and middle school. I would notice that the houses were nice and my education system was great. Since we had many family members and friends who lived in south Omaha, where there is a predominant Latino presence, I would notice the instant differences between these two parts of the city. There is an abundance of fast food chains in south Omaha along with beaten down buildings, cramped housing, and trash accumulating on the streets. At this young age, I did not know that these differences in living conditions would cause staggering differences in health outcomes. 

Social determinants of health are defined as where people live, work, play, and age that affect a wide range of health functioning along with the quality of life outcomes and risks (“Social Determinants..”). They can be divided into domains which include economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social community context. Some examples of how these domains can affect health outcomes include being exposed to polluted air and water along with having access to safe housing and transportation (“Social Determinants..”). 

Photo retrieved from Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion

Income Inequality Across Different Races

Social determinants of health are the primary contributors to health disparities and inequalities since they can lower life expectancies and raise the risks of health conditions like heart disease and obesity. Since social determinants of health include where people live and the education people receive, it is no surprise that income plays an important role. Almost every chronic condition follows a pattern of rising prevalence with declining income. It is no surprise that racial minorities, such as Hispanics and African-Americans are the ones that face the lower end of income inequality, and therefore experience the worst health outcomes. In 2013, the median family wealth for the white population was more than 10 times that for Hispanics and 12 times that for African-Americans (Dickman et al., 2017). It does not help that the U.S. healthcare system contributes to this inequality because many people are not able to afford expensive medical care and high cost-sharing since the U.S. is by far the world’s most expensive medical care. Since the most burden is placed on the uninsured, they delay seeking medical care which causes a rise in their preventable deaths (Dickman et al., 2017). Likewise, there is strong evidence that the quality of care is worse for racial and ethnic minorities. For example, African-Americans are more likely to live closer to high-quality hospitals, but they are less likely to receive care there (Dickman et al., 2017). 

It is evident now that social determinants of health, such as income and where someone lives, have a greater effect on the health outcomes of certain people. This can explain why the Hispanic and African-American population is more likely to have certain diseases, especially in light of the recent COVID-19 pandemic. Black and Latinx people are twice as likely to die from COVID-19 than white people in the United States (Maxmen, 2021). Even from a young age, the differences I would experience in a predominantly white population compared to a Hispanic population are proof of the drastic difference that income can have on one’s living conditions.

Recent COVID-19 Pandemic on Racial Minorities 

The racial disparities found in the U.S. healthcare system are most noticed in the recent COVID-19 pandemic. I vividly remember how the pandemic affected everything around me. I was worried for my dad who still had to go to work because his job could not be remote. It upset me how there was no intervention or virtual option available for people like my dad. Most of the jobs that could go remote were the ones of office jobs or middle-class jobs that most racial minorities do not have. Many immigrants or minorities were not able to be cautious because they needed to work to maintain their families. It is upsetting to know that poverty and discrimination drive disease but so little is done to help with these disparities. 

 “Farmworkers don’t stop for a pandemic,” he says. “We keep working.”

“Inequalities Deadly Toll” (Maxmen, 2021)

As someone who grew up as part of the Latino community, I have heard quotes very similar to the one above. Almost everyone I knew continued working despite all the CDC recommendations because they would have no other ways to pay for bills and food. Black, Latinx, and Indigenous people have been affected by COVID-19 more than white people in the United States. Latinx food and agriculture workers experienced a nearly 60% increase in COVID-19-related deaths compared with the previous years when the increase for white workers was only 16% (Maxmen, 2021). It is upsetting that the U.S. relies on immigrant labor yet they are not provided with a living wage or affordable health care, although they are paying taxes. 

Lack of Healthcare For Immigrants

The uninsured face the greatest barriers to care, and among the non-elderly population, one in four lawfully present immigrants, and almost half of the undocumented immigrants were uninsured (“Health Coverage..”). Because many of these people do not have insurance, they are less likely to access healthcare even when they need it. The high cost of healthcare in the U.S. does not help as 33% of non citizens have reported not having a usual source of care and 10% not going with medical care due to its high cost which is shown in the figure below (“Health Coverage..”).

Source: KFF analysis of 2021 National Health Survey (NHIS) sample adult interview

Immigrants are not the only population that suffers from lack of health care, but also many citizens in the United States. Action must be taken to reduce these racial disparities that stem from differences in social determinants of health. It has been known for decades that poverty and discrimination drive diseases, and, unfortunately, COVID-19-related deaths is just another demonstration of racial inequality.  

References

Dickman, Samuel L., David U. Himmelstein, and Steffie Woolhandler. “Inequality and the health-care system in the USA.” The Lancet 389.10077 (2017): 1431-1441. https://www.sciencedirect.com/science/article/pii/S0140673617303987. Accessed 20 February 23.

“Health Coverage and Care of Immigrants.” KFF, 20 December 2022, https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-and-care-of-immigrants/. Accessed 18 February 23. 

Maxmen, Amy. “Inequality’s deadly toll.” Nature (2021). https://www.nature.com/immersive/d41586-021-00943-x/index.html. Accessed 18 February 23. 

“Social Determinants of Health.” Social Determinants of Health – Healthy People 2030, https://health.gov/healthypeople/priority-areas/social-determinants-health. Accessed 18 February 23. 

Wu, Zheng, and Christoph M. Schimmele. “Racial/ethnic variation in functional and self-reported health.” American Journal of Public Health 95.4 (2005): 710-716. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2003.027110. Accessed 19 February 23.