Download PSCI 115F Actual Part 2 Essay

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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,
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“…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
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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
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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
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(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.
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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.