Context of Sub-Saharan Africa and San Francisco
Scientists and laypersons can agree and cite a huge body of work regarding the mechanisms of HIV spread and the effects of HIV/AIDS on the human body and whole communities, but HIV/AIDS must be examined through other lenses in order to gain a fuller understanding of the disease, or who it most affects and why. AIDS is a social justice issue. This becomes apparent when examining HIV/AIDS within the contexts of both Sub-Saharan Africa and San Francisco. The face of AIDS in each of these geographic contexts is different but in each context, AIDS is a social justice issue, with socio-economic inequalities, stigmas and discrimination, discriminatory gender norms, exploitative practices and structures and power structures that influence the face of the disease. Understanding the social justice aspect of HIV/AIDS is necessary to examine and effectively battle the disease on scales ranging from local to international.
In both San Francisco and Sub-Saharan Africa, AIDS disproportionally affects some groups of people more than others. Biology shows that everyone is potentially is at risk for HIV, but it does not show that or why some groups are at greater risk than others and that this does not spring from the actions of individuals alone but instead larger issues such as inequality and discrimination.
According to Michael Kelly, from a social justice perspective HIV/AIDS is driven by and drives four forces that include poverty, gender disparities and gender-related power structures, stigma and discrimination and socio-economic structures and practices. Kelly posits that these four forces drive HIV and AIDS and the presence of HIV and AIDS allows problematic structures and practices to flourish.
Gender disparities and gender-related power structures are among the biggest drivers behind HIV/AIDS at present. The United Nations Population Fund, or UNPF, declares that “girls and young women are the face of the HIV/AIDS pandemic” and young women are particularly vulnerable, as half of new adult infections occur among 15 to 24 year olds. As of 2002, more than 60 percent of the young people living with HIV/AIDS were female. According to the UNPF, this is attributed to several factors. Women, especially young women with immature genital tracts, are particularly susceptible to infection. Gender-based violence, coercion, contractual sex and sexual relationships or marriage between sexually-experienced older men and young girls, particularly prevalent in Sub-Saharan Africa, is also responsible for the disproportionate number of young women with the disease. Poverty, lower social status, and unequal economic rights put girls at particular risk for HIV.
Martin discusses gender inequality and the benefits of improving girls’ education, specifically. According to Martin,
“Of the nearly one billion adults in the world who cannot read, two-thirds are femalethe links between being uneducated and impoverished versus educated women who achieve independent economic stability, improved housing and better and more comprehensive health care are clear (218-219).”
HIV/AIDS is not necessarily a “disease of poor people” or a “disease of poor countries” but there is a strongly-established link between HIV/AIDS and poverty. Poor are more likely to develop conditions like malnutrition, micronutrient deficiencies and tuberculosis that make it easier for HIV infection and transmission. Poverty additionally enhances vulnerability and leaves individuals feeling as though they have a limited future regardless whether or not they protect themselves against HIV infection.
Just as poverty is linked to HIV/AIDS, the epidemic also burdens the already-poor with even greater poverty. Incomes and resources are lost through sickness and diversions in the form of payments for medical services, medicines and mourning.
Stigma and discrimination can make minority or marginalized groups reluctant to seek help, meaning that “those most in need of information, education and counseling will not benefit even where these services are available (UNAIDS Inter-Agency Task Team on Gender and HIV/AIDS).”
Comparing the AIDS epidemic in different contexts only serves to highlight the role social justice plays in disease prevalence. Looking at the collective “face” of HIV and AIDS in Sub-Saharan Africa and San Francisco, respectively, highlights significant differences between regions with different social justice issues or severity of issues.
According to the San Francisco AIDS Foundation, of the nearly 16,000 San Franciscans living with HIV/AIDS in 2010, 92 percent of individuals were male and 63 percent were white. Almost 75 percent of HIV/AIDS cases at this time were among men who have sex with men. In the three years leading up to 2010’s annual report, the number of newly diagnosed HIV cases declined each year from the previous year and the vast majority of new cases were males.
Even in San Francisco there are significant differences in survival after AIDS diagnosis between racial/ethnic groups. The percentage of African Americans surviving five years after AIDS diagnosis was 74 percent compared to 82 percent for whites and 84 percent for Latinos. Mean community viral load indicated that overall infectiousness is highest in communities that generally have San Francisco’s lowest median household incomes.
Estimating that the population of San Francisco as a whole at the same time the above statistics were obtained was around 805,000 (U.S. Census Bureau), the total percentage of the city’s population living with HIV/AIDS in 2010 was about 1.9 percent. This is significantly lower than the estimated HIV prevalence among adults in Sub-Saharan African countries. According to Table 1.1 in Trinitapoli and Weinreb (16), the estimated adult HIV prevalence in Swaziland and Botswana is around 25 percent, Lesotho has an estimated percentage of 23.6 and the countries of South Africa, Zimbabwe, Zambia, Namibia, Mozambique, and Malawi all have an estimated prevalence between 10 and 20 percent. The San Francisco AIDS Foundation provides that, as of December 2010, 94 percent of individuals with AIDS and 71 percent of individuals living with HIV who were eligible for treatment were receiving anti-retroviral therapy.
Numerous sources (Kelly; World Health Organization “HIV/AIDS Online Q&A) agree on many of the components that comprise the treatment of AIDS. Appropriate treatment of AIDS includes proper medication for common illnesses and opportunistic infections, antiretroviral drugs that are accessible, medical and social infrastructure capable of monitoring and delivering treatment, and supportive human care. On an even more basic level, according to the World Health Organization, “access to good nutrition, safe water and basic hygiene can also help an HIV-infected person maintain a high quality of life.
In some areas—like San Francisco and other parts of the developed world—all of these resources or requirements are more available than in other regions like in Sub-Saharan Africa. Resource-poor areas and households may struggle to obtain quality nutrition and economic instability negatively impacts, in regions, factors like health services. Regular, reliable lifelong treatment is critical for HIV/AIDS-infected individuals and economic and other instability poses a significant threat.
As previously discussed, HIV/AIDS is clearly a social justice issue. How does realizing this best translate into action that can effectively address HIV/AIDS in populations that are disproportionately affected by the disease? Traditionally, there have been two dominant approaches to addressing HIV/AIDS. One views the prevalence of HIV/AIDS as an epidemic that requires a biomedical and pharmaceutical response. The other traditional view is that HIV/AIDS results from human behavior practices and accordingly, the most effective response is to focus on changing behavior.
Kelly and other social justice-minded individuals and organizations are triticale of these two approaches for their tendency to focus on the immediate causes and effects of the disease and failure to address underlying and structural causes and believe that initiatives in these veins are unlikely to make significant gains against the disease. Policies that are largely in use are engaged in a perpetual battle with immediate causes of HIV including sexual behavior, mother-to-child transmission and injecting drug use. Advocates for a broader social justice approach call for initiatives that focus on the underlying and structural causes of the epidemic such as poverty, inequality, and disempowerment.
Kelly calls for determined measures that ensure women, individuals living in rural areas and commercial sex-workers and other marginalized groups have a right to treatment. Significant progress has been made in recent years to make drugs for HIV/AIDS more affordable and widely-available, but a good deal more work in this area is necessary. In developing countries, where women are so disproportionately affected and burdened by the epidemic, the education of girls and women is perhaps the most important underlying and pressing social justice issue behind HIV/AIDS and thus warrants the most extensive action.
Works Cited
Barusch, Amanda S. Foundations of Social Policy: Social Justice in Human Perspective. 3rd ed. Belmont, CA: Brooks/Cole, 2009. Electronic.
“HIV/AIDS and Gender: Fact Sheets.” United Nations Population Fund, 2006. Web. 13 Jan. 2014. <http://www.unfpa.org/hiv/docs/rp/factsheets.pdf>
“HIV/AIDS Online Q&A.” World Health Organization, 20 Oct. 2013. Web 13 Jan. 2014. <http://who.int/features/qa/71/en/index.html>
Kelly, Michael J. HIV and AIDS: A justice perspective. Lusaka, Zambia: Jesuit Centre for Theological Reflection, 2006. Electronic.
Kelly, Michael J. HIV and AIDS: A Social Justice Perspective. Nairobi: Paulines Publication Africa, 2010. Print.
Martin, Renee J. “Achieving Conceptual Equilibrium: Standards for Gender Justice in Education.” Social Justice, Peace, and Environmental Education: Transformative Standard. Eds. Andrzejewski, Baltodano and Symcox. New York: Routledge, 2009. 216-234.
“San Francisco (city), California.” U.S. Census Bureau, 17 Dec. 2013. Web. 13 Jan. 2014. <http://quickfacts.census.gov/qfd/states/06/0667000.html>
“Statistics.” San Francisco AIDS Foundation, 2014. Web. 13 Jan. 2014. <http://www.sfaf.org/hiv-info/statistics/>
Trinitapoli, J. & Weinreb, A. Religion & AIDS in Africa. New York: Oxford University Press, 2012. Print.
