Allison Beers United States and hiv/aids



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Beers


Allison Beers

United States and HIV/AIDS


The United States frequently prides itself on being one of the most developed countries in the world. It maintains a standard of living incomparable to a majority of other countries; it has a functioning democratic system of government, and a strong army with bases all over the world. Yet the United States is plagued by moments of corruption and weakness throughout history, including the failure to respond to those in need. America has been the host for cruelly fatal prejudices, especially during the height of the HIV/AIDS epidemic in the 1980s-1990s. Between 1992 and 1993, 78,948 cases of HIV/AIDS were diagnosed, of which 44,914 deaths occurred (Francis 2012). The United States, with all its development, was capable of handling this disease, so how did this number escalate to such a large number? Because the of the hostile social stigma associated with HIV/AIDS, the United States government and people failed to respond appropriately to the disease, actively choosing ignorance.

The way in which HIV/AIDS is transmitted and the habits of people who were first affected by it have produced a perception of disgrace; this stigma has increased the presence of HIV/AIDS dramatically. HIV/AIDS was first contracted by people who were typically discriminated against in the United States during the 1980s and 1990s – homosexual men and illegal drug users. The prejudice against these groups was strongly negative by both society and the government. As a result, they were not able to get the help needed to curb the effect of HIV/AIDS; in fact, “…drug users were generally unwelcome in most health and mental health settings, and so missed…opportunities for testing to detect their HIV infections early” (Drucker 2012). This failure would lead to increased infection rates, as needles used to inject drugs were unknowingly infected with HIV/AIDS and infected anyone who shared it. Similarly, homosexual men, who were the most susceptible to the disease at its beginning, experienced great difficulties in getting the support needed if they were infected HIV/AIDS. The attitude of society at the time was one of “official hostility to gays,” one that was comparable to that towards drug users as well; this perception discouraged the government from actively creating policies. In fact, the government actively refused to make policies. The social stigma associated with HIV/AIDS has created dramatic hurdles in the United States’ ability to overcome the obvious negative effects of the disease on public health.

The consequences of the stigma associated with HIV/AIDS extend far beyond those of societal disgrace; in fact, it even extended to Washington, where the Reagan administration was almost completely inept in handling the crisis. President Reagan and his administration made many decisions during his time in office that benefitted America; their response to HIV/AIDS, however, was definitely not one of them. Donald Francis, a former employee of the Center for Disease Control during the time of the HIV/AIDS crisis, recalls his frustration at the government’s refusal to fund HIV/AIDS treatment and research efforts. The plan the CDC proposed to the White House for curbing HIV/AIDS (which Francis helped to draft) was rejected with the commentary “Look pretty and do as little as you can” (Francis 2012). It was not ignorance of the effect of HIV/AIDS that prevented the Reagan administration from taking action against the disease but a genuine disinterest, which may or may not have been heightened by homophobia. In some cases, the prejudice is clear; for example, Patrick Buchanan, the White House Director of Communications at the time, was an outspoken homophobe who claimed that homosexuals were victims to HIV/AIDS because they “declared war on nature and now nature is exacting an awful retribution” (Francis 2012). Buchanan’s statement is extreme. Not all members of the White House shared the same sentiments, and even if they did, it is likely that they would not express it to such a shocking degree. However, it was this prejudice that won out over the others in the end. At a time when the government was trying to cut back on spending, a disease such as HIV/AIDS that carried such a negative stigma was unlikely to receive any special attention until absolutely necessary. When it was absolutely necessary, it was too late – HIV/AIDS epidemic was quickly escalating into a pandemic, affecting parts of Africa and Europe, and there were over 10,000 cases reported in the United States (Francis 2012). Due to misguided priorities, the United States government failed to respond appropriately to the HIV/AIDS crisis.

Once the magnitude of patients infected by HIV/AIDS pushed discrimination into the background, the United States government began enacting policies to combat its prevalence, only to find that its resource advantage had been dramatically damaged by the programs’ late start. In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act (to be managed by the U.S. Health Resources and Services Administration (HRSA)). Perhaps the most important provision of this act was that it provided $220.5 million in federal funds for HIV-related programs (HRSA 2011). The most recent attempt to control HIV/AIDS is the U.S. National HIV/AIDS strategy (NHAS), which was composed under President Obama. However, “HIV programs have generally been flat funded or received small percentage increases which are not at levels estimated to be necessary for full implementation of the NHAS” (Holtgrave et al 2012). While HIV/AIDS prevalence has certainly decreased since the 1980s-1990s, the United States is still experiencing the same implementation problems it did in the past, but on a smaller scale. Had the government taken steps earlier in the process, it could have saved valuable resources and money by not having to treat as many patients because not as many people would be affected today.

Even though the United States may possess and distribute antiretroviral drugs, the drugs are useless if the patients do not use them correctly, which they often do not due to various characteristics of HIV/AIDS, including stigma, transmittance, and a long incubation period). The presence of antiretroviral drugs has no doubt allowed for the prevention of HIV/AIDS and a slower increase in its spread; however, “problems with adherence have prevented many from realizing the full benefits of treatment” (Leeman et al. 2010). This unfortunate hurdle of lack of cooperation stems from several qualities of HIV/AIDS. First of all, the disease has a long incubation period of around ten years; that is, victims and potential victims do not see the immediate consequence of the disease’s presence. This leads to the second problem that preventing HIV/AIDS presents: there is no cure, and in order to keep it contained, a person will have to change their behavior for life. Illegal drug users who are used to sharing needles will either have to stop using drugs (unrealistic for most addicts) or find clean needles (which is harder than it should be). The most effective preventative method for homosexual men – abstinence – is also not a likely lifetime behavioral change. It has also been a problem for patients with HIV/AIDS to seek help and treatment, although it seems that if the patient develops a strong, personal relationship with his doctor that cooperation is more effective (Leeman et al 2010). Because of the characteristics of this disease, HIV/AIDS has had a nulling effect on the resources made available by the United States government, increasing its prominence in the community.

Dr. James Mason, the Director of the CDC during the HIV/AIDS crisis, summed up the effect of HIV/AIDS on development in the United States quite nicely. He stated, “there are certain areas which, when the goals of science collide with moral and ethical judgment, science has to take a time out” (Francis 2012). Although this is a discouraging claim, especially from the head of one of the most important science departments in the world, it proved to be true. It is a testament to the prejudice of the society at the time that saving lives and preventing the spread of disease would be considered immoral simply because of the nature of the lives being saved. Yet such was the case. By the time these views had altered enough due to the immense spread of HIV/AIDS, the United States found itself at a disadvantage, despite its comparably adequate resources available. Choice, not ignorance, was the main factor at play in the HIV/AIDS crisis.


Bibliography

"A Timeline of AIDS." A Timeline of AIDS. 2011. Accessed October 02, 2013. http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/.

Drucker, Ernest. "Failed Drug Policies in the United States and the Future of AIDS: A

Perfect Storm." Journal of Public Health Policy 33 (2012): 309-16. Accessed September 17, 2013. ProQuest.

Francis, Donald P. "Deadly AIDS Policy Failure by the Highest Levels of the US Government: A Personal Look Back 30 Years Later for Lessons to Respond Better to Future Epidemics." Journal of Public Health Policy 33 (2012): 290-300. Accessed October 2, 2013. ProQuest.

Holtgrave, David R., Irene Hall, Laura Wehrmeyer, and Cathy Maulsby. Costs,

Consequences, and Feasibility of Strategies for Achieving the Goals of the National HIV/AIDS Strategy in the United States: A Closing Window for Success? Report. May 19, 2012.

Leeman, Jennifer, Yun Kyung Chang, Eun Jeong Lee, Corrine I. Voils, Jamie Crandell,



and Margarete Sandelowski. "Implementation of Antiretroviral Therapy Adherence Interventions: A Realist Synthesis of Evidence." Journal of Advanced Nursing 66, no. 9 (April 2, 2010): 1915-930. Accessed October 1, 2013. Wiley Online Library.

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