Question 1
Health status and health outcomes are influenced by a multi-factorial of factors all which act concurrently, simultaneously or independently. From a more detailed view, this is because of the dynamism with which the socioeconomic health indicators exist. Within this dynamism, there is much truth in the knowledge that the health outcomes and health status will vary across different geographic regions whereby we can denote that geography has its independent role in influencing health disparities (Singh, Azuine & Siahpush, 2013). This implies that some regions will indicate high prevalence of an illness while others will indicate lower prevalence of the same and such patterns and trends tend to exist over long durations of time and at times even demonstrating historical relations. The prevalence of HIV within the Hispanic population in Puerto Rico in the US is such a case.
While the Hispanic population depicts a significant high prevalence of HIV as compared to other ethnic and racial groups, the likelihood of HIV diagnosis for people within Puerto Rico and of Hispanic origin is extremely higher than on other regions. This is attributed to the fact that the region, Puerto Rico holds a significantly larger population of Hispanics than any other region (Singh, Azuine & Siahpush, 2013). This concentration of one racial or ethnic group within a region implies that the cultural influences of health are more stringent and especially those that limit health living as well as influencing social behaviors that promote risk lifestyles. On the other hand, the prevailing aspects of low educational levels, high unemployment rates and ignorance of the existing systems that increase access to care such as coverage all signal a population whose health status will continually degrade due to the societal influence, perceptions and attitudes towards health (Singh, Azuine & Siahpush, 2013).
Question 2
The cultural and societal beliefs hold significant influence as to the ability of the existing public health structures to manage and prevent the spread of HIV. Within the target Hispanic population in Puerto Rico for instance, there exists a strong originality of Hispanic and Latino culture sand these cultures tend to influence the norms, beliefs and attitudes of the people within this region. Most of these beliefs do not align to the demands of the modern public health demands and strategies towards the prevention of HIV (CDC, 2015). For instance, within the Hispanic population, there exists a perception of the traditional gender roles as well as cultural norms of machismo and marianismo. Machismo on its part emphasizes on the perception that men are expected to show or demonstrate high sexual drive and should not be limited in any way to achieve or satisfy their humanly sexual needs (CDC, 2015). This culture has a definite influence on the levels of promiscuity within the male gender which could even be attributed to the apparent position of Puerto Rico as the epicenter of HIV prevalence associated with gay sex activity. On the other hand, marianismo on its part insists on the need to have all women demonstrate and practice purity (CDC, 2015). This and the effect of machismo mean that the female gender is subjected to a position where they are stigmatized in the event they report or are known to have HIV. The level of reporting or search for medical care within this gender then remains low and this further increases the risk to the opposite gender since there is a notion of concealing the HIV status to fit within the cultural values of marianismo (CDC, 2015).
Question 3
One of the major barriers that exists in relation to the management of HIV/AIDS at community level in the low levels of reporting or screening to help commence the management of the condition at an early stage and prevent further spread through status knowledge. This is usually attributed to the general perception that HIV/AIDS is a depiction of an individual’s promiscuity and immorality. For the public health structures, it is actually difficult to manage HIV/AIDS in the absence of data, patterns and trends so as to unearth the modifiable factors that influence the prevalence and spread. With such perceptions especially those pegged to cultural and societal values and norms, there is a tendency among those with the illness to forego any form of care in the fear that disclosing their HIV status will render them outcasts within the society. This form of discrimination implies that the basic support mechanisms at family and societal levels are non-existent for these people and thus subjecting them to emotional and psychological turmoil (Ameh et al., 2014). The next level of action or possible occurrence is depression within this group and this can be manifested either through increased indulgence into drugs and alcohol, unprotected sex with complete disregard of the health of the partner or partners as well as increased cases of suicide.
Question 4
The demand by public health entities for increased awareness for screening and testing for HIV/AIDS within communities is based on the fact that authorities can effectively develop strategies to combat the menace only when there is available data related to these groups. Currently, there exists a very fragmented strategy in the management and prevention of HIV/AIDS because of the void of current and viable data on this population (Lehman et al., 2014). The intention to utilize criminalization as a strategy to force people and communities to seek screening and testing on HIV/AIDS or any other law that hideously discriminates these people living with HIV/AIDS is one of the desperate measures that authorities have sought out and this in particular has been witnessed in collection centers as well as communities described as epicenters (Lehman et al., 2014). However, criminalization cannot resolve this challenge. HIV/IAIDS prevention and management is a social and health issue as opposed to a criminal or justice issue. The probability of criminalization working within the current settings and challenge is low especially in the knowledge that the justice system has its challenge in managing justice issues and thus this would be a new burden in its entirety. There is a need to separate the notion that people or groups have ignored testing and screening on the basis of criminality and recognize that it is the lack of awareness and the existing cultural attitudes and perceptions that influence this state of affairs. The N.J. Stat. Ann. § 2C:34-5 (1997) (sexual exposure) for instance required the express disclosure of serostatus for persons to engage in sexual activity (Lehman et al., 2014). This law despite the good intention it serves to achieve all but subjects the people living with HIV to a notion that their condition is a criminal issue recognized by law and they could be deemed as walking criminals who are out there to cause harm. A better approach would be to set out civic and health education strategies in which these people can be assisted to overcome the prejudice of HIV/AIDS as a condition that limits their rights as enshrined in law.
Question 5
Intimate partner violence as a social and health issue has its significant impact on the entry to treatment. On one hand, for the parent who is the victim of violence within the relationship they are subjected to a position where they feel submissive and act submissively to their offender (Hatcher et al., 2014). In this case, even in the knowledge that they may have HIV/AIDS this individual will have to inform the partner of the intention to seek medical care or treatment for HIV. In the event that the offending partner does not subscribe to the idea of seeking treatment probably as a result of preference for an anonymous HIV/AIDS status, they will thus demand that the partner should not seek treatment (Hatcher et al., 2014). The submissive nature of victims of intimate partner violence then implies that they will have to live with the condition untreated. For pregnant mothers within such an environment, there is the large implication of mother to child infection as the prenatal clinical visits may only be dome informally at the will of the offending partner (Hatcher et al., 2014).
References
Ameh, D., Uchendu, U. O., Adeyemi, O. A., Ideh, R. C., Ebruke, B. E., Mackenzie, G., & Corrah, T. (2014). Is the absolute requirement for informed consent before HIV testing a barrier to public health? A case report and management challenges. African Journal of AIDS Research, 13(1), 93-98.
CDC. (2015). Latinos | Race/Ethnicity | HIV by Group | HIV/AIDS | CDC. Retrieved from http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/
Hatcher, A. M., Woollett, N., Pallitto, C. C., Mokoatle, K., Stöckl, H., MacPhail, C., & García-Moreno, C. (2014). Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission. Journal of the International AIDS Society,17(1).
Lehman, J. S., Carr, M. H., Nichol, A. J., Ruisanchez, A., Knight, D. W., Langford, A. E., & Mermin, J. H. (2014). Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS and Behavior, 18(6), 997-1006.
Singh, G. K., Azuine, R. E., & Siahpush, M. (2013). Widening socioeconomic, racial, and geographic disparities in HIV/AIDS mortality in the United States, 1987–2011. Advances in preventive medicine, 2013.
