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POPH8108 Social Determinants Of Health

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POPH8108 Social Determinants Of Health Question: Compare and contrast the impacts of social determinants of health in the context of HIV/AIDS. To make this comparison, use two of the following social determinants of health and one vulnerable group along with the corresponding countries.  Answer: Introduction Social determinants of health refer to factors in human economic and social environment which affect the health status of a person or a group of individuals (Braveman & Gottlieb, 2014). The social determinants to be discussed are the stigma and discrimination along with social justice; a vulnerable group is injecting drug users of Australia and USA. The essay will demonstrate the condition of Human ImmunodeficiencyVirus/Acquired Immune Dsficiency Syndrome in Australia and USA and compare the impacts of stigma and discrimination together with social justice on injecting drug users in the context of HIV/AIDS in the two nations. The use of heroin has increased among women and men in the United States of America across all income levels and in most age groups which have risen by 63 percent amidst 2000 and 2013. The contributing factor to the increase is the prescription of opioid misuse specifically in non-urban regions where formerly injecting drugs had not been a substantial problem which concurs with the rise in hepatitis C infections and the new outbreak of HIV/AIDS. For example, in 2015 Scott County in Indiana with a population of only 23,744 encountered 181 new HIV infections (Des Jarlais, 2017). The present statistics between 2008 and 2014 indicate that the annual number of new HIV/AIDS diagnosis among individuals who inject drugs decreased by 48 percent in the USA. However, the decline has slowed down, and there are concerns that it may reverse or stagnant because of the increased levels of injecting. 6 percent of new HIV/AIDS diagnosis in 2015 was characterized by injecting drug use and another 3 percent to male-to-male sexual contact along with injecting drug use (Spiller et al., 2015). Moreover, of the HIV/AIDS diagnosis attributed individuals who inject drugs, 41 percent were among women and 59 percent among men in 2015. When analyzed on ethnicity, 19 percent were among Latino people, 38 percent African American, and 40 percent among white people. In Australia, 2 percent of newly diagnosed HIV/AIDS infection cases were attributed to injecting drug use between 2008 and 2012 which indicates the success of prevention strategy of HIV/AIDS among individuals who inject drugs (Degenhardt et al., 2017). This success was supported by the early introduction and maintenance of syringe and needle programs along with the contribution of peer-based education and drug-user institutions in the avertion of HIV/AIDS. In 2015, 3 percent of transmissions were attributed to injecting drug use (Degenhardt et al., 2017). In the period between 2011 and 2015, a higher proportion of notifications of newly diagnosed HIV/AIDS infection were attributed to injecting drug use with 16 percent among the Aboriginal and 3 percent among the Torres Strait Islander population (Ward et al., 2014). Stigma And Discrimination The impacts of HIV-related stigma and discrimination continue to be a significant barrier to dealing successfully with the outbreak of HIV in Australia and around the globe (Johannson et al., 2017). This effect is not only felt by people living with HIV but also has direct repercussions on the public health retaliation of Australia to the epidemic by undermining avertion, care, and medication efforts. HIV related stigma and discrimination is a root of substantial harm in the lives of people resulting in the decline in health and quality of life via shame, anxiety, and depression along with social isolation (Major, Dovidio, Link & Calabrese, 2017). Also, in physical health social isolation is correlated with poorer adherence to HIV medication. In Australia, stigma, and discrimination has been discovered to result in several adverse health results given the strong association amidst poor health and stress (Wilson, Brener, Mao & Treloar, 2014). It has been demonstrated to elevate negative health behaviors like smoking and also it is a significant effect on the willingness of individuals to access general attention. However, in a study conducted in the USA to assess the relationship between the access to public care among low-income persons and the discerned stigma from a health care provider showed that stigma was substantially related to low access to general attention (Chaudoir & Fisher, 2017). This outcome suggested that the perceptions of patients that health care providers attend to them in a stigmatized and discriminatory way could significantly impact their use of necessary medical services. Moreover, fear has been associated with injecting drug users with HIV which impacts the uptake of HIV medications along with the adherence to HIV medication (Dawson et al., 2018). When individuals are stigmatized it becomes very hard to present to healthcare facilities for attention and this fear bars them from engaging with healthcare providers regarding risk behaviors and even preventing them from adhering to medication (Philbin, Hirsch, Wilson, Ly & Parker, 2018). These factors, in turn, pose a risk to the public health objectives of reducing the transmission of HIV/AIDS. For instance, in the USA, higher levels of stigma were related to not taking up HIV treatment together with lower HIV treatment adherence (Temoshok, 2016). This unwillingness to involve in medication seems to stem from fears around the undesirable revalation of one’s HIV status along with subsequent stigma and discrimination (GaddyNoy & Forstein, 2017). Notably, those injecting drug users with HIV felt that if they were seen collecting or taking their treatment their HIV status would be disclosed and therefore the shame of taking the medication in a social setting would contribute to poor treatment adherence (Ahmed et al., 2018). Stigma and discrimination are so prevalent in the USA than in Australia. As an illustration, individuals who live with HIV in the USA  do experience denial and termination of employment, loss of insurance coverage along with social isolation (Freeman et al., 2017). On the other hand, Australia does provide critical legal protections against discrimination by HIV status (Delany?Moretlwe et al., 2015). Social Justice My second social determinant of health was social justice. However, social justice is defined as the equal access to opportunities, wealth and privileges in a society (Bell & Adams, 2016). Considering the vulnerable group as the injecting drug users in the USA, this social determinant of health has several impacts within the context of HIV/AIDS. To start with, in the United States of America, the social justice has helped reduce HIV infection by setting aside save injection sites where there are fewer chances of blood transfusion among the individuals which might result to HIV infection (Fordham & Haase, 2018). There is also equal consideration to employment, and therefore individuals are in a position of using drugs with a sterile injection which they can afford instead of sharing due to poverty (Cloud et al., 2018). On the other hand, the social justice to the injecting drug users in Australia in the context of HIV has also had a high impact on the individuals. As an illustration, there has been low HIV infection among the injecting drug users in Australia. Supply restriction of drugs which is a kind of regulation of markets is one of the strategies that has helped in Australia. There is a peer-based organization in Australia which advocates for access to sterile injecting equipment and funding for peer education (Newland, Newman & Treloar, 2016). There are also programs that provide readily accessible sterile injecting equipment, syringe, and needles. In that case, social justice has helped Australia to control HIV infections among the injecting drug users (Newland, Newman & Treloar, 2016). This is the reason why Australia has maintained as one of the world’s lowest HIV infection rates among those who inject drugs (Madden, & Wodak, 2014). Social justice has an extraordinary impact to injecting drug users in Australia as compared to the USA in the context of HIV/AIDS. This is because Australia’s response to HIV is well regarded internationally and its model has been endorsed by WHO and hence used in other nations (World Health Organization, 2015). The international HIV funding from donor governments is contributed via multilateral along with bilateral channels. PEPFAR is among the bilateral funding sources committed by the government of USA to handle the world wide HIV/AIDS outbreak (Dieleman et al., 2015). On the other hand, Australia provide most of their HIV/AIDS funding via multilateral channels which may include UNITAD, Global Fund together with other United Nations agencies (Kates, Wexler, Lief & Joint United Nations Programme on HIV/AIDS, 2017). Recommendations I would recommend the injecting drug users both in Australia and USA to use preexposure prophylaxis for the avertion of HIV infection. Accordingly, programs, such as giving out injecting equipment such as syringes for free should be encouraged in both nations since some does not afford to buy such materials and if they end up sharing, then it can result to HIV infection (Green et al., 2017). Accordingly, save injecting sites should be increased where every drug user can access easily. Conclusion In summary, stigma and discrimination along with social justice are crucial social determinants of health to injecting drug users in the context of HIV. Stigma and discrimination usually discourage individuals from taking medication which makes their situations to worsen. Accordingly, social justice typically helps prevent the spread by the provision of resources such as equipment, fundings along with programs which happens to be educative. Therefore, the HIV prevention and harm reduction programs for injecting drug users should also highlight drug use stigma. References Ahmed, S., Autrey, J., Katz, I. T., Fox, M. P., Rosen, S., Onoya, D., … & Bor, J. (2018). Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low-and middle-income countries. Social Science & Medicine. Bell, L. A., & Adams, M. (2016). Theoretical foundations for social justice education. In Teaching for diversity and social justice (pp. 21-44). Routledge. Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31. Chaudoir, S. R., & Fisher, J. D. (2017). Stigma and the “Social Epidemic” of HIV: Understanding Bidirectional Mechanisms of Risk and Resilience. The Oxford Handbook of Stigma, Discrimination, and Health, 457. Cloud, D. H., Castillo, T., Brinkley-Rubinstein, L., Dubey, M., & Childs, R. (2018). Syringe Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm Reduction Coalition. Current HIV/AIDS Reports, 1-7. Dawson, L., Strathdee, S. A., London, A. J., Lancaster, K. E., Klitzman, R., Hoffman, I., … & Sugarman, J. (2018). Addressing ethical challenges in HIV prevention research with people who inject drugs. Journal of medical ethics, 44(3), 149-158. Degenhardt, L., Peacock, A., Colledge, S., Leung, J., Grebely, J., Vickerman, P., … & Lynskey, M. (2017). Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. The Lancet Global Health, 5(12), e1192-e1207. Delany?Moretlwe, S., Cowan, F. M., Busza, J., Bolton?Moore, C., Kelley, K., & Fairlie, L. (2015). Providing comprehensive health services for young key populations: needs, barriers and gaps. Journal of the International AIDS Society, 18, 19833. Des Jarlais, D. C. (2017). Harm reduction in the USA: the research perspective and an archive to David Purchase. Harm reduction journal, 14(1), 51. Dieleman, J. L., Graves, C., Johnson, E., Templin, T., Birger, M., Hamavid, H., … & Murray, C. J. (2015). Sources and focus of health development assistance, 1990–2014. Jama, 313(23), 2359-2368. Fordham, A., & Haase, H. (2018). The 2016 UNGASS on Drugs: A Catalyst for the Drug Policy Reform Movement. In Collapse of the Global Order on Drugs: From UNGASS 2016 to Review 2019 (pp. 21-47). Emerald Publishing Limited. Freeman, R., Gwadz, M. V., Silverman, E., Kutnick, A., Leonard, N. R., Ritchie, A. S., … & Martinez, B. Y. (2017). Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. International journal for equity in health, 16(1), 54. GaddyNoy, F. A. S., & Forstein, M. (2017). HIV AND AIDS IN THE AMERICAS. Comprehensive Textbook of AIDS Psychiatry: A Paradigm for Integrated Care. Green, T. C., Case, P., Fiske, H., Baird, J., Cabral, S., Burstein, D., … & Bratberg, J. (2017). Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. Journal of the American Pharmacists Association, 57(2), S19-S27. Johannson, A., Vorobjov, S., Heimer, R., Dovidio, J. F., & Uusküla, A. (2017). The role of internalized stigma in the disclosure of injecting drug use among people who inject drugs and self-report as HIV-positive in Kohtla-Järve, Estonia. AIDS and Behavior, 21(4), 1034-1043. Kates, J., Wexler, A., Lief, E., & Joint United Nations Programme on HIV/AIDS. (2017). Donor government funding for HIV in low-and middle-income countries in 2016. The Henry J Kaiser Family Foundation, Menlo Park. Madden, A., & Wodak, A. (2014). Australia’s response to HIV among people who inject drugs. AIDS Education and Prevention, 26(3), 234-244. Major, B., Dovidio, J. F., Link, B. G., & Calabrese, S. K. (2017). 1 Stigma and Its Implications for Health: Introduction and Overview. The Oxford Handbook of Stigma, Discrimination, and Health, 3. Newland, J., Newman, C., & Treloar, C. (2016). “We get by with a little help from our friends”: Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia. International Journal of Drug Policy, 34, 65-71. Philbin, M. M., Hirsch, J. S., Wilson, P. A., Ly, A. T., & Parker, R. G. (2018). Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access. PloS one, 13(4), e0195000. Spiller, M. W., Broz, D., Wejnert, C., Nerlander, L., & Paz-Bailey, G. (2015). HIV infection and HIV-associated behaviors among persons who inject drugs–20 cities, United States, 2012. MMWR. Morbidity and mortality weekly report, 64(10), 270-275. Temoshok, L. (2016). Adherence to Antiretroviral Therapy among Patients Attending an Inner-City HIV Primary Care Clinic: Non-obvious Factors are Most Important. J Hum Virol Retrovirol, 4(1), 00121. Ward, J., Costello-Czok, M., Willis, J., Saunders, M., & Shannon, C. (2014). So far, so good: Maintenance of prevention is required to stem HIV incidence in Aboriginal and Torres Strait Islander communities in Australia. AIDS education and prevention, 26(3), 267-279. Wilson, H., Brener, L., Mao, L., & Treloar, C. (2014). Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia. Drug and Alcohol Dependence, 144, 274-278. World Health Organization. (2015). The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2015 (including the 19th WHO Model List of Essential Medicines and the 5th WHO Model List of Essential Medicines for Children) (No. 994). World Health Organization.

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