A Holistic Approach to HIV: Social Disparity and Its Impact

Getting infected by the Human Immunodeficiency Virus (HIV) doesn’t only depend on one’s choices, like choosing to wear a condom while having sex or sharing needles during injection drug use. Instead, there are other societal factors to consider such as one’s income, access to education, and the availability of pre-exposure treatments (PrEP). Just as a fetus has no decision as to whether they contract HIV from their mother during pregnancy, transmission is contingent on several uncontrollable factors.

What Is HIV?

Symptoms in HIV-positive patients can include a swollen abdomen, diarrhea, pneumonia and various infections. Infection may also make patients more susceptible to various life-threatening cancers. HIV progresses to Acquired Immunodeficiency Syndrome (AIDS) when one’s CD4+ cells – the immune system’s key infection fighters – fall below normal levels. Without health interventions, life expectancy is around 5 years. However, people who are HIV-positive and stick to a beneficial treatment regimen can still live a long and healthy life and may never develop AIDS. 

One thing everyone should understand is that anyone can acquire HIV. Dr. Brooke Rogers, a research scientist and psychiatrist at The Miriam Hospital and the Warren Alpert Medical School of Brown University, has dedicated her time to researching the virus in the U.S., concurrently uncovering universal trends. She describes how a person’s “intersecting identities” affect their probability of becoming infected. These identities can encompass gender, race, economic status and more.

“A person isn’t just one of those factors, but all of them contribute to risk and resilience in the face of stressors,” says Dr. Rogers. 

There are many social determinants unrelated to a person’s genetic predisposition to illness that play an equally significant role in their vulnerability to sickness. Due to people following the general practices of their cultures, infection rates vary between different ethnicities and religions. For instance, Muslims in sub-Saharan Africa, who commonly practice male circumcision, reduce their chance of contracting HIV by up to 70%. At the same time however, sexual customs in that region of the world contribute to an increased number of HIV cases.

The LGBTQ+ community is also particularly vulnerable to HIV. This is especially seen in men who have sex with men. However, despite it being easier for gay men to contract specific mutations of HIV DNA because of male anatomy; the likelihood of HIV in a person hinges primarily on societal discriminations.

Discrimination and COVID-19

COVID-19 is an example of how discrimination in society impacts disease transmission. Crowded housing and lower income jobs that often require one to work in close proximity to others, make impoverished communities an easier target for the coronavirus.

Although transmission works differently for HIV, the underprivileged are affected in both cases. In regard to both HIV transmission and treatment, Rogers states the way our society is structured benefits the “people that have more privilege and social power and access.” It is and always has been the privileged who are able to know their HIV status and can afford healthcare, just as it was the privileged who had a fairer chance at staying safe while the world went virtual at the start of the COVID-19 pandemic. It’s like playing Monopoly; the rich get richer until everyone else has lost the game. 

But the game’s not over yet. Contraction of HIV is often blamed on a patient’s inability to adhere to society’s preconceptions of a healthy and normal life, when – to fully understand the extent of the disease – patients should instead be “addressed holistically,” considering all surrounding aspects of their lives. Doctors and nurses have started adopting a new philosophy that includes understanding a person’s social environment and mental state, in addition to their physical state.

According to Dr. Rogers, “Thinking about what it means to be human and alive and doing well is still really important even when you have a treatment to address the medical aspect of it.” This way the patients are addressed as more than patients; they are seen as people too, people with a fighting chance.