Public Health Challenge of AIDS Public health seeks to prevent disease, prolong life, and promote health through organized efforts of society, organizations, and community. The goal of public health is to create a safer and healthier society through prevention of possible health issues to society, while also helping to respond to health challenges that are negatively impacting the public. One of the greatest public health challenges of the current century is HIV/AIDS, which kills millions of people worldwide each year. In developed nations, there has been a reduced death rate from the disease due to increased access to antiretroviral therapy which has been very successful in prolonging the lives of those infected with HIV. In developing nations, there is less access to this treatment because of the lack of technology the nations possess, and due to the high costs associated with the treatment. There are different theories of public health and disease causation that changed from the 19th to 20th to now 21st century, which influenced and can explain certain policies that were made for handling HIV/AIDS. Policymaking for this deadly virus also came with the stigmatization of certain groups of people, and these stereotypes about people with HIV/AIDS even hampered policymaking to an extent. “The Age of AIDS” is a PBS Frontline documentary that looks into the disease and the public health response to it, showing how all of this really worked. There are many theories of disease causation that influenced public health policies in the 19th, 20th, and 21st century. In the 19th century, there was the supernatural theory, the personal behavior theory, the miasma theory, and the contagion theory. The supernatural theory was the idea that God caused diseases when he was unhappy with the human race. This theory started when the Black Plague of the 14th century killed close to 25 million people in a short period of time (the most deadly disease in history) and people had no explanation for house such widespread sickness was possible, so the people who were dying were assumed to be unholy and bad people. The personal behavior theory is the idea that unhealthy behavior and an overall unhealthy lifestyle was the cause of disease. This started as bars and prostitution became more widespread with the influx of people into cities during the industrial revolution of the 18th century. It led to this belief that if you practiced unhealthy actions you would suffer for disease, and people mainly stigmatized the poorer classes into this category. The miasma theory was created after city life had become more popular, and was the idea that diseases were caused by the odor from decaying materials. The sanitation systems of major cities were pretty pitiful at this time in history, and there was much waste and decay due to this. People didn’t know that germs or microorganisms were found on types of decaying material, but believed it was the odors from them. The contagion theory was the idea that epidemics resulted in the spread of germs from one person to another. Germs were not thought of how they were today; it simply meant that it was a disease that spread from one person to another. This idea was established around the 17th century when Yellow fever broke out in almost every city in world, and quarantines did nothing to prevent it. In the 20th century, there were the development and use of four different theories for disease causation which influenced public health. Germ theory was created with the development of new technology, and it was discovered that microorganisms we refer to as germs cause disease. Then there was the discovery of penicillin to fight certain infections and disease, as well as the founding of vaccinations. The lifestyle theory is the idea that living an unhealthy lifestyle can cause diseases in certain people. For example, people who smoke cigarettes could possibly develop lung or throat cancer and people who don’t regularly exercise or eat healthy could be at risk for heart disease or other possible sicknesses. The environmental theory is the idea that toxins and chemicals can cause disease in people, for example pesticides getting into drink-water supply or chemicals and genetically modified organisms used in the mass-production of food. The multi-casual disease theory states that diseases are caused by a number of factors that range from a person’s genetics to the environmental, community, and social conditions they live in, as well as the quality and accessibility of medical care they have. In the 21st century which we live in today, there has been the development of the idea of the aforementioned public health, and theories surrounding the idea that it is necessary to prevent the causation of disease. The idea of global dynamics has to do with the changes in the world around us shape the theory of public health. There is increased interconnection across the globe, with people traveling from country to country and different areas constantly leading to problematic diseases being able to spread with much ease. Global dynamics also includes the idea that the richest countries that control most of the world’s wealth have much better health care than the developing nations who do not have the resources. The OneWorld theory is the idea that as Laurie Garret it; “Public health needs to be-must be- global prevention”. It is the idea that developed nations need to spend more money to create infrastructure like community health care centers and clean water systems in third world countries. If you can stop new diseases at the source, they won’t be able to spread back to the developed nations. The other new theory that has emerged this century is public health 2.0, which is the idea that citizens participation and empowerment in public health challenges leads to the most successful public health outcomes. Many of these theories are seen across different countries as the HIV/Aids epidemic spread globally. Originally in America, the black, gay, and drug using communities were seen as the main victims and cause of the epidemic. The supernatural theory was seen across the black community, specifically in Selma, Alabama, and throughout the African-American church community. Black churches would not talk about the HIV/AIDS epidemic, and people who did have the disease were forced to hide it because they were ashamed to admit it to the community. The church took the approach that the people who contracted the virus were unholy and it was God’s form of punishment on these bad people. This led to people not really talking about the deaths of family members or friends because they did not want to admit too contracting the virus, and in the Selma example specifically from the documentary, many African-Americans who did contract the virus didn’t even seek treatment because they were too embarrassed and ashamed to let people know about it. During the time that the HIV/AIDS epidemic came out in the United States, many people were not for gay lifestyle, which was considered to involve heavy partying and sex. Here we see the general public show the personal behavior theory, and the lifestyle theory. People did not feel that money and resources should be used on the gay community because they made poor lifestyle choices and actions that resulted in them getting this disease. Many Christian groups also displayed the supernatural theory here because gayness was considered to be unholy and un-Christian to live a gay lifestyle. The three theories, personal behavior, lifestyle, and supernatural that are displayed towards the gay community with HIV/AIDS were also shown towards the drug community. Heroin addicts and people who use drugs that involve needle injections were also experiencing a massive outbreak of the virus due to the sharing of needles and re-using of needles with people who were sick. These people were treated the same, and people thought that they got the disease through their poor decisions and lifestyle choices. Other religious groups even felt that these people were being punished by God due to the fact that they were partaking in illegal activities that society looked down upon. In poorer countries, like we see with the example of South Africa in the video, there were a number of theories being undertaken by different classes of people. Activists who tried to spread awareness and get help for the people suffering and also increase prevention seemed to follow the multi-casual theory. There wasn’t a particular reason that this disease was spreading, it was instead due to a number of factors. It was primarily being spread in poorer areas, and not only to people who “deserved it”. Women were getting it because their husbands were sleeping with prostitutes, who had contracted it, and then these men were going home and sleeping with their wives, passing it to them and their unborn children, as many babies and children were starting to get the disease. There was also a women who was raped by four men when she was walking home, and she also developed HIV/AIDS. There were men in the gay community of South Africa who also contracted the virus, and it spread through the wealthy and the poor. It was predominately affecting the poorer classes, and with the end of Apartheid and other important issues the government of South Africa did not really acknowledge or do anything about the epidemic. All of the wealthier people who contracted the disease, like the Judge from the film and government members of South Africa, all had the money to pay for drugs that would make them better. President Mbaki took a denialist attitude towards the epidemic, claiming that HIV didn’t really cause AIDS, because HIV was a virus and couldn’t lead to a full blown disease. He stopped allowing government hospitals to administer the drugs, which was fine for the more prominent South African members of society who could afford them on their own, but awful for the poorer classes who were the vast majority of people actually sick. He took an environmental theorist approach to the banning of the drugs, saying that they were toxins and not good for anyone so he would not allow them because they would cause disease. He said that the virus was a cause of social and environmental conditions that people were poorly choosing to put themselves in, leading to the disease and that it was their own fault. President Mbaki’s stance here is more in line with the personal behavior and lifestyle theory. In many countries, like Russia and China were shown in the video, the HIV/AIDS epidemic was swept under the rug and not talked about. These countries were ashamed to admit that the epidemic had enter their country, either because of the stigma that is was spread through sexual contact or gayness or drug use, or these countries tried to deny it because they did not want to put money and resources towards fixing the problem. This type of behavior didn’t really seem to fit any of the theories that were talked about in class, but I felt that this kind of reaction by countries to just ignore such a major problem and act like it wasn’t happening was worth noting. In Uganda, the documentary shows a very positive response by the government and society towards tackling the AIDS epidemic. The president was very supportive in trying to fight the disease, and publically made appearances and speeches to spread awareness and in trying to get people the help they needed, through empowering society to be active in the public health process. This showed an example of the Public Health 2.0 theory, and according to the documentary the efforts in Uganda were very successful. The stigmatization of people who had been inflicted with the HIV/AIDs virus definitely hampered the policymaking efforts to try and fix the epidemic. In South Africa, there was the stereotype that only a small portion of poor people were actually sick with the disease. This led to the majority of the population not looking into it and getting involved because the government wasn’t taking action and acting like there was no problem. In America, there was a stigma that the disease was only affecting the homosexual, drug addict, and African American population. In Russia, China, and other countries who chose to ignore the epidemic as it took off in their countries, there was a stigma that only people who partake in bad activities were victims of the disease and this is why they were ashamed to admit there was a problem. This is the underlying theme that I noticed from the documentary that really hampered all policymaking efforts; the fact that people were using stereotypes against the sick people and this led to less action and support to fight the epidemic. In reality, everyone was at risk for capturing the disease, and I believe this is because it falls under the multi-causal theory. There was no one reason or way for people to contract this virus. A women who was raped in Africa or whose husband commits adult then gave her the virus did not do anything “wrong” to end up with the virus. Someone who was going for a standard blood transfusion or hospital procedure and got the virus from a needle or blood sample did not do anything “wrong”. The stereotype that HIV/AIDS was an illness that people who acted badly received just was not true. The stereotype in fact is not true, as I feel that it is still engrained in the heart of the epidemic today. Today, there is more treatment for the virus/disease and it is universally accepted as a problem finally, but there is still a negative attitude and stereotypes towards the people who contract it that needs to change.