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jueves, 20 de febrero de 2014

Could the NATIONAL HIV/AIDS STRATEGY FOR THE UNITED STATES be an example of a plan towards equality?

The United States (US) is a country with an increasingly inequality within its health system, perhaps due to poor participation of the State in primary care which might lead to profitable purposes. However, it is also important to observe the strategies implemented to cope with inequalities in some health issues.   

For instance, the topic of Men having Sex with Men (MSM) in the black community. Recently the Centers for Disease Control and Prevention (CDC) has updated the data in regards of HIV: African Americans face the most severe burden of HIV/AIDS in the United States. Among African Americans, gay, bisexual and other MSM (Black MSM) are especially hard hit, representing more than half of all estimated new HIV infections among African Americans each year.1 

To understand the full scenario we have to remember that Black MSM represent 1 in 500 US citizens and 9% of all MSM in the United States 2, yet they accounted for 38% of new HIV infections among MSM and 70% of new HIV infections among Black males in 20103. Nationally, MSM represent about 4% of the male population, yet they account for 52% of all people living with HIV. HIV prevalence among Black MSM is roughly double the prevalence among White MSM.3 A particularly disconcerting estimate in 2010 showed that young Black MSM aged 13 to 24 accounted for the greatest number (4,800) of estimated new HIV infections among African Americans.



One of the NATIONAL HIV/AIDS STRATEGY three goals is to “Reduce HIV-Related Health Disparities”. For this goal, some are mentioned 5:

1) Reduce HIV-related mortality in communities at high risk for HIV infection. 
2) Adopt community-level approaches to reduce HIV infection in high-risk communities.
3) Reduce stigma and discrimination against people living with HIV.

Analyzing the second step, it is described herein that in order to address this greater vulnerability to HIV infection, it is necessary to reduce the high proportion of individuals in these communities who are living with HIV, as well as the viral load of a person living with HIV. Therefore one recommended action is to measure and utilize community viral load. Thus, ensuring that all high prevalence localities are able to collect data necessary to calculate community viral load, measure the viral load in specific communities, and reduce viral load in those communities where HIV incidence is high.

A second recommended action is to establish pilot programs that utilize community models. This last recommendations comes with a less specific description and is more likely to be disintegrated by the traditional model of imposing “healthy” norms. Some efforts have already done in this matter, for example, a qualitative study analyzed thoroughly the black community leaders’ concerns about the barriers that HIV prevention actions in their community. Within this paper, participants supported the need to:4
- Create an environment in HIV prevention research that supports prolonged and mutually beneficial partnerships with a focus on infrastructure and capacity- building initiatives that serve to strengthen communities most impacted by HIV and AIDS.
- Hiring and training community research assistants.
- Developing community dissemination plans in collaboration with community partners.
- Generating a community involvement plan detailing the involvement of community members and leaders as equal partners

Although in the Obama´s commitment HIV/AIDS STRATEGY it is recognized the importance of community participation for the planning of specific prevention actions, it is not described how these recommendations would be carried out. Achievement would, then, depend on the local governance and their public health programs, and it is well known that not all the States are similarly motivated to set up agreements with black MSMs. Therefore, the Strategy might be a good first-step approach to eliminate inequalities in the AIDS epidemic, nonetheless, the key leading to failure or success rely on the prevailing social structure within the regional Government; I dare to say that community activism is crucial to reach the goals previously mentioned.

By Eduardo Vaquero

1 Centers for Disease Control and Prevention. HIV in the United States: at a glance. 2013. Available at: http:// www.cdc.gov/hiv/statistics/basics/ataglance.html. Accessed February 17, 2014.
2 HIV surveillance report: diagnoses of HIV infection and AIDS in the United States and depending areas, 2010, Centers for Disease Control and Prevention. volume 22. 2012
3 Lieb S, Fallon SJ, Friedman SR, et al. Statewide estimation of racial/ethnic populations of men who have sex with men in the US public. Health Rep. 2011;126(1):60--72
4 Andrasik MP, Chandler C, Powell B, Humes D, Wakefield S, Kripke K, et al. Bridging the Divide: HIV Prevention Research and Black Men Who Have Sex With Men. Am. J. Public Health [Internet]. 2014 Feb 13 [cited 2014 Feb 17];1–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24524520
5 NATIONAL HIV/AIDS STRATEGY FOR THE UNITED STATES. Jul 2010. WASHINGTON

1 comentario:

  1. Meu nome é Adilson Tajuana eu sou do México, era real sério na minha vida como um HIV positivo, quem vai acreditar que a erva pode curar Oito anos HIV no meu corpo e eu estava tendo problema na minha pele em resultado deste vírus, eu nunca acreditar que isso vai funcionar eu tenho gasto muito dinheiro comprando drogas do hospital para me manter saudável e eu estava esperando por essa morte para vir, porque eu era impotente, um dia i duro sobre este grande homem que é bem conhecido de HIV e cura do câncer, eu decidi enviar-lhe (okonofua_solution_tem99@hotmail.com), sem saber, para mim que este será o fim do HIV no meu corpo, preparou a erva para mim e para enviá-lo ao serviço de correio através de, e deu me instruções sobre como levá-lo, no final dos cerca de alguns dias, ele me disse para ir para o hospital para um check-up, e eu fui, surpreendentemente, após o teste, o médico confirmou-me negativa, eu pensei que era uma piada , eu fui para outros hospitais não acreditei que sou HIV negativo. Eu realmente quero dar graças a DR. PAUL EMEN por salvar a minha vida, eu nunca acreditei que eu vou ser HIV negativo hoje, por favor, meus queridos amigos, me ajude a agradecer DR. PAUL EMEN para o que ele tem feito na minha vida eu sou grato Sir. se você está tendo mesmo problema por favor entre em contato com ele através deste e-mail (okonofuatem99@gmail.com).
    eu te amo DR. PAUL EMEN eu nunca te esquecer, e eu prometo para compartilhar este testemunho todo lá e em qualquer lugar que eu esteja. obrigado novamente....

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