Access to medication and proper medical care depends on where you live and how much money you make. Since 95% of those infected with HIV and AIDS live in developing countries, many of these people do not have access to proper treatment. This is one of the major problems that is currently preventing progress in bringing an end to the global pandemic.
The spread of HIV/AIDS is not only contributing to a major health problem. It is also adding to the long list of problems in the economic development of developing countries.
HIV/AIDS is not just a health problem, but also a development problem. How? By
Spreading fast mostly to young people and working-age adults, HIV/AIDS affects
the economy, society, family and schooling in a country, weakening the country as a
When 8% or more of a population becomes infected with HIV, the growth of the
economy slows down, according to a World Bank study. This is because the labor
force gets reduced and demands on the already overwhelmed government, economic
and health care systems increase (15).
Poor countries are most vulnerable to HIV/AIDS for a multitude of reasons. First and foremost, they are often lacking the medical facilities and resources to give proper treatment. It is likely that health care systems in developing countries are not sufficiently developed. These problems create even more obstacles to properly treating an already large and growing population infected with HIV. In addition, HIV treatment is very expensive and, as a result, is not available everywhere in the world. Specifically, there are countries too poor to be able to afford it. In addition, (R) basic care and treatment for an HIV/AIDS patient can cost as much as 2-3 times per capita gross domestic product (GDP) in the poorest countries(R) (8). Finally, HIV/AIDS and sexual education is often few and far between, not only because of limited resources, but also because many people are not willing to talk about the dangerous behavior associated with HIV/AIDS (8).
HIV/AIDS in The U.S.
AIDS was first identified in the United States in 1981, and was first known as Gay Related Immunodeficiency Disease. Since its discovery, it has spread to all races, sexual orientations, and socioeconomic divisions of our society. 476,749 people were reported to be living with HIV/AIDS in the United States at the end of 2005 (4). However, the total number of those living with HIV/AIDS in the United States is thought to be much higher: between 1,039,000 and 1,185,000 (3). The CDC and Prevention¥s figures only come from those states which implement confidential name-based reporting of HIV diagnoses. During 2005, there were about 38,133 new diagnoses of HIV reported by those areas participating in the confidential name-based reporting. Of these new reported diagnoses, about 74% were adolescent or adult males, and about 26% were adolescent or adult females. Less than 1% of the new reported diagnoses were children under the age of 13 (3).
The discovery of AIDS in the United States in June of 1981 was followed by a large increase in the case number and number of deaths in the 1980s. This level of increase was followed by large decreases in the number of new cases and deaths later in the 1990s. As the number of deaths caused annually by AIDS has decreased, the number of people currently living with AIDS has increased (4). During the 1980s, most cases of AIDS transpired among whites. However, as the disease manifested itself in the U.S. population, the number of cases among blacks in the U.S. gradually increased. By 1996, (R) more cases occurred among blacks than any other racial/ethnic population (4).(R) Cases among all other ethnic groups have also increased, including Hispanics, Asians and Pacific Islanders, as well as Indians and Alaska Natives. Over time, HIV/AIDS cases have greatly increased among minorities. Although AIDS began as a disease prevalently affecting MSM (men who have sex with men), the number of those infected through heterosexual contact has also greatly risen.
Currently, the United States has no comprehensive national strategy to address HIV and AIDS. Such a strategy would need to incorporate the issues of prevention, treatment of the disease, and finally, support services for those affected. Such a strategy would need to incorporate the issue of distributing resources in an effort to deal with the racial disparities. Such a strategy would also need to address a lack of attention to quality prevention efforts and treatment delivery. Although the U.S. funds AIDS-related programs, funds have not increased much over the past few years. The lack of financing for such services inhibits (R) access to quality HIV care(R) (9).
According to a report by Public Health Watch, the number of new HIV cases has stayed stagnant for about a decade at 40,000 cases per year. One of the major problems with HIV and AIDS prevention programming and services is that there is incomplete information about where these new infections are taking place and who the services that are provided are assisting. As in many other countries in the world, those people in higher risk groups do not have proper access to the variety of prevention methods that have been proven effective. What is even more striking that is in the United States, (R) only about half of people living with HIV/AIDS are receiving regular HIV care, and only about half of people who meet government criteria for use of anti-retroviral treatment for HIV are receiving these drugs(R) (9). There are many reasons for such frightful statistics, but it is predominantly caused by the misdistribution of resources.
HIV/AIDS in the United States continues to hurt those that are most in need: those in higher needs communities and of a lower socioeconomic status, as well as minorities, homosexual men and men who have sex with men, and finally, injection drug users. The statistics in the United States are astounding. According to the same report put out by Public Health Watch, previously mentioned, (R) éfrican Americans accounted for an estimated 50 percent of new HIV infections and nearly half of all AIDS diagnoses in 2004. African Americans have more limited access to health care and poorer outcomes for AIDS-related treatment than other groups(R) (9).
It is important to question why it is that minorities and those with lower incomes continue to share such a large proportion of new HIV/AIDS cases. In 2004, African Americans, Latinos, Asian/Pacific Islanders, and American Indians made up 71 percent of new AIDS diagnoses. Unfortunately, these groups only account for 31 percent of the total United States population (9). HIV/AIDS rates among Hispanic and African Americans are quickly rising. There are many reasons for these statistics. Those living in higher needs communities tend to have a lower education, and there are less resources available in terms of prevention programs. There continues to be an uneven distribution of prevention tactics in the United States, across income levels and races.
HIV/AIDS in the U.S.-Hispanic Community
It is important to distinguish who exactly we are talking about when we use the word Hispanic. The word ¥Hispanic¥ is defined by the United States Census Bureau as those people that originate from Spanish-speaking regions or countries. Also noted by the Census Bureau is that Hispanics may be of any race, and defines these people as ¥Latinos.¥ Hispanic and Latino are two separate terms with two separate but similar definitions, although they are often used interchangeably. In this unit, I am going to use the word Hispanic. On the 2000 U.S. Census, more than 35 million people identified themselves as either Hispanic or Latino, and this number does not even include those 3.9 million United States residents of Puerto Rico. The U.S. Census puts the most current estimates over 44 million. Today, more than half of those Hispanics living in the U.S. declare Mexican heritage. The second largest group of Hispanics living in the United States is made up of Puerto Ricans. Finally, the rest of those 44 million are from more than twenty countries. Thus, when the term Hispanic is used, it is identifying a large and broad category of people.
The United States Hispanic population has been gravely affected by HIV/AIDS. In 2004, Hispanics accounted for 20% of new AIDS diagnoses and 19% of total AIDS cases, while Hispanics only make up 14% of the total United States population (4). In 2001, only 6 years ago, the sixth leading cause of death for Hispanics aged 25-34 was HIV (9). In 2004, 79% of those adolescent and adult Hispanics reported with AIDS were male. The AIDS case rate in the Hispanic adolescent and adult population is the second highest of any other ethnic or racial group in the United States, second only to African Americans (4). The 2004 rate is 25 cases per 100,000, and this rate is a striking 3.5 times more than the rate of whites (4).
Research shows that it is commonplace for a late detection of HIV for Latino immigrants to occur. This late detection causes further problems, including a delay in access to antiretroviral treatments. Certain factors add to this late detection, including (R) a general lack of knowledge regarding HIV risk, poor understanding of condom use and social stigma(R) (10). One cause to these factors is that Spanish-speaking Hispanics do not have the same access and therefore do not benefit from mainstream prevention and treatment efforts, as there is a language barrier. In addition to the language barrier, there is a major cultural barrier. Traditionally in Hispanic and Latino cultures, it is unacceptable and even offensive to discuss sex and sexuality (14).
It is interesting that the four states reporting the highest number of AIDS cases in 2005, New York, Florida, California, and Texas, also have the highest number of Spanish speakers (4). In addition, these same four states have the highest number of cumulative AIDS cases through 2005.
AIDS cases amongst the Hispanic population in the United States in 2000 were spread out among many nationalities, although the bulk of them occurred in those Hispanics born in the continental United States (35%) and Puerto Rico (25%). 13% of them occurred among those Hispanics born in Mexico, 8% among those born in Central and South America, and 2% were among those born in Cuba. In addition, 18% of the cases reported were from Hispanics with an unknown birthplace, and 2% were among those born elsewhere (14).
Hispanics, as well as other minority groups in the United States, are at a greater risk to HIV due to certain shared factors. These include (R) discrimination, poverty, lack of information, substance use and negative attitudes toward condoms(R) (14). In addition to this greater risk, there are many barriers to HIV prevention in Hispanic communities, including (R) racial and ethnic discrimination, anti-immigrant attitudes, policies on mandatory testing for immigrants, and fear of deportation for undocumented immigrants(R) (14). Another barrier to HIV prevention in Hispanic communities is culture, specifically
. The former is the Hispanic dedication to the family. On the one hand, it can aid in getting Hispanic men to decrease amounts of unprotected sex outside of their committed relationships. On the other hand,
, along with homophobia, can avert prevention because homosexuality is recognized as incorrect by many families.
can further hinder prevention because in some cases, it may cause Hispanic men to use sex as a tool to establish their masculinity. It may also be employed as a justification for unprotected sex (14).
There are a number of organizations around the United States that are working to prevent the spread of HIV in the Hispanic community. Such organizations include Prevention Point Philadelphia, which offers a variety of services, including a needle exchange, HIV testing, drug treatment referrals, as well as medical care. Hermanos de Luna y Sol is an intervention program for gay and bisexual men in San Francisco, California. Mujeres Unidas y Activas is another program established in San Francisco, for Latina women (14).
Much still needs to be done to bring an end to the HIV epidemic, specifically in the Hispanic community. There needs to be more of an effort to provide bilingual HIV education and services. Such efforts could include the addition of HIV prevention messages in Spanish media, health services, and religious centers. However, greater societal issues are at play in the HIV epidemic, which continue to hamper prevention efforts. Racism, homophobia, and poverty must all be addressed in our endeavor to prevent the spread of HIV in the United States as a whole (14).
HIV/AIDS in Puerto Rico
Although Puerto Rico is not a state of the United States, it is a commonwealth as of 1952. What this means is that Puerto Rico governs itself, although it is associated with the United States. The chief of state is the President of the United States, and the head of government is an elected Governor. All Puerto Ricans are U.S. citizens. However, they cannot vote for the U.S. president and have no voting representation in Congress. They do not pay income taxes, and receive very limited benefits. They may join the U.S. military, and if a draft were to go into effect, Puerto Ricans would be subject to that draft. The fact of the matter is, however, that Puerto Rico remains a part of the United States.
Yet the HIV/AIDS statistics in Puerto Rico are frightening. Today, 26 people out of 100,000 in Puerto Rico has HIV/AIDS. This is a shocking number, which is almost twice the rate of the mainland United States. What is even more shocking is the lack of funding for HIV/AIDS clinics in Puerto Rico (6).
As of March of 2007, the United States stopped payments to AIDS clinics in Puerto Rico, causing hundreds of poor people desperately in need to go subsist without their free medication. The Puerto Rican health care system is riddled with corruption and administrative ineffectiveness, causing further troubles to an already distressed system. Thousands of patients in the San Juan area have had to deal with rationing their medication, receiving enough to last not even one week per month. In other areas of Puerto Rico, operations have remained normal. However, because the health care system itself faces so many problems, as previously stated, there are many other obstacles to come in the future. One of these major hindrances is equal access to medications based on class and income, as demonstrated in the case of San Juan.
The most troubling matter relating to the HIV/AIDS epidemic in Puerto Rico is the fact that Puerto Rico is indeed a part of the United States, but as Guillermo Chacon, the vice president of the Latino Commission on AIDS stated, "One of the most difficult things is getting the mainland to recognize Puerto Rico as being part of the country" (6).
HIV/AIDS in the Spanish-Speaking World and Beyond
About 67% of the world¥s AIDS cases are located in Sub-Saharan Africa. This is over two-thirds of the world¥s AIDS cases. While this is an extreme and tragic number, there is currently a disturbing spread of HIV/AIDS in Latin America and the Caribbean (13). According to UNAIDS, the number of those living with HIV in Latin America has grown to 1.8 million. About 300,000 people currently live with HIV in the Caribbean (11). It is evident that all over the world, the more poverty that exists, the larger the HIV/AIDS epidemic.
An estimated 24,000 people died from AIDS in the Caribbean in 2005. AIDS is the leading cause of death among those between the ages of 15 and 44 in the Caribbean. Today, the Caribbean ranks as the second-most affected region in the world. HIV prevalence is greater than 1% in the Dominican Republic. However, it has not even reached 0.2% in Cuba. While Cuba is achieving universal access to treatment, only 10% of those in need of antiretroviral treatment in the Dominican Republic are actually receiving it (11).
Latin America (South and Central America)
As previously stated, there are now approximately 1.8 million people liing with HIV in Latin America. An estimated 66,000 people died of AIDS in 2005. That same year, there were approximately 200,000 new infections. The largest epidemics in Latin America are in the three countries with the largest populations: Argentina, Colombia, and Brazil. Although Brazil is not a Spanish-speaking country, it is important to discuss the HIV/AIDS epidemic in Brazil in part because it is so large. Of the 1.8 million people living with HIV, Brazil accounts for more than one third of this number. The highest HIV incidence, however, or the highest percentage of population infected with HIV, occurs in the smaller countries of Guatemala, Honduras, and Belize
(also a non Spanish-speaking country)
. As of the end of 2003, an estimated 1% or more of adults were infected with HIV in these three countries (11).
There have been continuous improvements to access to antiretroviral treatments, specifically in Brazil. Brazil has by far achieved above and beyond many other countries in the world, because the government has enacted a policy of providing antiretroviral drugs to all those in need of them. Under Brazil¥s national healthcare system, those living with advanced HIV qualify for antiretroviral drugs. As of September of 2005, an estimated 170,000 people in Brazil were on antiretroviral therapy. The conditions under which antiretroviral therapy is provided in Brazil are by far the best out of all of Latin America. Treatment levels are also high in Argentina, Uruguay, Chile, Venezuela, Mexico, and Cuba. Access to antiretroviral treatment has greatly increased in Panama and Costa Rica, and with this increase has come a decrease in the number of AIDS related deaths (11).
Despite these successes, conditions are far worse in other countries which are much poorer, including several in Central America, as well as the Andean region of South America. Improvements in these poorer countries has been much slower. As of 2004, less than 1,000 people in Ecuador living with HIV/AIDS were receiving retroviral treatment. Attempts to increase and improve treatments have been slow to limited in Paraguay, Nicaragua, El Salvador, Honduras, and Guatemala (11).
Equatorial Guinea (Africa)
Equatorial Guinea is located in Sub-Saharan Africa, the part of Africa located to the south of the Sahara Desert. A little over 10% of the world¥s population resides in this region of the world, and yet over 60% of
people living with HIV can be found in Sub-Saharan Africa. 25.8 million people are currently living with HIV in the region that is thought to be the origin of the human race. In 2005, just 2 years ago, it is estimated that 3.2 million people in the region were infected with HIV, and 2.4 million people died of AIDS (11). Equatorial Guinea is no exception to the massive epidemic affecting this large region. Approximately 8,900 people are currently living with HIV in Equatorial Guinea, where the population is estimated to be around 504,000 people. About 2% of the entire population is currently living with HIV (11).
To put this number in perspective, about 26 out of 100,000 people are currently living with HIV in Puerto Rico, as previously stated. That is about .026%, a number that is almost twice as high as the HIV/AIDS rate of the United States. The percentage of the population of Equatorial Guinea that is infected with HIV is much greater than that of Puerto Rico, and the United States. This is quite a frightening statistic. An even more frightening statistic is that of HIV prevalence among adults: 3.2% of adults in Equatorial Guinea (those aged 15 and above) are infected with HIV (11).
Equatorial Guinea ranks 109 out of 177 countries on the United Nation Development Programme¥s Human Development Index, an index used to measure and compare the development levels of countries in the world. This ranking places the country in the (R) medium development category(R) (12). Although the government has generated new oil revenue, and the country is clearly not as poor off as others, based on its ranking in the Human Development Profile, the health profile of the country is similar to that of a least developed country (12). This poor health system has clear ramifications for the HIV/AIDS epidemic in Equatorial Guinea.