literature review :How inequality contributes to HIV/AIDS

How inequality contributes to HIV/AIDS

This literature review assesses the impact of inequality on HIV/AIDS, and discusses the implication of research and policy for social workers. The first inequality explained is gender inequality. The different forms of gender explained include male, female, and non-gender conforming LGBTQ identified individuals. Besides social exclusion and discrimination, economic insecurity affects especially women’s ability to access HIV/AIDS care and treatment. The second inequality explained is racial and ethnic inequality where African Americans and Latinos, regardless of their gender, have significantly less access to HIV/AIDS care and treatment compared to Whites. However, some scholars and policy makers argue that these minority groups with HIV/AIDS, despite their economic disadvantage, have adequate support and resources. The final inequality explained regards adequate access to information on HIV/AIDS. Inadequate access to information that educates on the spread of the virus leaves populations within communities of color susceptible to infection. Both research and policy have implications on social work practices.

How inequality contributes to HIV/AIDS

Introduction

There is a disproportional share of HIV/AIDS cases globally. Over recent and previous decades, significant evidence has shown that social factors affect health outcomes (Bekalu & Eggermont, 2014). Currently, HIV/AIDS outcomes are significantly affected by inequalities in social elements that include gender, race, and communication. The spread of HIV/AIDS is prevalent because marginalized groups suffer from discrimination, limited access to HIV/AIDS care, treatment, and information (Strug et al., 2002). It is imperative to point out that in the US, the spread of HIV/AIDS occurs mainly through unprotected anal and/ or vaginal sex, as well as the sharing of intravenous drugs equipment with people infected with the virus and from mother to child during or after pregnancy (Santana et al., 2006). Literature on transmission of HIV among the marginalized groups identify that particular individuals are susceptible to the infection. The first group encompasses people of minority genders. The second group consists of people of minority ethnicities. The final group entails individuals with limited access to modern sources of information, such as the digital and social media platforms. Subsequently, for these people, access to non-discriminatory adequate HIV/AIDS care and treatment remains a significant concern that demands the attention of social work professionals.

Gender Inequality

Research shows that gender inequalities, such as gender-based and intimate partner violence, have a significant impact on the spread and prevalence of HIV/AIDS. These inequalities increase the psychological vulnerability for women and most importantly, the lesbian, gay, bisexual, transgender, questioning, queer (LGBTQ) community to HIV, subsequently blocking their access to HIV/AIDS services (UNAIDS, 2016). According to the World Health Organization (2017), HIV/AIDS is not only promoted by gender inequality, but also entrenches this form of unfairness. This leaves not only women, but also LGBTQ identified individuals more vulnerable to its consequences. For example, in most countries, women have inadequate access to quality healthcare services, experience stigma and discrimination, and are highly abused and their sexual and reproductive rights violated (World Health Organization, 2017).
What is more, female health and economic insecurity play a major role in the HIV/AIDS prevalence among women. The Center for Disease Prevention and Control (2017a), points that considering that women may be unaware of the HIV risk factors their male partners are exposed to, such as IV drug use and MSM behaviors, they may fail to use condoms. When HIV preventing methods are not used, women are at higher risk than men to contract HIV through vaginal and more so anal sex. A behavioral survey conducted in the US among heterosexual women showed that 92 percent and 25 percent of the respondents had vaginal sex and anal sex, respectively, without a condom (CDC, 2017a). Meanwhile, due to economic hardship, some women are forced to take risky sexual behaviors such as prostitution to secure their financial future (Miles, 2012). According to Miles (2012), female sex workers are at risk of contracting HIV/AIDS because of multiple sexual partners. For these women, financial security remains paramount over personal health. Unfortunately, some of the women, which also to commercial male sex workers, find themselves in a position to negotiate about the use of condoms with their clients. The risk of transmission further increases as a result of forced and violent sex (Miles, 2012).

Moreover, empirical evidence shows that LGBTQ identified individuals also face gender inequality in HIV/AIDS. Strug et al. (2002), established that individuals identified as gay, especially those of color, have to deal with inequality. In a study conducted in the US, among black gay men, 26 percent of the respondents were aware of their HIV positive status, and less than 29 percent were receiving anti-HIV therapy and medical care (Strug et al., 2002). Furthermore, transgender people experience stigma, discrimination, exclusion, and social rejection that discourage them from fully participating in the society, such as accessing health care, health and formal education, employment, as well as housing (CDC, 2017b). These factors affect the health and wellbeing of transgender communities, exposing them to increased HIV/AIDS risk. What is more, the Center for Disease Prevention and Control (2017b), established a surge of insensitivity to transgender issues by the primary health care providers, which has a significant impact on newly HIV diagnosed transgender people and their ability to seek quality treatment and care services. The organization maintains that few health care provides either access proper training or are knowledgeable about transgender healthcare related issues and their special needs (CDC, 2017b). This contributes to negative HIV/AIDS encounters, more so, for women and LGBTQ identified individuals. Overall, HIV disproportionately, affects the females, gays, and transgender people because of their unequal social, cultural, and economic status in the society, demonstrating that gender inequality must be addressed to stop the HIV/AIDS epidemic.

Racial/Ethnic Inequality

Significant literature reveals that racial and ethnic inequality plays a major role in the spread and prevalence of HIV/AIDS. Miles (2012), embarked on a study to assess the inconsistencies related to how HIV/AIDS is addressed within the public realm. According to Miles (2012), minority groups living in bifurcated contexts tend to be marginalized in light of opportunity and outcomes. Those who live in poor conditions do not have access to resources that promote healthy living, and thus, are susceptible to diseases in general besides being discouraged to curtail high-risk behaviors (Miles, 2012). Statistics reported by the Center for Disease Prevention and Control (2017c), shows that while African Americans are only 12 percent of the population, they account for the highest proportion of new HIV/AIDS diagnoses and those living with the virus than any other ethnicity or race in the US. For instance, in 2015, the African Americans accounted for nearly half (45 percent) of HIV/AIDS diagnoses in the US, with the majority of the population being men (CDC, 2017c). Overall, gay and bisexual African Americans comprised of more than half (58 percent) of African Americans diagnosed with HIV/AIDS. Strug et al. (2002), demonstrates that HIV cases among Hispanics also outnumber that of whites, while African Americans continue to top the HIV proportion in terms of diagnoses and deaths. Among African American and Hispanic women, most of those diagnosed with HIV are of childbearing age, all accounting for 81 percent of new diagnoses (Strug et al., 2002). Miles (2012), however, points at a contradictory aspect of inequality and access to HIV/AIDS intervention programs. The author demonstrates that racial and ethnic minority groups, which tend to be economically disadvantaged, have better access to medical care, proper nutrition, and healthy living conditions (Miles, 2012). Apparently, the government politically out much effort through policy to provide HIV/AIDS support. According to Miles (2012), sociologists have established that the political economy of HIV/AIDS that extends its reach into the ethnic minority groups is because of racism, classism, and poverty, leading to loss of self-efficacy. This loss of efficacy influences women, gays, and bisexuals in the minority communities to tolerate unsafe sexual attitude and behavior of their sexual partners.

Communication inequality

Other studies reveal that communication inequality significantly contributes to the spread and prevalence of HIV/AIDS. Bekalu and Eggermont (2014), embarked on a study to establish how communication inequality contributed to socioecological and socioeconomic disparities in the knowledge and risk perception of HIV/AIDS. The study was conducted in Ethiopia, in both urban and rural settings. The authors concluded that indeed, communication inequality between urban and rural dwellers significantly affected HIV/AIDS outcomes in both settings (Bekalu & Eggermont, 2014). Significant studies, maintain Bekalu and Eggermont (2014), have shown that communication inequality remains a crucial factor that offers a significant explanation for poor health outcomes. Health communication outcomes, including seeking health information and exposing oneself to and trusting health information from different media sources are linked to health outcomes. Thus, according to Bekalu and Eggermont (2014), negative health outcomes are associated with inequality in the access to, trust in, and the use of health information, and this is not limited to the information source, but rather the dissemination of that information, for instance, via the internet. Apparently, not everyone has access to the internet, which is currently the most prevalent source of information. Those who have access to the internet and are able to use the information obtained therein have particular characteristics: young, better-educated, high income, urban dwellers (Pew Research Center, 2017). This disparity in terms of internet access contributes to significant poor health, a sentiment that is consistent with Bekalu and Eggermont’s (2014) prediction. In their study, the scholars demonstrated that HIV/AIDS communication inequality in rural and urban areas contributed to poor HIV/AIDS knowledge and exacerbated risk behaviors in rural areas than urban areas (Bekalu & Eggermont, 2014). That is because the risk perception among the rural dwellers was quite low as they barely access information concerning HIV/AIDS.

Implications of Research and Policy on a Social Work level

Research and policy on HIV/AIDS significantly influence social work practices. Wheeler (2007), sought to assess the direction in which social work practice is headed to in light of HIV/AIDS work. The study demonstrates that social workers in the US currently face changing demographics of HIV/AIDS. For instance, more black and Latino gay men and women are exposed to HIV/AIDS compared to white gay men (Wheeler, 2007). Today, there are more HIV/AIDS testing and intervention programs than before, and many people are diagnosed with HIV/AIDS because of more rapid testing programs Wheeler (2007), therefore, argues that social workers are committed to working with PLWHA. In another study, Strug et al. (2002), embarked on assessing the challenges and the challenging HIV/AIDS social work roles and their impact on social work training and education. The article acknowledges the significant change in social work because of increased HIV/AIDS intervention methods such as medication, noting that HIV/AIDS social work has fundamentally transformed following the introduction of medication, which have prolonged the lives of PLWHA (Strug et al., 2002). Strug et al. (2002), explain that earlier, social worker took part in assisting people to find housing, and for those with chronic illnesses, assisting them with will preparation to ensure their valued possession ended up in the hands of their loved ones. Today, social workers must be knowledgeable about antiretroviral therapy (ART) to promote medication adherence by assisting and following up patients with their treatment.

Notably, HIV/AIDS is widespread among heterosexuals, LGBTQ community, IV drug users and their sexual partners, women, children, and different ethnicities (Strug et al., 2002). These demographics, further stretch HIV/AIDS social work, creating new challenges for practitioners, scholars, and policy-makers in the field. Strug et al. (2002), assert that because of the long-term illness, social work professionals expect that eventually, all their clients will die, leading to stress and hopelessness. Moreover, in 2015, the World Health Organization recommended immediate ART to PLWHA; for those substantially at risk of infection, the organization recommended pre-exposure prophylaxis as an additional preventive measure (WHO, 2017). As such, social workers are compelled to convince HIV positive breastfeeding mothers to not only take their medication but also provide PrEP for their breastfeeding children. Moreover, the World Health Organization (2017), maintains that married women on ART must be persuaded to influence their sexual partners to get tested and be enrolled on either ART (if tested HIV positive) or PrEP (if tested HIV negative). Through a women centered approach, social workers ensure that women are provided with information and options to make informed choices (WHO, 2017).

According to Barbour (1994), social workers have the responsibility to not only educate but also convince PLWHA to take medication while remaining ethical in their practice. Barbour (1994), embarked on a study to assess the experiences of social workers who work with PLWHA. In the comprehensive overview of research conducted on professionals and volunteers in different locations, the authors concluded that on the job experiences significantly affected social work ethics, client interaction, training, collaboration, and psychosocial wellness. Apparently, volunteers, who must apply the knowledge and ethics of social work, are most impacted by HIV/AIDS work than professionals (Barbour, 1994). HIV/AIDS policy recommends a combination of anti-HIV drugs to successfully suppress the virus, but this must be done regularly considering a long-term medication does not currently exist. Social workers must also recognize, based on research, that HIV infection can also become permanently resistant to the anti-HIV drugs (Strug et al., 2002). As such, they are bound to educate PLWHA on medication adherence to avoid incomplete suppression of virus replication as a result of incorrect use of medication, which causes resistant viral variants to crop up. Even so, social work practitioners are likely to face ethical issues and professional dilemmas when performing their professional responsibilities. For instance, social workers’ professional values and training may conflict with clients’ values such as regarding infected women’s reproductive health decisions, be concerned about their rights to know the individual clients with HIV/AIDS infection when HIV status remains confidential, and have issues with partner notification, as well as mandatory testing for discordant couples, among other things.
Research further shows that thousands of new HIV/AIDS infections continue to occur annually (Center for Disease Prevention and Control, 2017a, b, c). In that regard, social work practitioners have the responsibility to become increasingly involved in the primary prevention efforts to address the epidemic. More so, social workers must actively collaborate with researchers and policymakers to address the issues facing HIV/AIDS social work (Wheeler, 2007). According to Strug et al. (2002), there exist greater possibilities for social workers to find themselves taking up roles as researchers and/or participants in social science collaborative projects. With more social workers getting involved in primary prevention, they are forced to adhere to the current HIV/AIDS policies as well as implement policies that guide social work practice. For example, the International Federation of Social Workers (2018), demands for social work professionals to collaborate with health institutions and professionals, families, community, and the individual to promote sustainable comprehensive care and treatment. As such, social workers are likely to play the role of primary prevention of HIV/AIDS through service delivery, research, and policy formulation and implementation to assist the uninfected individuals at risk of HIV/AIDS infection and curtail risky behaviors, such as unsafe sex.

Conclusion

In sum, this literature review has discussed the issue of inequality regarding the current HIV/AIDS epidemic. More so, it has unearthed conclusive arguments that that social workers are seen as important in their roles with PLWHA and are encouraged to marshal up their resources to ensure that the adverse impacts of HIV/AIDS within the minority groups are addressed professionally. Gender inequalities, such as gender-based and intimate partner violence, have a significant impact on the spread and prevalence of HIV/AIDS. HIV disproportionately, affects the female and transgender people because of their unequal social, cultural, and economic status in the society, demonstrating that gender inequality must be addressed to stop the HIV/AIDS epidemic. In addition, racial and ethnic inequality plays a major role in the spread and prevalence of HIV/AIDS. Apparently, the political economy of HIV/AIDS that extends its reach into the ethnic minority groups is because of racism, classism, and poverty, leading to loss of self-efficacy, influencing women, gays, and bisexuals in the minority communities to tolerate unsafe sexual attitude and behavior of their sexual partners. Moreover, there is no doubt that communication inequality significantly contributes to the spread and prevalence of HIV/AIDS. Apparently, not everyone has access to the internet, which is currently the most prevalent source of information on HIV/AIDS. As such, social workers are likely to play the role of primary prevention of HIV/AIDS through service delivery, research, and policy formulation to assist the uninfected individuals at risk of HIV/AIDS infection and curtail risky behaviors, such as unsafe sex. This literature review has established that scholars propose active collaboration between social workers, researchers, health institutions, care providers, families, communities, and policymakers to address the issues facing HIV/AIDS social work. Furthermore, they have the responsibility to not only educate but also convince PLWHA to take medication while remaining ethical in their practice.

References

Barbour, R. S. (1994). The impact of working with people with HIV/AIDS: A review of the literature. SW. Sci. Med., 39(2), 221-232.

Bekalu, M. A., & Eggermont, S. (2014). The role of communication inequality in mediating the impacts of socioecological and socioeconomic disparities on HIV/AIDS knowledge and risk perception. International Journal for Equity in Health, 13(16), 1-11.

Center for Disease Prevention and Control (2017a). HIV Among Women. Retrieved from: https://www.cdc.gov/hiv/group/gender/women/index.html

Center for Disease Prevention and Control (2017b). HIV Among Transgender People. Retrieved from: https://www.cdc.gov/hiv/group/gender/transgender/index.html

Center for Disease Prevention and Control (2017c). HIV Among African Americans. Retrieved from: https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html

Human Rights Campaign (2017). How HIV Impacts LGBTQ People. Retrieved from: https://www.hrc.org/resources/hrc-issue-brief-hiv-aids-and-the-lgbt-community

International Federation of Social Workers. (2018). HIV and AIDS. Retrieved from: http://ifsw.org/policies/hiv-and-aids/

Miles, T. (2012). Minority HIV Rates, Inequality, and the Politics Of Aids Funding. Dissertation Prepared for the Degree of Doctor Of Philosophy.

Pew Research Center. (2017). Mobile Fact Sheet. Retrieved from: http://www.pewinternet.org/fact-sheet/mobile/

Santana, M. C., Raj, A., Decker, M. R., La Marche, A., & Silverman, J. G. (2006). Masculine Gender Roles Associated with Increased Sexual Risk and Intimate Partner Violence Perpetration among Young Adult Men. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 83(4), 575–585.

Santana, M.C. et al (2006) ‘Masculine gender role associated with increased sexual risk and intimate partner violence perpetration among young adult men’ Journal of Urban health 83(4):575-585

Strug, D. L., Grube, B., A., & Beckerman, N. L. (2002). Challenges and Changing Roles in HIV/AIDS Social Work. Social Work in Health Care, 35(4), 1-19.

UNAIDS (2016). Prevention Gap Report. Retrieved from: http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf

Wheeler, D. P. (2007). HIV and AIDS Today: Where is social work going? National Association of Social Workers. 155.

World Health Organization. (2017). Consolidated guideline on sexual and reproductive health and rights of women living with HIV. Retrieved from: http://apps.who.int/iris/bitstream/10665/254634/1/WHO-RHR-17.03-eng.pdf?ua=1