HIV+-+The+Silent+Killer

= HIV – The Silent Killer =

Brittany Eddy – n8580570 – Health Culture and Society - PUB209 - Michelle Newcomb

http://www.cdc.gov/nchhstp/newsroom/2012/HIVIncidenceGraphics.html

=__Artefact__=

This cultural artefact is a graph that shows the percentages of HIV infections in 2010 among different groups of people. These groups of people are men who have sex with men (MSM), men who have sex with men who are injecting drug users (MSM-IDU), injecting drug users (IDU) and heterosexuals. The proportions of new HIV infections are as follows: MSM 63%, heterosexual 25%, IDU 8% and MSM-IDU 3%. This pie-graph clearly shows the health inequalities that have arisen from the health problem of HIV and distinctly shows that there is are massive inequalities in transmissions. =__Public Health Issue__=

HIV among MSM is the chosen topic for this wiki. A notable increasing prevalence of HIV among MSM has been reported in Australia (CSIRO, 2008). HIV (or Human Immunodeficiency Virus) is a virus, which can lead to chronic illness and death, attacks the immune system, making it easier to contract illnesses (CAN, 1990). This priority health concern can be spread through semen, blood and breast milk (CDC, 2013). The rising issue of HIV has been of increasing prevalence since the 1990’s (CSIRO, 2008). Men who have sex with men have been marked as having higher proportions of HIV diagnoses and this has sparked the Australian government to make this a priority health issue in the National Strategy for HIV (Kirby, 2012). Men who have sex with men have been reported to account for 63% of all new diagnoses in Australia (Jaffe, 2007). 24, 731 Australians had HIV in 2011 and this number increased by 8.2% from the year previous (2010) (Kirby, 2012). This health issue has become strikingly important among the MSM community over recent years. =__Literature Review__=

In 2001, an article published in the American Journal of Public Health, named “ Are we headed for a resurgence of the HIV epidemic among men who have sex with men? ” investigated the likelihood of an epidemic of HIV in men who have sex with men (Wolitski, 2001). They observed that there have been significant increases per year of new diagnoses within the MSM community and predict that this will only continue to rise if something drastic is not done. This article implores health professionals to consider not only the implications of the HIV infection in itself, but also the associated health conditions such as physical, mental and sexual health that can result. The authors highlight the devastating loss of life that has been of consequence to this infection, reporting 260,000 deaths within the MSM community since the infection entered America (Wolitski, 2001). This article gives examples of serious issues that need to be addressed when looking into this particular health outcome, such as increased rates of STD’s and risky sexual behaviour, which are both very important factors to consider as they not only affect the lives of those with the diagnosis, but any sexual partners linked to HIV sufferers (Wolitski, 2001).

Not only does this article assess the health outcomes for this priority health issue, but so too does it address the risk factors that can be determinants of this problem, such as sexual risk taking, positive advertisements about the advancements in HIV treatments and an increased amount of men seeking ‘bare backing’ partners which could be a result of over-simplified sex safety advertising. Not only does this article address the determinants of the problem, implications of HIV for MSM who are diagnosed and their partners, it also addresses the issues that may face public health as a result. They talk about the risk that the public health system may need to increase funding to HIV intervention strategies and this may result in less money being spent elsewhere. They also discuss how more research and treatment will be needed in order to ensure that those diagnosed with HIV can manage the illness, this will also cause strain on the public health system. (Wolitski, 2001). This article, overall, was very effective in identifying the statistics related to the increase of HIV diagnoses in MSM, but also discussed in detail the determinants and health outcomes of HIV diagnosis.

In a journal called AIDS Education and Prevention, a systematic review of HIV prevention explored the reasons why there was an increase in HIV in an article titled “If HIV Prevention Works, Why Are Rates OF High-Risk Sexual Behaviour Increasing Among MSM?” (Elford, 2003). This article discusses possible reasons as to why there is an increase in HIV rates among MSM outlines possible determinants (focusing on high risk sexual practices) and explores what needs to be done to address this issue. The article states that between 1998 and 2002, the rates of unprotected sex doubled (alongside STD’s) and highlighted the imperative need to examine the risk factors for HIV acquisition. This article examines in depth health promotion methods and scrupulously questions, despite HIV interventions being majorly successful, the reasons why HIV continues to increase. They discussed a few systematic reviews that have been done and discussed how the results higlighted that most interventions were found to be effective. They then go on to question why it is, then, that this issue is increasing. The article authors hypothesise that to be successful in decreasing HIV rates, interventions need to be devoted to larger communities and implemented on a population scale rather than small community settings and randomized trials. They also suggest more research into the “mobility of success” and how to make interventions more flexible to suit adversity within communities. (Elford, 2003).

Although this article points out some important questions that need to be addressed, much of the research that was conducted, despite the article being written in 2002, was from before the introduction of the HIV treatment Highly Active Antiretroviral Therapy (HAART) in 1995, a treatment which had a massive impact on the death rates and quality of life of those with HIV. The systematic reviews that this article reported on focused on evidence that was released prior to HAART and therefore, this article is has many flaws due to changing statistics and changing interventions and may not be a reliable source of information. (Elford, 2003).

=Cultural and Social Analysis=

HIV is something that was relatively unheard of before 1983, where a sudden breakout saw many people in the gay community being diagnosed and this number has increased since then (HIVINSITE, 2013). A major reason why HIV was more predominant in gay communities can be attributed to a few things, including the very little sexual health education targeted at the LGBT community, so many didn’t understand the implications of unprotected anal sex. Not only this, but many researchers have noted a correlation between high rates of drug use among MSM and increased prevalence of HIV and risk taking behaviour (including unprotected anal intercourse) (Purcell and Parsons et al., 2001). There are a number of reasons why MSM are more likely to partake in risk taking behaviours, but a large proportion of the reasoning can be attributed to the severe marginalisation and discrimination that occurs within this community and oftentimes, mental health issues and substance abuse result, which leads to increased predisposition to HIV acquisition.

It has also been identified that MSM in lower socio-economic areas are more likely to have HIV and countries such as China have seen a recent dramatic increase in HIV diagnoses (Gao, 2007). Certain areas around the world are more prone to increases in HIV diagnoses, due to stigma within cultures that result from unaccepting communities which can be due to religious reasons or purely societal norms (Baral, 2009). There are still many countries where it is illegal to be gay and this often results in much less information about the dangers of HIV and subsequently, increased rates of mental health issues, substance abuse and unprotected sex, which are all very important determinants of the problem (Kok, 2007). According to the Social Cognitive Theory, having access to correct health information is crucial when acknowledging when one needs to change their behaviour (Theory At A Glance, 2005). Unfortunately, the access MSM have to this information is extremely limited. The imperative need for sexual health education specifically tailored to MSM is unaddressed within school curriculums and instead the sexual health education curriculum within Australia only mentions safe sexual practices not specific to sexual orientation and places an emphasis on preventing contraception (Australian Curriculum, 2013). This could be due to the stigma that is still attached, but this is extremely important when assessing the reasons why HIV rates are higher among MSM.

Among many studies focussing on intervention methods for HIV in MSM, one of the preliminary baseline questions often relates to knowledge about HIV and this is extremely diminished among many MSM (Jewkes, 2006). Knowledge about the issue is the first step, and with very little funding from the government and very little media coverage of the issue, it is very hard for MSM to actually receive accurate information on the topic and therefore safe sex can be a lower priority for MSM as they don’t fully understand the implications that can arise. As addressed previously, the sudden infection of HIV within western cultures arose in the early 1980’s, but with the introduction of HAART in 1995, the death rates dropped dramatically (HIVINSITE, 2013). With the number of diagnoses still increasing dramatically, it’s important to address this issue and encourage more public health programs to continue to implement interventions targeted at this group and of those successful interventions, apply them on a widespread community scale.

=Analysis of the Artefact and Own Learning Reflections=

This artefact is a very bold way to describe the extremely prevalent issue that is becoming an important health inequality that needs to be addressed across the world. The artefact exemplifies the imperative need for health education and behaviour change within communities and it also makes it very clear to see that MSM are disproportionately affected by this health issue. This issue is very close to my heart, my brother is gay and he experienced an insane amount of discrimination and marginalisation growing up, and it was not until I did this piece of assessment that I realised just how significant the health inequalities he faces are. With a large number of gay male friends, I have spread the message to them after learning about how little information there is out there and in the future, I will encourage my friends and acquaintances to stop discriminating against this minority group and encourage others to do the same. This assessment piece has taught me that, as part of my degree, I need to critically assess the health of people in a way that goes beyond how people look or feel at the present time, and instead think about the determinants of these health issues and how behaviours can lead to serious health problems.

=Comments on other wikis:=

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=References=

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<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Baral S, Trapence G, Motimedi F, Umar E, Iipinge S, et al. (2009) HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana. PLoS ONE 4(3): e4997. doi:10.1371/journal.pone.0004997

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Elford, J. and Hard, G. (2013). If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM?. //AIDS Education and Prevention//, 15 (4), pp. 294-308. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/14516015 [Accessed: 25 Oct 2013].

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