Intro to Health HIV Lecture Notes PDF

**[Intro to Health HIV (Lecture 12)]** ***Determinants of Health*** - Think of health as biological but also should think of it from a sociological perspective: - Recent research (from sociological to medical) asks us to think about the Social Determinants of Health. Which are defined...

**[Intro to Health HIV (Lecture 12)]** ***Determinants of Health*** - Think of health as biological but also should think of it from a sociological perspective: - Recent research (from sociological to medical) asks us to think about the Social Determinants of Health. Which are defined as access to: - Health Care - Education - Economic Stability - Social and Community context - Neighborhood and Built Environment - Ask us to think about the social nature of both contracting diseases, experiencing poor health, and access to medical treatment - We Can think about the interconnection of the issues we have been talking about this quarter: - Poverty, Inequality, Criminal legal system, Health ***U.S. Health Disparities*** - Class disparities - Lower income residents report fewer average healthy days - Air pollution-related disparities associated with fine particulates and ozone are often determined by geographical location ***Inequality and Health Connection*** - Gini Coefficient - Measure extent to which the distribution of income or consumption expenditure among individuals or households within an economy (society) deviate from a perfectly equal distribution. - Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality. **[Introduction to HIV/AIDs section]** ***AIDs as a social problem*** - Interesting problem from sociological perspective -- why? - When in the 80s it was prevalent in gay men - Explore AIDS in terms of how morality is associated with the disease - Images & attitudes - Investigate stigma - Study related issues (poverty, racial/ethnic inequality, drug usage, stigmatized groups etc.) **[(1) What is HIV/AIDS?]** ***Pop Quiz*** 1. What are the ways that HIV can be transmitted? - Unprotected sex, shared needles, mother to child 2. What is the best way to decrease your likelihood of getting HIV? - Safe sex, abstinence 3. How many people in the world are infected with HIV/AIDS? - 38.4 million 4. There is one stupid answer to a question -- what is the question? What is the answer? - What's your status? I don't know ***What does "AIDS" Mean?*** - AIDS stands for Acquired Immune Deficiency Syndrome: - Acquired - Immune Deficiency - Syndrome - AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. ***Transmission of AIDS*** 1. Penetrative sex 2. Blood transfusion 3. Sharing of contaminated needles 4. Between mother and infant ***Mother to Child Transmission (MTCT) -- vertical transmission*** - Can occur through: - in the womb or during childbirth - post-natally, through breastfeeding - Risk - If not breastfeeding: 15-30% - If breastfeeding: 30-45% ***Decrease Likelihood of Contraction*** - Abstinence - "Safer-sex" - Don't share needles - Drugs during child-delivery - HIV PrEP Medication for high risk ***History of AIDS*** - First case in U.S. 1981 - HIV is a descendant of Simian (monkey) Immunodeficiency Virus (SIV) - Monkey -\> Chimpanzees - HIV could have crossed over from chimpanzees as a result of a human killing a chimp and eating it for food ***History of AIDS Cont.*** Three of the earliest known instances of HIV infection are as follows: 1. A plasma sample taken in 1959 from an adult male living in what is now the Democratic Republic of Congo 2. In U.S. - HIV found in tissue samples from an American teenager who died in St. Louis in 1969 3. HIV found in tissue samples from a Norwegian sailor who died around 1976 ***History of AIDS Cont.*** - Why associated and prevalent among gay men? - Majority of initial cases occurred among men who had intercourse with men (MSM) - Failure to use protection (didn't know it was needed) - Why changing to straight couples? - Saturation of high-risk communities' w/ AIDS - Behavioral change in gay community **[(2) Who Does HIV/AIDS Affect?]** ***Terms*** - HIV Incidence (new infections): - The estimated incidence of HIV has remained stable overall in recent years, at about 50,000 new HIV infections per year. - **39.9 million affected with aids** - HIV Diagnoses (new diagnoses, regardless of when infection occurred or stage of disease at diagnosis) - In 2013, an estimated 47,352 people were diagnosed with HIV infection in the United States. - 2013 an estimated 26,688 people were diagnosed with AIDS. - Overall, an estimated 1,194,039 people in the United States have been diagnosed with AIDS - **38.4 million people infected in the World** - Deaths: - An estimated 13,712 people with an AIDS diagnosis died in 2012 - Approximately 658,507 people in the United States with an AIDS diagnosis have died overall. - The deaths of persons with an AIDS diagnosis can be due to any cause---that is, the death may or may not be related to AIDS ***2023 Global HIV Statistics -- Still a major global public health issue*** - Living with HIV globally -\> 39.9M - Don't know their status -\> Apx 5.4 M - Number of Children -\> 1.4 million - US population size -\> 334.9M - US rate -\> 1.1 million U.S. ***People Most Affected by HIV (2023)*** Median HIV prevalence among the adult population (ages 15--49) was 0.8% globally. However, because of marginalization, discrimination and in some cases criminalization, median prevalence was higher among certain groups of people. - 2.3% higher among young women and girls aged between 15 and 24 in eastern and southern Africa - 7.7% higher among gay men and other men who have sex with men - 3% higher among sex workers - 5% higher among people who inject drugs - 9.2% higher among transgender people - 1.3% higher among people in prisons ***Sub-Saharan Africa*** - 50 countries total - 47 Countries (World banking borrowing privileges) - All countries south of the Sahara desert - Other Regions - Central & East - Southern - West ***1993 Definition Change*** - Expanded def of AIDS - HIV people with "severe immunosuppressant", pulmonary tuberculosis, recurrent pneumonia, invasive cervical cancer - With change increase by 111% ***Diagnosing AIDS*** Measure CD4 Cells - when below 200 cells per cubic millimeter -- no longer protect self against AIDS-defining illnesses  Candidacies of bronchi, trachea, or lungs ("thrush") - Cervical cancer (invasive) - Coccidioidomycosis, Cryptococcus, Cryptosporidiosis (fungal infections, a type of meningitis) - Encephalopathy (HIV-related) - Herpes simplex (an infection lasting longer than 1 month or in an area other than the skin such as esophagus or lungs) - Kaposi\'s sarcoma (KS) - Lymphoma characterized by swollen lymph nodes (lymphadenopathy) - Mycobacterium avium complex - Pneumocystis carinii pneumonia (PCP) - Pneumonia (recurrent) - Progressive multifocal leukoencephalopathy (PML) - Salmonella septicemia (recurrent) - Toxoplasmosis of the brain - Tuberculosis - Wasting syndrome ***Continued*** By age group, in 2022 people aged 13 to 34 accounted for more than half (56%) of the 37,981 new diagnoses. People aged 25 to 34 represented 37% (14,160) of those newly diagnosed. By region of residence, HIV diagnoses are not evenly distributed regionally. In 2022, among all persons newly diagnosed with HIVj, 52% (19,793) lived in the South; 21% (7,848) lived in the West; 13% (5,069) lived in the Northeast; 13% (4,891) lived in the Midwest; and 1% (380) lived in the U.S. territories and freely associated states. Most diagnoses are now highly concentrated in certain geographic areas. The Ending the HIV Epidemic in the U.S. initiative is focused on 48 counties; San Juan, Puerto Rico; and Washington, DC, where \>50% of HIV diagnoses occurred in 2016 and 2017, along with seven states with a disproportionate occurrence of HIV in rural areas. ***Summary*** - 38.4 million people I the world have HIV/AIDS - 36.2 Adults - 1.8 Children - Health issues as a social problem - Racial disparities -- different groups are affected differently - Regional differences - Global differences - Stigma associated with pos individuals, but also to groups stereotyped to have the virus - Comparable to current moment of global pandemic - Take home -- We can see how a health issue can also be a social problem **11/21/2024** **[The Social Construction of HIV/AIDS (Lecture 13)]** ***Socioeconomic perspective on racial differences in health (hayward)*** - Race/racism determines \> childhood poverty, inadequate education, marginal employment. Low income, segregated living conditions - "Fundamental social causes of disease" - Stress, social ties, diet and health-risk behaviors, nature of work and work environment, availability of health care - Social origins + adult social conditions - Cumulative disadvantage - Over the life course of people how disadvantage builds - Life course perspective - Structural -- looks at various institutional contacts and life stage - Framework of scholars to think about the health components: **Social determinants of health** ***David Williams -- Discrimination and Health*** - Leading scholar on health disparities in U.S. - Review of studies examining discrimination and health - Identify issues - Measuring perceived discrimination (acute vs. chronic) - Assessing discrimination over the life course - Subjective nature - Need to identify specific mechanisms ***Three health related issues*** 1. Suicide 2. Covid 3. Access to cancer treatment **[Death by Suicide]** - The age-adjusted suicide rate in 2020 was 13,48 per 100,000 individuals - The rate of suicide is highest in middle-age white men - In 2020, men died by suicide 3.88x more than women - On average, there are 130 suicides per day - White males accounted for 69.68% of suicide deaths in 2020 - In 2020, firearms account for 52.83% of all suicide deaths "**Structural indicators of suicide**: an exploration of state-level risk factors among black and white people in the United States, 2015 -- 2019" Robertson et al - Death by suicide among black people in the USA have increased by 35.6% within the past decade - Among youth under the age of 24, death by suicide among black youth have risen substantially - Examined structural variables (correlations) **Robertson et al** - Aim -- understanding structural state-level differences in suicide rates between black and white people across the age spectrum - Found that incarceration rates were positively associated with suicide rates across all groups - Consistent with prior research that highlights the negative impact of incarceration on overall mental health as well as risk of death by suicide - Suggest researchers use and develop relevant theoretical frameworks such as intersectionality (Crenshaw, 1989) and socio-ecological theory (Cramer and Kapusta, 2017) to holistically examine risk and prevention - For example, given that suicide attempts among black youth in urban areas about double the national rate additional research examining how institutionalized racism impacts community-level policies which then contribute to suicidality is necessary. **[Covid ]** ***Many ways to think about covid as a social problem*** - Economic sector and who was most impacted - Racial differences in transmission - Racial differences in life expectancy ***Structural perspective*** - Access to healthcare - Inability to take time off - Poverty - Where one lives ***Structural perspective on COVID*** - Recursive nature: Between these institutional factors and likelihood of getting COVID, but also on the effects COVID had on a person's institutional position **[Cancer Treatment]** ***Health disparities -- cancer*** - Race/Ethnicity - Black people have higher death rates than all other racial/ethnic groups for many, although not all, cancer types - Despite having similar rates of breast cancer, Black/African-American women are more likely than White women to die of the disease - American Indians/Alaska Natives have the highest rates of liver and intrahepatic bile duct cancer, followed by Hispanics/Latinos and Asians/Pacific Islanders - SES: - The incidence rates of colorectal, lung, and cervical cancers are much higher in rural Appalachia than in urban areas in the region - People with more education are less likely to die prematurely (before the age of 65) from colorectal cancer than those with less education, regardless of race or ethnicity - Sexual Identity - The rates of smoking and alcohol drinking, which increase cancer risk, are higher among lesbian, gay, and bisexual youths than among heterosexual youths ***Thinking through causes*** - People with low incomes, low health literacy, long travel distances to screening sties, or who lacks health insurance, transportation to medical facility, or paid medical leave are less likely to have recommended cancer screening tests and to be treated according to guidelines than those who don't encounter these obstacles - People who do not have reliable access to health care are also more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed at an earlier stage - Some groups are disproportionately affected by cancer due to environmental conditions, people who live in communities that lack clean water or air may be exposed to cancer-causing substances - The built environment can also influence behaviors that raise one's risk of cancer. For example, people who live in neighborhoods that lack affordable healthy foods or safe areas for exercise are more likely to have poor diets, be physically inactive, and obese, all of which are risk factors for cancer ***Why aren't people on the registry*** - Trust within the medical system - Lack of knowledge - Again, thinking through our perspectives - Social constructionist - Structural - Conflict - Symbolic interaction **12/5/2024** **[Summary Lecture]** ***Questions to begin with:*** 1. What are the ways that HIV can be transmitted? - Unprotected sex, shared needles, mother to child 2. What is the best way to decrease your likelihood of getting HIV? - Safe sex, abstinence 3. How many people in the world are infected with HIV/AIDS? - 38.4 million 4. There is one stupid answer to a question -- what is the question? What is the answer? - What's your status? I don't know ***Social Features of Disease*** 1. Effect of marginal & stigmatized groups - Connection to gay men - Early designation was called GRID - Linked to marginal populations -- "deviants" 2. Sexually related transmission - Linked to puritanical concerns, promiscuity ***Ways to study*** - Impact on individuals/communities - Stigma - Structure - Communities of emphasis - Countries - Structural (infrastructure, generations, goods, education, etc) - Stigma - Social movements ***Summary of different ways to explore issues*** - [Social Construction] - Broadhead et al 1999 - Did surveys (methodology: statistical) - Statements and articles/newspaper - [Symbolic interactionist] - Herek and Capitanio, 1993 - Telephone survey (understanding education of HIV/AIDS and the stigma of people who might be infected and stereotype) - Stigma wanted to know: courtesy stigma -- type of stigma one is given because being part of a broader identity (marginalized group) - [Structural] - Sacks (Social impact on countries) - Different ways of high infection rates in destabilized countries levels (countries that lack resources) macro approach - Looking at broader and general description on how countries are infected - Johnson and Raphael (incarceration) - Question about mass incarceration and infection rates - Bearman and Stovel (spanning tree network analysis) - Spanning tree analysis: networks between individuals in the school (sexual contact) - Policy -- targeting everyone and educating them - Conflict perspective (?) **[Making Connections]** ***Social Construction*** - Focus on how societies make claims, understand, label and then do or do not take action about an issue - Gives insight to who has power in society - Which claim makers have the most authority? - Can help us understand why something is considered a social problem in a given society and time - How might this vary? ***Social Construction Pt.2*** - Research: - Bogard -- Homelessness, review of newspapers, claims and claims makers in NY and DC - Broadhead - needle exchange program, claims and claims makers re closure ***Structural Functional*** - Focus is on institutions, processes and policies - Assumption from this perspective is that societies can generally function if they have good, stable, infrastructures - Social problems are viewed as emergent from something going wrong within the system of society - Policies? Institutional failure? Economic Shifts? - Concepts: Norms, Roles, Institutions, Values, manifest and latent functions ***Structural Functional Pt.2*** - Theorists: - Spencer -- rationality - Durkheim - Solidarity, collective consciousness - Gans - uses of poverty - Sub theories: - Merton - theory of differential access/strain theory, same goals/values, blocked opportunity - Shaw & McKay -- Social Disorganization ***Structural Functional Pt.3*** - Research - Wilson - deindustrialization, urban underclass - Hayward -- social determinants of health, health life course, cumulative disadvantage - Kohler-Hausmann -- Misdemeanor Justice - Robertson -- suicide - Perry - Pandemic Precarity - Johnson & Raphael -- data simulation on connection between AIDS and Incarceration - Sacks - sub-Sahara Africa and AIDS - Bearman -Network analysis, spread of disease in a school ***Conflict*** - Societies do not work for all citizens, instead there are contradictory interests, inequalities between social groups that lead to conflict and change - Concepts: stratification, power, social structures, alienation, capitalism ***Conflict Pt.2*** - Theory: - Marx - Ida B. Wells - DuBois - Mills - Research: - Oliver & Shapiro --wealth accumulation - Massey & Denton- residential segregation, argue with Wilson, purposeful racism - Williams - health discrimination - Manza & Uggen - voter disenfranchisement - Harris - monetary sanctions/LFO, contemporary iteration of social control of poor and people of color - Sub theories - Minority Threat Hypotheses (Sampson & Laub) ***Symbolic Interaction*** - Society is the product of individuals interacting with one another -- and we can see patterns that emerge, also the interactions lead to formation of people's behavior - Society is an on-going process of negotiating identities and related behavior ***Symbolic Interaction Pt.2*** - Theorists: - Mead -- meanings, manipulate symbols - Sub theories - Lewis Culture of Poverty - Becker Labeling theory - Anderson Code of the Street - Research: - Harris -re-entry - Light - Rotating credit associations, cultural connections build trust - Pager - criminal legal/employment, employer stereotype about race and criminal activity - Anderson -Code of the Street, local culture evolving around respect, when disrespected violence occurs - Herek & Capitanio - Sigma and AIDS, surveys, misinformation ***Critical Race Theory (CRT)*** Daniel Solorzano (1997, 98) 1. Centering race and racism with other forms of subordination -- argues racism is central, endemic and permanent in US society 2. The challenge to dominant ideology -- believes in and challenges white privilege 3. Commitment to social justice 4. The centrality of experiential knowledge 5. The transdisciplinary perspective -- goes beyond disciplinary boundaries to conduct analysis -- history, sociology, ethnic studies, women's studies, law, psychology... ***Intersectionality and the Sociology of HIV/AIDS (Watkins-Hayes 2014 article)*** - Returning to Intersectionality - "Emphasizes approaches that interrogate how race, class, gender, sexuality, and other social locations operate simultaneously in social life" (pg 433) - Builds from scholarship of Collins, Crenshaw, King - At the same time: power relations, methodological changes to identify the interlocking dimensions of power, with a political claim that recognizes inequality and racialized inequality in society. - Asks for scholars to think about how our identities might inform our research questions, data collected, assumptions we make, the scholarship we use. Acknowledge and interrogate positions of privilege. ***Key Underlying Dimensions*** - Poverty - Employment - Lack of: - Education, housing, health care access, quality food - Stigma, Racism - Regional disparities (think Allard, but across all issues) ***Connections*** - Gatekeepers -- policies and decision makers - Stereotypes -- assumptions create barriers - Location - where institutions are located, how location impacts access and quality - SES/Class -- perpetuates cycle, type of home, education, access health care - Culture -- values, beliefs, norms - Statistics -- the type of data we use to measure outcomes, how we analyze it - Power -- access to wealth, discretion - Life course -- key transitions in people's lives, how do they vary by different communities? - Cumulative disadvantage -- disadvantage, hurdles experienced in life (utero to death), how different communities experience more or higher hurdles than other groups ***What is the Answer?*** Individual or group change (think Tupac) Structural changes in education, employment, housing Reimagining (think Conflict) the social structure completely? What is our role in the replication of inequality and in the transformation of it? ***Themes*** - Poverty, inequality - Class - Homelessness - Penal expansion - Crime - Education - Disproportionally - Culture - Drugs - Power - Gender dynamics - Stigma - Govt - Media - Location ***The Role of Power*** - Juvenile and criminal justice - Who has the ability to influence, create, and implement policy - Poverty and Inequality - Creation of jobs (hiring, firing, monitoring of process) - Creation and maintenance of the "safety net" - HIV/AIDS - Who is infected (marginalized, poor, politically underrepresented, powerless) - Access to prevention, education, healthcare - The imagery generated (Symbolism)- media ***Key Concepts*** - Life Course Perspective - Stages throughout life - Transitions to Adulthood - Family - Education - Employment - Marriage - Cumulative Disadvantage (racism, poverty, education, CJ) ***Debate about "Public Sociology"*** Herbert Gans -- yes (information) - Media quotes, popular books, survey of ideas and findings, research reports Francois Nielsen - no (just analysis) ***Examples*** - Crutchfield -- Panels for fellowship review, Farrakhan case - Pattillo (N.W.) -- Urban Prep Charter Academy for young men in Chicago - Harris - Testified before WA legislature (PDL), Worked to develop and advocate for Clean Dreams, Report for WA MJC and for ACLU -- LFOs in WA state, Testify before WA State Supreme Court ***Policy Implications & Engagement*** - Policy Development & Testimony - U.S. Commission on Civil Rights - WA SB1783 (2018), WA SB6476 (2020) - City of Seattle testimony/report - Practitioner Engagement - CLEs, judicial conferences, State Sup Ct - Convenings/Taskforces - National Taskforce Fines, Fees, Bail - White House/DOJ "price of justice" - WA State workgroup (BJA grant) - WA State Race and CJ Taskforce 2010/2020 - Media - Op eds (NYT, LA Times), shaping investigations (e.g., Shapiro NPR) - Press release of findings ***What role do you think sociologists should play? What role can you play now and moving forward?*** - As a researcher? - Teachers? - Public engagement? - Policy? - Students? Closer walk (film) -- Each country came from different perspectives