Public Health

1) HIV/AIDS

AIDS has been one of the most devastating epidemics recorded in history. UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981. According to the 2006 UNAIDS Global Summary, there are currently 39.5 million people living with HIV/AIDS worldwide: 37.2 million adults, 17.7 million women, and 2.3 million children aged 15 years or younger. This same report states that in 2006, at least 4.3 million people were newly infected and at least 2.9 people died from AIDS (Blankenship, 10).

What will it take to bring about change in the social stigmatization of people living with and dying of AIDS? Some would argue, and quite rightly, that the social stigmatization of PWAs is less evident now than it was a decade ago. Antiretroviral drugs allow people with HIV/ AIDS to live longer and perhaps delay revelation of their illness. Surveys have found that most Americans are fairly knowledgeable about HIV/AIDS and supportive of PWAs (Blankenship, 12), but AIDS-related stigma still exists. Continued progress in three areas will help to lessen the social stigmatization of persons with AIDS: changes in societal attitudes about death, the continued management of HIV/AIDS as a chronic illness, and societal recognition of the inequity of associating HIV/AIDS with marginalized existence (CDC, 1062).

The hospice and palliative care movements have begun to humanize and naturalize death. We have a long way to go to overcome our existential fears, but these movements, which change the settings where death takes place and acknowledge the need for comfort care, not cure, represent a step in the right direction (CDC, 1063). Antiretroviral therapies are extending the lives of people with HIV/AIDS, such that we have now begun to think of AIDS as a manageable disease as opposed to one that is always fatal (CDC, 1064). (This, unfortunately, is strictly a Western phenomenon. People with AIDS in developing countries are not able to afford AZT, much less the combination of drugs that will extend their lives, and drug companies appear to be more concerned about profits than about care (Blankenship, 14).

Until these changes, a staggering majority of AIDS deaths will take place in non-Western cultures.) As AIDS education and prevention efforts have proceeded in the United States, there has been more openness about sexuality and the sexual practices most linked with HIV/ AIDS, and as needle-exchange programs have advanced, the sharing of infected needles has declined. Both of these efforts remain extremely controversial in some segments of society (e.g., the Christian Right), therefore we need to remain vigilant and not let complacency and harassment undo the good that has been done thus far (www.cdc.gov). Finally, over time, Americans are slowly recognizing that AIDS is not associated exclusively with members of marginalized groups. People living with AIDS are pursuing empowerment strategies, and many members of mainstream society realize that they, too, are at risk.

All of these are positive first steps; however, we still need to work to dismantle the structures that led to ...