Policy Implications of Adopting a Syndemics Approach to Overcoming Barriers to HIV/AIDS Testing and Treatment among Vulnerable Populations - PowerPoint PPT Presentation

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Policy Implications of Adopting a Syndemics Approach to Overcoming Barriers to HIV/AIDS Testing and Treatment among Vulnerable Populations

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Title: Policy Implications of Adopting a Syndemics Approach to Overcoming Barriers to HIV/AIDS Testing and Treatment among Vulnerable Populations


1
Policy Implications of Adopting a Syndemics
Approach to Overcoming Barriers to HIV/AIDS
Testing and Treatment among Vulnerable Populations
  • Merrill Singer, PhD
  • University of Connecticut

2
When one tugs at a single thing in nature, he
finds it attached to the rest of the world.
John Muir
  • Syndemic the concentration and deleterious
    interaction of two or more diseases or other
    health conditions in a population, especially as
    a consequence of social conditions that promote
    disease clustering.

3
  • We need to assess the nature of the specific
    interconnections and pathways of influence among
    the parts,
  • including the intricate ways in which they foster
    and reinforce each other and
  • thereby create complex, burdensome and
    challenging webs of entwined health and social
    problems.

4
HIV/AIDS
  • Studying this history-changing disease and
    responding to it within public health frameworks,
    as though it were separate from other diseases is
    a distortion.
  • As it exists in the world, HIV/AIDS is never
    separate from other diseases,
  • nor is it detached from social structures and
    social environments
  • that channel the lived experiences and health and
    mental states of infected individuals

5
  • CDC research protocols, prevention programs,
    policy interventions, and other aspects of public
    health practice is that they have focused on
    one disease at a time, leaving other health
    problems to be addressed by parallel
    enterprises.
  • Using the term epidemic to describe HIV/AIDS does
    not adequately describe this public health
    crisis,
  • which involves the transmission of this disease
    in close conjunction with a set of opportunistic
    diseases but also with many non-opportunistic
    health conditions.

6
Syndemic perspective
  • The multiple contemporary threats to the health
    of disadvantaged and marginalized populations are
    not concurrent epidemics in that they are not
    completely separable phenomena.
  • They constitute sets of enmeshed and mutually
    enhancing synergistic health problems that,
    working together in a context of noxious social
    and physical conditions, can significantly affect
    the overall disease burden and access to services
    of a population

7
Structural violence
  • The host of offenses against human dignity
    including significant social disadvantage,
    discrimination, and stigmatization suffered by
    the poor, people of color, documented and
    undocumented immigrants from developing
    countries, women, the homeless, and sexual
    minorities.
  • Latent or hidden and delayed or sequential
    consequences.

8
Hidden Delayed Consequences
  • Housing
  • Housing directly contributes to a debilitating
    lack of a sense of safety and to feelings of
    hopelessness,
  • poor physical and emotional health
  • exhaustion of social capital
  • resulting weakened social support networks
  • poor education
  • diminished life opportunities

9
  • Immigration
  • those with lower acculturation scores were more
    than twice as likely to test positive for
    HIV/AIDS
  • more than twice as likely never to have been
    tested for hepatitis C
  • documented immigrants were twice as likely as
    their undocumented counterparts to have been
    tested for HIV and hepatitis C
  • each measure of lowered acculturation contributed
    to a 6 decline in chances that a participant
    would have access to health care

10
  • Drug users in New England
  • 25 of our participants were infected with HIV
  • Of these, over 90 reported suffering from at
    least one other major disease, including
    hepatitis, tuberculosis, endocarditis, STDs,
    diabetes, liver disease, or mental illness.
  • Almost half of HIV-infected participants reported
    three or more of these diseases.
  • Most participants in this and our drug user
    studies reported lifetime and enduring
    experiences with violence in various forms

11
  • Female Drug users in New York
  • over 80 reported drug use during the incident.
  • In 40 of cases, both partners were using drugs
  • 20 of the women in this study reported that they
    used drugs immediately after an episode of
    partner violence had ended as a means of coping
    with their emotional upset and physical pain.
  • a similar proportion of the women reported that
    they had been forced to have unprotected sex
    either during the most recent episode of violence
    they had endured or just after it concluded.

12
  • There is a critical need for longitudinal
    research on (a) causal pathways and cumulative
    effects of the syndemic issues of violence, HIV,
    and substance abuse and (b) interventions that
    target intimate partner violence victims at
    risk for HIV, as well as HIV- positive
    individuals who may be experiencing
    violence.
  • -- Andrea Gielen

13
Challenges Barriers
  1. finding hidden populations of people living with
    HIV-related syndemic health and social burdens
  2. addressing issues of the availability,
    accessibility, and acceptability of testing,
    treatment and care programs for this vulnerable
    population based on syndemic health and social
    assessment
  3. attending to the challenges of sustaining people
    in treatment by insuring the coordination,
    integration, and comprehensiveness of services

14
New resources for meeting challenges
  1. improved methodologies for finding and engaging
    hidden and hard-to-reach populations
  2. availability of community-based rapid assessment
    strategies for identifying local structural and
    situational barriers to testing and care
  3. growing recognition of the value of
    community-based participatory approaches and the
    availability of local networks
  4. enhanced awareness of the importance of cultural
    factors and the role of stigmatization in
    avoiding or delaying help-seeking
  5. expanding understanding of HIV/AIDS syndemics and
    the challenges of treatment adherence for
    vulnerable populations
  6. recognition of the significant cost savings, both
    in terms of human suffering and monetary
    expenditure, of early as opposed to late
    intervention

15
The end
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