Browsing by Subject "HIV/AIDS"
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item Decentralizing HIV/AIDS care in the U.S. based on social determinants of health(2016-08) Vázquez-Ruelas, José; Springer, David W.; Bacon, Kevin MIt has been almost 40 years since the first cases of HIV/AIDS were recorded in the late 1970s and early 1980s. In the US, political action and medical treatment has shifted HIV/AIDS from a deadly infection with no treatment, to a manageable and preventable disease. Yet, current infection rates reflect the continued challenge. This report is comprised of two sections. The first section, Social Determinants of Health Model and HIV/AIDS, provides a brief trajectory of the HIV/AIDS epidemic in the US. The second section, Decentralizing Care, presents a process for how a medical service organization primarily devoted to HIV/AIDS services may decentralize care to other locations, with the intention to increase access to HIV/AIDS services and reducing stigma.Item Destabilizing science from the right : the rhetoric of heterosexual victimage in the World Health Organization's HIV/AIDS controversy(2009-05) Mack, Ashley N.; Cloud, Dana L.; Brummett, Barry, 1951-In this project, I am interrogating discourse surrounding the 2008 WHO/UNAIDS controversy, which both preceded and followed the publication of an article in the U.K. newspaper The Independent. The article reported that the head of the World Health Organization’s HIV/AIDS initiative admitted that the threat of an AIDS pandemic among heterosexuals was “officially” over. These texts are particularly important for such an endeavor because, as I will argue below, the controversy enables both “AIDS” and “heterosexuality” to operate as floating signifiers whose meanings are contested in public discourse in ways that ultimately reinforce heterosexual privilege and under-attention to the AIDS crisis. In the end, the destabilization of the meaning of HIV/AIDS does not serve emancipatory ends. Although the destabilization of meaning is the emancipatory gesture ‘par excellence’ for the poststructuralist tradition, my investigation shows that the destabilization of meaning in the WHO controversy actually results in the reification of master narratives.Item Geopolitical influences on German development policies in Africa and AIDS policies in Kenya(2009-06-02) Bachmann, VeitAt the beginning of the twenty-first century Germany geopolitics can be characterized by its grand strategy as a civilian power. Germany has come to depend on a civilianized international system based on multilateralism, international institutions and the rule of law, supranational integration, free trade, and the restriction of the use of force as a means for international politics. Such a system requires the players in it to be peaceful and civilian, developed and cooperative, legitimate and law-abiding. Many African countries do not fulfill those conditions. Extremely high prevalence rates of HIV/AIDS in Africa severely undermine social structure, economic development and political stability and thus contribute to state failure. State failure is in fundamental conflict with Germany's prime geopolitical interest in promoting a civilianized international system, because a failing state is incapable of creating civilianized structures. After analyzing Germany's foreign and development policies since World War II, I came to the conclusion that all German foreign policies aim at promoting a civilianized international system. I am arguing that development policies are part of broader foreign policies and thus pursue this goal with respect to developing countries. However, for the system itself it is much more important that the big players in the world are included and committed to it. Therefore, German foreign policy focuses on the major powers in the world and, just as developing countries play a minor role in international politics, development policies play a minor role in Germany's grand strategy as a civilian power. German grand strategy, however, plays a major role in the design and the conduct of German development policies, policies used as tools to pursue Germany's broader geopolitical interest in promoting a civilianized international system.Item Health disparities between blacks and whites with HIV/AIDS : an analysis of U.S. national health care surveys from 1996-2008(2011-05) Oramasionwu, Christine Uzonna, 1982-; Frei, Christopher R.Blacks are more affected by Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) than any other race or ethnicity in the United States. The purpose of this dissertation was to investigate potential race-based differences in cardiovascular disease (CVD)-related hospitalizations and use of opportunistic infection (OI) prophylaxis between Blacks and Whites with HIV/AIDS. This dissertation includes two systematic literature reviews that identified knowledge gaps in the areas of CVD diagnosis and OI prophylaxis use between Blacks and Whites with HIV/AIDS, as well as two independent studies that addressed some of the gaps identified in the literature. The first study evaluated the association between race and CVD-related hospitalization in Blacks and Whites with HIV/AIDS. Data were retrieved from the 1996-2008 National Hospital Discharge Surveys (NHDS). Approximately 1.5 million hospital discharges were identified. After controlling for confounders, the odds of CVD-related hospitalization were 45% higher for Blacks than Whites (OR=1.45, 95% CI, 1.39-1.51). There was a statistically significant difference in the proportions of CVD-related hospitalization type and race (x2=479.77; df=3; p<0.001). Compared to Whites with HIV/AIDS, Blacks with HIV/AIDS had greater proportions of heart failure and hypertension, but lower proportions of stroke and coronary heart disease. These results suggest that there is an influence of race on both the occurrence and type of CVD-related hospitalizations in patients with HIV/AIDS. The second study assessed if race was associated with the use of OI prophylaxis (Pneumocystis jiroveci pneumonia [PCP] and Mycobacterium avium complex [MAC]). Data for this study were retrieved from the 1996-2008 National Hospital Ambulatory Medical Care Surveys (NHAMCS). Approximately 9.1 million hospital ambulatory visits were identified. After controlling for confounders, the odds of PCP prophylaxis use were 16% higher for Blacks than for Whites (OR=1.16, 95% CI, 1.15-1.17). In a separate regression analysis, the odds of MAC prophylaxis use were 12% higher for Blacks than for Whites (OR=1.12, 95% CI, 1.10-1.13). These findings suggest that Blacks with HIV/AIDS may have increased odds for OI prophylaxis. Based on this work, there is a need for further research to confirm these findings and to identify the causes of these race-based disparities.Item Impact of HIV/AIDS on the Agricultural Sector in Northern Namibia(2011-02-22) Carter, Charles RussellIn agrarian societies, HIV/AIDS extends far beyond the realm of healthcare into agricultural production and food security as well. Namibia is a developing country with a large portion of its population involved in agriculture; the average HIV/AIDS infection rate of 21.3% in the country leaves a large portion of agricultural workers living with or affected by HIV/AIDS. The purpose of this study was to further evaluate the impact of HIV/AIDS on national and community level food security in northern Namibia by ascertaining the perceptions and experiences of local farmers living with HIV/AIDS. In addition, this research aims to define the specific training needs for this population, and to identify possible barriers to access. Four focus groups and four key informant interviews were conducted in northern Namibia, and participants were asked a variety of questions relating to People Living with HIV/AIDS (PLWHA) in agriculture. Qualitative analysis drew out prevailing themes and ideas from the data. This study found that there is a greater need for HIV/AIDS specific education and programs targeted to HIV/AIDS infected agrarian workers. Additionally this study found there were barriers to education present in the current system, and identified needs for joint programming initiatives between the ministries of health and agriculture.Item Pain management experiences in adults living with HIV/AIDS(2011-08) Mikan, Sabrina Quintanilla; Carter, Patricia A.; Acton, Gayle; Fredholm, Leigh; Garcia, Alexandra; Volker, DeborahEven though pain is common and often chronic in people living with HIV/AIDS (PLWHA), the management of pain is complicated and frequently woefully inadequate. Many factors influence the way PLWHA experience and communicate their pain. These factors can be categorized as both physiological and emotional. PLWHA often resort to self-care activities to control their pain because of the pervasive lack of adequate pain management by health care providers. The purposes of this study were to increase understanding of the pain management experiences in people living with HIV/AIDS (PLWHA) who report chronic pain and to elucidate the factors that influence this experience. Recruitment was conducted at 3 locations in Central Texas, USA; serving over 3,000 clients/year. A cross-sectional descriptive design and open-ended questions were used to explore PLWHA experiences in reporting chronic pain needs for at least 3 months and to describe pain management choices (self-care and/or seeking care activities) and communication with health care providers. Variables of interest were assessed with paper-pencil surveys (HIV-Self Efficacy Questionnaire, Coping Inventory for Pain in Persons Living with HIV/AIDS and Pain Self-Efficacy Questionnaire) and open-ended questions. Interviews ranged from 7-35 minutes each. One hundred PLWHA participated in the study, 53% African-American, 21% Hispanic and 25% Caucasian. They were primarily male (66%), 34% female, reported a mean age of 48 years and a mean of 13 years living with HIV. 83% of the participants rated their pain as consistently moderate to high levels; 82% rated they are likely to “tolerate the pain.” A majority of the participants (63%) reported they exercise or walk as a way of self-managing their pain. There was a significant association between use of pain management choices (self-care and/or seeking care activities) and confidence in performing life activities (r= 0.344, p<0.05). These findings indicate a need for health care providers to move beyond quantitative measures for this complex problem. Clinicians can use this information to understand the coping strategies used by PLWHA to manage pain. Future implications will be to develop appropriate pain management approaches (behavioral and pharmacological) for health care providers to improve control of chronic pain in PLWHA. Longitudinal studies are needed to explore the causative relationships between pain management choices (self-care and/or seeking care activities) and functional outcomes in PLWHA.Item Pharmaceutical governance in Brazil : globalization, institutions and AIDS(2010-12) Flynn, Matthew Brian; Roberts, Bryan R., 1939-; Buckley, Cynthia J.; Ward, Peter; Ugalde, Antonio; Charrad, Mounira; Wilson, RobertThe Acquired Immune Deficiency Syndrome (AIDS) caused by the human immunodeficiency virus (HIV) represents one of the biggest challenges facing today's globalized world. Meanwhile, transnational drug companies have strengthened their market positions in developing countries as a result of the Agreement on Trade-Related Aspects of Intellectual Property (or TRIPS). Patent protection provided by TRIPS has led to higher prices and reduced access to essential medicines. Low- and middle-income countries are under increased pressure to provide expensive life-saving medicines to their citizens. Brazil's AIDS program is deemed successful in reducing morbidity and mortality rates through universal provision of free AIDS medicines. The program's sustainability came under threat as the result of TRIPS, pressures by transnational corporations, and trade threats by the US government. The research question that drove my dissertation centered on the impact of these threats on policy space available to Brazilian government to sustain its universal social program. How has the incorporation of patent protections for drugs affected the ability of local firms to develop pharmaceutical technology and challenged states like Brazil to fulfill social democratic obligations? Under what conditions can a developing country challenge the interests of transnational drug companies? I employed mixed methods for gathering and analyzing data. These included ethnographic field techniques, content analysis, and archival research. My findings are threefold. First, TRIPS has increased the power of foreign firms to secure monopoly positions in Brazil’s drug markets and weakened Brazil's labs to quickly make generic copies of essential medicines. Second, policy space, though curtailed due to external pressures and treaty obligations, expanded through the development of symbolic power, or what I call "reputational dividends," based on a successful social program. Third, by adroitly marketing its banner AIDS program by employing human rights principles, health officials constructed a triple alliance between the state, local private drug manufacturers, and domestic activists tied into transnational advocacy networks. I employ institutional and power analyses to examine the changing sources of power for transnational capital, social movements, and state actors, as well as analyze the impact patent protection has on the ability of Brazilian firms to produce medicines locally. I posit that globalization results in the formation of strong domestic coalitions who are capable of exploiting the "reputational dividends" of a successful social program in order to contest transnational corporate power. This symbolic form of power appears particularly well-disposed for "middle-income" countries that lack the material forms of power held by a global hegemon or transnational corporations.Item Stigma : the negatives of being HIV positive(2010-12) Burke, Christina Michelle; Darling, Dennis Carlyle; Reed, EliThis report addresses the issue of stigma surrounding people living with the human immunodeficiency virus and the acquired immunodeficiency syndrome or HIV/AIDS. It examines the relationship between the disease and a person’s willingness to seek treatment and how an HIV diagnosis affects self-acceptance, family relationships, friendships and well being of people living with HIV/AIDS. In many cases the self-imposed stigma is just as menacing as external stigma. The global pandemic of HIV/AIDS affects every class, color and creed. It is a public health crisis that quietly infects new victims daily. In the thirty years since its discovery there is still no known cure. The passage of the Ryan White act was the federal government’s first official response to the issue. While the disease is manageable for many who can afford expensive anti-retroviral medication, the side effects and psychological turmoil they face is oftentimes unbearable. This report, and the accompanying video, Stigma, which can be found at http://christinaburkephoto.blogspot.com/ examines the social and psychological effects on people living with HIV/AIDS.Item Testing differences : the implementation of western HIV testing norms in sub-Saharan Africa(2010-12) Angotti, Nicole Catherine; Regnerus, Mark; Auyero, Javier; Roberts, Bryan; Watkins, Susan C.; Weinreb, AlexanderThis dissertation considers how Western health interventions are incorporated in non-Western societies. It focuses specifically on ‘HIV Testing,’ a key strategy that emerged to fight the spread of HIV in the West and was later institutionalized globally and exported to other, very different parts of the world. The empirical object of study is the “3Cs,” the cluster of Western norms and ideals upon which global testing policy rests: (1) that it includes counseling, (2) that it be conducted with informed consent, and (3) that the test results be confidential. Employing several methods of field research, this project investigates how the rationalities and motivations of various actors at national and local levels affect the implementation of a key global AIDS intervention in Malawi, a high HIV prevalence, rural African setting. Fundamental differences between the West and sub-Saharan Africa form the basis of this inquiry as to how imported models fare when implemented outside of their context of origin. Towards that end, this study considers how three strata of social and institutional actors who inform the HIV Testing encounter in Malawi interpret, and put into practice, the same ideas: the Counseling and Testing Establishment (CTE), HIV Counselors, and rural Malawians. For the CTE, its proponents, the “3Cs” are Western, human rights imports that are worth defending formally, but not necessarily worth prioritizing in practice. For HIV Counselors, its implementers, knowledge of the “3Cs” as Western biomedical jargon distinguishes them from villagers, but places them in situations where the ethics of testing conflict with moral concerns they have for those whom they were trained to help; thus they adapt them in practice. And for rural Malawians, its beneficiaries, the “3Cs” have little inherent value, and are perceived largely as doing harm rather than good in their communities. Thus, the net contribution of this study is that the “3Cs” have no single meaning as a normative testing regime, but rather acquire (differential) meaning (and import) during their implementation. Indeed, unless policy makers and analysts know something about this, interventions developed from afar are unlikely to have their intended effects on the ground.