Table of Contents
Socio-economic Factors and HIV/AIDS Incidence
List of References
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For a long time, health policies advocated for funding and ensuring adequate provision of medical care as the most appropriate way of maintaining a healthy society. Emphasis was laid on the research and development in curative and preventive Medicare so that the members of the society lived a healthy life. The issue of health determinants was not given enough consideration. It remained an aspect for the academic realms but not in the practical aspect of health care provision.
However, this ceased to be the trend. After thorough research, it was ascertained that many factors played different roles in determining the health of an individual or a society as a whole. This brought the issue of health determinants into question. This paper will hence try to point out the role played by the health determinants in the prevalence of HIV/AIDS in Africa. The case of HIV/AIDS affliction in Kenya will be analyzed on the backdrop of the health determinants so that a clearer approach could be devised to salvage society.
What are health determinants? According to the World Health Organization (2006), health determinants are the social, economic and environmental conditions that contribute to an individual’s health status. To be precise, an individual’s economic and social environment, physical environment around him and the individual’s characteristics and how he behaves are health determinants that determine how healthy or unhealthy he becomes. These factors include poverty, unemployment, good policies concerning food and transport, drugs, working conditions and availability of social support initiatives.
This position affirms Professor Michael Marmot’s suppositions that medical care can truly prolong life. However, he purports that it is important to ensure that the social and economic conditions of an individual are appropriate so that they live healthily and consequently do not need medical care. Just like he says, the World Health Organization also highlights the importance of the socio-economic environment in maintaining a healthy society. Considering these factors, could any link be identified between them and the prevalence of HIV/AIDS in Kenya? Can the social and economic conditions of an individual determine his chances of contracting HIV/AIDS?
HIV/AIDS has been one of the greatest afflictions in the World for the last decade. Africa is the most affected continent. Accordingly, Kenya is one of the countries affected by the pandemic. Joint research by the UNAIDS and WHO (2008) points out that the total population of Kenyans living with this virus is between 1,500,000 million and 2,000,000 by the year 2008. This is a great increase of between 1,300,000 and 1,700,000 in 2001. This is the total population that includes males, females and children. These statistics are consistent with another study carried out by the Kaiser Foundation which also identified that by the year 2003, more than 1,200,000 were living with HIV/AIDS. This accounted for a total percentage population of 6.7%.
Considering individual population brackets, statistics point out that adults account for a total of between 1,400,000 and 1,800,000 of the mentioned population. This is compared to a total of between 130,000 and 180,000 population accounted for by the children. The children in this division were characterized by age 14 and below. The total population of women living with this virus was found to stand at between 800,000 and 1,100,000.
On their part, an estimate of between 1.3 and 5.9 of young adults who are between age 15 and 24 was estimated to be living with HIV/AIDS. Of this estimate, young adult women accounted for an estimate of between 4.6 and 8.4 while the male young adults accounted for an estimate of between 0.8 and 2.5 of the population (UNAIDS/WHO 2008). Finally, the research estimates that more than 100,000 people died of HIV/AIDS-related deaths in 2001. This population reduced to 85,000 in the year 2007.
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In their research, the Kaizer family foundation shows that in comparison, women were the most afflicted as compared to men. 65% which is two-thirds of the whole population who were living with the virus in 2007 were women. The research further points out that the prevalence of the disease in women was twice that of their male counterparts. This percentage of 655 is higher than the overall Sub-Saharan estimation of 57% women living with the virus.
Another relevant factor to be considered is that the highest number of new infections has been portrayed by young people aged between 15 and 24. Furthermore, females in this bracket accounted for the highest rate of new infections. Statistics showed that the number of young women living with HIV/AIDS virus was twice that of young men of an equal age bracket (Kaizer Family Foundation 2005; CBS and MOH 2004).
In their contribution to the topic, Forsythe and Rau (1996) give statistical data of the HIV/AIDS affects all around the world. In their study, the year 2005 had accounted for a total death tally of 25 million people all around the globe. In addition, 39 million others were living with the virus. The same year accounted for a total of 4 million new infections. The report further points out that of the 4 million new infections, 95% were from Sub-Saharan Africa.
Other greatly infected areas included Eastern Europe and some parts of Asia (Montana et al 2007; McCoskey 2003). However, the spread continues to increase all over. This continues to increase despite the stepped-up campaigns through improved strategies to contain productivity and sexual health. Why therefore could this not yield positive results? Why does the pandemic continue raking havoc in societies when reproductive and sexual health efforts have been stepped up? In addition, why does Sub-Saharan Africa, Eastern Europe, and Asia account for 95% of the total new infections? An answer to these questions could give insight on whether medical researchers are the only solution to this problem or other forms of remedies could help contain the pandemic.
Socio-economic Factors and HIV/AIDS Incidence
Wilkinson and Marmot (2003) argue that “Life expectancy is shorter, and most diseases are more common further down the social ladder in each society” (p. 10). This argument could be ascertained by a closer look at the issue against the backdrop of HIV/AIDS prevalence in the world. According to the statistics given earlier, Sub-Saharan Africa, East Europe and some parts of Asia are leading in HIV/AIDS prevalence in the world.
Analyzing these regions leaves them with one common characteristic. Most of them are not developed countries. This means that the social characteristics of a region could play a great role in the health of the community. Kenya is one of the countries that make up the Sub-Saharan region which has accounted for the highest percentage of people living and dying from HIV/AIDS. In this country, the Gross National Income per capita was 1,400 according to the World Bank as quoted by the WHO. In addition, the country has a per capita total health expenditure of 95. Kenya has a Human Development (HDI) ranking of 148 and a Human Poverty Index (HPI) of 60.
With such characteristics, we find that Kenya can be ranked among countries low on the social ladder when measured on the global platform. This could be one reason why Kenya accounts for a high HIV/AIDS prevalence.
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In their argument, Wilkinson and Marmot point out that the characteristics of these low-class societies which include inadequate assets for the family, poor or lack of education during adolescence, having insecure employment, doing a hazardous job, housing conditions that are poor and struggling to raise a family in difficult conditions are among the disadvantages that lead to poor health for low-income societies. How does this apply to the case of HIV/AIDS in Kenya?
The named disadvantages are among the core causes of the spread of this virus (Ministry of Health, Kenya 2005). In addition, Inungu and Karl (2006), in their contribution to the subject of factors leading to the spread of HIV/AIDS argue that poverty plays an integral part in a society’s rate of HIV/AIDS prevalence. According to them, the relationship between HIV/AIDS and poverty is bidirectional. Poverty contributes greatly to the transmission of the virus while at the same time the virus contributes greatly to the creation of poverty and hence a further promotion of transmission.
Other social factors that have led to the increasing transmission of this virus are society’s cultural beliefs and practices. Moses et al (1990), Inungu and Karl (2006) and Bongaarts and colleagues (1989) further show that HIV/AIDS transmission rate is faster in regions where certain cultural beliefs and practices like the position and role of women or traditional initiation practices. As pointed out in the statistics above, it is clear that women are the most affected by this virus as compared to men. This is attributed to their roles in reproduction. This subjects them too difficult conditions of taking care of their families.
Consequently, they are forced to have multiple sexual partners who in return give them financial support. In Kenya, for instance, women in urban areas are forced to work as commercial sex workers or bar hostesses. These expose them to high risks of HIV/AIDS virus contraction. According to the research carried out by Morrison and coworkers as quoted by Inungu and Karl 75% of sex workers in Kisumu, the third-largest town in Kenya, were living with the virus by the year 2006.
World Health Organization (2009) and the European Commission (2009) identify housing as one of the health determinants. The different dimensions of housing pose great threats to the health of an individual. Among the dimensions of the housing are the quality of houses, increase in rent, housing tenure, homelessness, housing design and indoor air qualities are among the different dimensions which have a role in the health of an individual or the society.
What therefore is the role of this in the increase of the spread of HIV/AIDS in society? As mentioned earlier, many women find it difficult to produce rent for affordable estates and villages. In Kenya for instance, many women who crowd the city of Nairobi find housing cheaper in slums like Kibera which is the second-largest slum in Africa. Poor housing design and overcrowding have led to a substantial number of people living with viruses. In Kibera, one-fifth of the 2.2 million people living in this slum are HIV positive (Fountain of hope 2009).
GDFCC (2003) clearly outlines the relationship between shelter and HIV/AIDS prevalence. They purport that poor housing plans and design can greatly increase the risks of contracting HIV/AIDS. In addition, the design could pose a great risk to those already living with the virus. Through such poor housing, opportunistic infections could take advantage of the situation and hence lead to more deaths of the people.
The organization further argues that such housing could lead to factors like urban promiscuity which is promoted by the spontaneous neighbourhoods. Furthermore, such environments promote prostitution, drug abuse, poverty etc. these are the exact conditions in Kibera in Kenya that has led to the spread of the virus to more than a fifth of the population. Sadly, these conditions cause each other and hence continue the cycle of poverty and the spread of the disease which again contribute further to poverty.
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Another prominent socioeconomic health determinant that plays a role in the spread of HIV/AIDS is urbanization. This forms the basis through which several other determinants take advantage and hence causing afflictions to human lives. For instance, through urbanization, people engage in rural-urban migration which leads to poverty, poor housing, poor urban planning, inadequate health strategies etc (WHO 2009).
Urbanization as a form of health determinant has played a great role in the spread of HIV in Kenya. This is evidenced through the HIV prevalence rate in urban centres like Kisumu where research pointed out that 75% of all the commercial sex workers were found to be HIV positive. This fact is also promoted by the example in Kibera, the second-largest slum in Africa which is also a result of urbanization.
From Kibera, all forms of socioeconomic health determinants play a great role in demeaning the health of the population. Prostitution plays an integral part in society’s search for money. Most women struggle for the upkeep of their families through engaging in this practice. Furthermore, some of them do not engage in commercial sex work but have multiple partners who in return support them financially. These are the conditions that promote the spread of HIV in a society (Collins and Rau 2000).
Other factors associated with urbanization, and which contribute to the determination of the health of an individual are poverty, and poor housing (National Library of Medicine 2009; UN General Assembly 2003). As pointed out earlier, Kibera is a slum that contains poor undersigned housing that is densely populated. Most low-income earners look for accommodation from these houses due to their affordability. As a result, the places are filled with poor sanitation, health hazards, poor social support networks et cetera. These are the main health determinants that have played a role in the rampant spread of HIV/AIDS in the Kibera and Kisumu regions of Kenya.
Given the conditions of the prevalence of the virus in Kenya, it is evident that women are the most affected of all the population brackets. The research by UNAIDS/WHO (2008) points out that women both mature and young adults account for more than half of those living with the virus and those who die from the same each year. This, therefore, means that women are more at risk of contracting the virus. What, therefore, could be the attributes of this population bracket that makes them more prone to this virus? Inungu and Karl (2006); Ayieko (1998) attribute this to the role of women in society.
They point out that the reproductive role of women makes them at the greatest risk of contracting the virus. In addition, other cultural practices like polygamy also make women at higher risk of contracting the disease. In the Kenyan context, 23% of women were found to be engaged in a polygamous union. This increases their risk of contracting the virus. With one person within the union contracting the virus, it will spread to several women aligned to the single man. Finally, younger women stand an elevated risk of infection due to the notion that has been greatly held in Africa that having sex with a virgin could heal a person from HIV/AIDS virus. This subjects women to a higher risk of contracting the disease.
Does the revelation of these extra medical factors have a role in the way a medical condition can be controlled? Can controlling these socioeconomic factors help reduce the spread of HIV/AIDS in Kenya? The answer is yes. A problem can be accurately solved if tackled from its grassroots. For instance, by tackling a medical condition from their socioeconomic points, fewer new cases will be reported and hence reduced costs of medication.
In the case of the spread of this virus in Kenya, socioeconomic factors must be considered. As Marmot and Wilkinson (2003) argue, “good health involves reducing levels of education failure, reducing insecurity and unemployment and improving housing standards.” By allowing all citizens to actively participate in the day-to-day socioeconomic activities, society will experience a better and healthier life as compared to a society that subjects some of its citizens to pathetic conditions.
In Kenya, the conditions under which people are living in the slums must be improved. The government should for instance try to improve housing in the slums, form welfare support systems for women so that they could have the capital to start their businesses, sensitize people on the importance of avoiding certain cultural practices like polygamy, promote safe sex by the commercial sex workers and the youth so that the rate of new infections within the youth and commercial sex workers can be reduced (Jackson 1992; Muhangi and Kabali 1998).
If the above mentioned is done, Marmot and Wilkinson argue that society will experience a healthier life. The above arguments point out the validity of Marmot and Wilkinson’s argument that the most appropriate way of improving the health of a population is through addressing the population’s socio-economic conditions.
List of References
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