A Statistical Analysis of AIDS - Research Paper Example

?Running head: A Statistical Analysis of AIDS A Statistical Analysis of AIDS Table of Contents Introduction 3 The Statistics of AIDS in the United States 3 Factors Associated with Disparities in AIDS Mortality Between Blacks and Whites 6 The Government’s Role in Addressing Health Disparities 10 Conclusions 12 Appendix A 13 Appendix B 14 Appendix C 15 Appendix D 16 Bibliography 17 Footnotes 19 Introduction Acquired Immunodeficiency Syndrome (AIDS) is an incurable sexually transmitted disease. The disease was originally found in gay men but it has progressed to infect people from other genders. The number of casualties fromAIDS has been increasing in the past years. In fact, health professionals fear that the disease will progress into a pandemic. The number of individuals acquiring the disease is also increasing. The growing concern today however, lies on the mounting difference in the number of African Americans and their White counterparts being infected or even dying from the disease. Women in particular, have constantly become the subject of people’s concerns regarding the matter of AIDS. This paper aims to present and discuss the statistics regarding the disparity between Blacks and Whites being diagnosed with AIDS. Moreover, the factors affecting this disparity will be presented. The importance of the role of the government in addressing this issue will be discussed and finally, a conclusion will be provided. The Statistics of AIDS in the United States In past statistics, African Americans were found to constitute the majority of individuals infected with AIDS1, 2. In the Black population, males comprised two-thirds or about 65% of new infections3. Furthermore, the rate at which Black men acquire new HIV infection is 6 times higher than White men and 2 times higher than black women4. On the other hand, the rate at which Black women acquire new HIV infection is 15 times higher than White women.5As such, the rate of death is also expected to be higher among Black women. Black females have a lower rate of infection in comparison to Black males. However, Black females are more affected by the disease in comparison to women from other races.6The large scale of Black womenbeing infected with, as well as dyingfrom AIDS has attracted attention from different areas and departments of the society. More so since there is yet to be a clear decline in the mortality rates of AIDS-infected African-American womenwhereas mortality rates of AIDS-infected White women have continually decreased. Ethnic disparities concerning HIV/AIDS infection and mortality are consistent in all states.7Figure 1 below presents a comparison of HIV/AIDS mortalities between Black and White populations in the United States. The huge difference between the races is evident except perhaps among the 15- to 24-year-old age group where the statistics were almost the same if not, slightly different. Figure 2 below presents the gender and racial comparisons with regards to new cases of HIV infectionin Massachusetts. The large disparity between Black females and White females as well as the large difference between the number of White males and Black males getting infected with AIDS are evident. According to Cole, Church, Fukuda et al.,8the percentage of Black women who have acquired HIV in the year 2006 – 2008 is 51% as compared to 20% of White women. This shows that Black women have almost twice the risk of acquiring the disease as compared to White women. However, it is also shown that from 2006 – 2008, White men have a higher percentage of new infections compared to Black malesin Massachusetts.This could be attributed to gay activities; however, not well-defined. In 2007, it has been reported that HIV was the third leading cause of mortality for black men and women aged 35-44.9 HIV also became the ninth leading cause of mortality for all blacks.10 In fact, about 233,624 Blacks who were diagnosed with AIDS had died in the United States.11 Moreover, African American women were known to be 22 times more likely to die from HIV/AIDS compared to women from other ethnicities12. In 2008, African Americans had the highest rate of death from AIDS, which amounted to 27.5 per 100,000 population13. The combination of data from new incidences until mortalities associated with HIV/AIDS between genders and races is shown on Figure 3. According to Maryland Statistics, Black females incurred higher rates of AIDS mortality compared to women from other races. Table 1 below also supports these statistics. The peak of mortality observed from all races was seen in 199514. In 1995, highly active antiretroviral therapy (HAART) was introduced to the public15. Before 1995, the useof protease inhibitors in the United States was not allowed16. The United States Food and Drug Administration approved the drugs on December of 1995 and on March of 199617. HAART is associated with decreased mortality and morbidity of patients with HIV/AIDS18.Although it is not a cure, it is used for the purpose of improving a patient’s symptoms or even their quality of life. As a result, the patient’s survival rate is also prolonged. HAART is just one of lifesaving innovations that has been discovered. Thus, after the year 1995, the mortality rate started to decline slowly. The decline is quite evident and steady on White females. However, with regards to Black females, the mortality rate decreased post-HAART but would increase again after 1998. Afterwards, the rate intermittently increased and decreased. The trend in the mortality rates of Black women with AIDS as compared with White patients is truly intriguing. The disparity is profound. Certain factors can be attributed with such disparities in mortality and morbidity rates observed between ethnicities of women - most especially Blacks and Whites - with HIV/AIDS. It is relevant to identify such factors in order to come up with solutions that could help ease this disparity. Some factors are discussed in the following chapter. Factors Associated with Disparities in AIDS Mortality Between Blacks and Whites From the demographics above, the high AIDS death rate observed in Black women presents an area of concern. Since the introduction of HAART, AIDS death rates should have generally decreased among women in the United States. However, Black women remained to have a higher death rate in comparison to White women19. It is supposed that social conditions are essential for life sustenance20. As such, the fundamental social causes theory has been proposed to explain mortality rates. Rubin, Colen & Link (2009, p. 1053) described the fundamental cause theory as follows: “Mortality follows the SES [Socioeconomic status] gradient in a predictable pattern under dissimilar circumstances because SES embodies access to resources—knowledge, money, power, prestige, and beneficial social connections—that can be used in different places and at different times to confer a significant health advantage.”21 Under the fundamental social cause theory, it is stipulated that as people find ways to prevent or cure a disease, these knowledge or findings are unevenly distributed in the society. People who are less likely to be discriminated and who have money, prestige, knowledge and social connections often gain access to such health benefits.22 As a result, knowledge for preventions, neighborhood locations, social networks and occupations dictate how people could get access to health benefits.23 For example, people who know about flu shots, quitting smoking and safe-sex procedures are better protected from diseases. Furthermore, people who live in low-income housing or neighborhoods are located in health hazard areas and are less served by police, sanitation and fire services.24 Blue-collar workers performing more stressful and dangerous jobs also have more inferior health benefits than white-collar workers.25 Thus, health inequalities are aggravated by factors such as socioeconomic status and race. The high AIDS mortality rates of African-American women are therefore attributed to racial discrimination, as well as low socioeconomic status.26Racial issues have always been connected to American living. The poor attainment of antiretroviral medications of African-Americans infected with AIDS could be related to the practice of racial discrimination by health workers in hospitals or clinics. Furthermore, poor African-Americans infected with AIDS may not necessarily afford the medications. Poor transportation and time demands are also associated with less attendance to therapies.27 Such factors can even be amplified by the patients’ perception of risk, fear, as well as negative traits portrayed by health providers or the health system as a whole.28 Certain studies have also attributed health insurance coverage and race with regards to the use of HAART.29 Such studies have stipulated that insured women are more likely to use HAART compared to uninsured women. This observation was evident in women of all races. Furthermore, women with Medi-Cal or Medicaid (public insurances) have a higher chance of using HAART compared to women under private insurances.30 It is alleged that the coverage and resources provided by private insurance companies could be a factor that delineates such observation.31 Certain researchers have also tried to know the effect of substance abuse to the use of HAART.32Still, certain differences in results have been observed. Some studies have found a correlation between drug use and non-use of HAART33 but some studies did not reveal the same result.34 A more recent study by Lillie-Blanton, Stone, Jones et al. (2010) revealed no association between illicit drug use and non-use of HAART.35 However, the researchers found a correlation between alcohol use and non-use of HAART.36 The researchers stipulated that patients with problems regarding substance abuse are less likely to seek medical help or to follow prescribed regimen.37 In relation to substance abuse, AIDS-infected women with depressive symptoms were also found to have a higher risk of HAART non-use.38, 39 Finally, health disparities are associated with the effects of U.S. Federal laws.40 There is a perceived failure of the laws to account for renowned social factors; thus favoring Whites in accessing lifesaving therapies or medications.41 Even with existing laws that aim at providing equal access of health benefits to people of all races and gender, the limited definitions of medical assistance and drug efficacy still pose as problems. Therefore, health disparities can also be attributed to insufficient or ineffective laws that do not address important social factors. The Government’s Role in Addressing Health Disparities AIDS is a disease that holds many disadvantages. The fact that it is sexually transmitted makes the spread of the disease hard to control. As a result, it is close to reaching a pandemic. The role of the government should therefore be focused on prevention as well as the treatment of currently infected patients. As shown in earlier chapters, African American women are often affected in health disparities associated with AIDS treatments. Thus, African American women have a higher AIDS mortality rate in comparison to women from other ethnicities. The large disparity is observed between Blacks and Whites. Federal laws can be a factor to such health disparity. There are deficiencies attributed to the way these laws provide health benefits to people among races. Therefore, government institutions should find ways to draft or modify laws to allow for equal distribution of therapies, medications or lifesaving innovations. The laws should take the factors of racial discrimination as well as socioeconomic status into context. Furthermore, there may be a need to expand health insurance coverage in order to allow for a better access to HIV medications for all women42, regardless of race. If not, perhaps insured HIV-infected individuals should be given more extensive accesses to healthcare benefits such that HAART use will be included. A more relative issue that the government should address is poverty. This may be harder to implement and could take time to address but if this issue is given proper attention, the total mortality rate of the country will decrease. With regards to health disparities, Blacks often identify cost as a prime barrier to accessing relevant health care.43 This is especially true with low-income populations. As such, it is imperative that the government acts on alleviating lifestyles of low-income citizens. With regards to AIDS, the government should enforce extensive and regular preventive screening. With the data presented in this study as well as in other studies, it may be relevant to focus preventive screening tests as well as information dissemination or education programs on Black communities. With a lower incidence rate attributed to White women, further preventive programs should be advocated to them, especially with adolescents. Furthermore, since the spread of AIDS has been particularly attributed to the gay society, the government should enhance health education within this group regardless of race. In conclusion, since Black women form a group that is known to be poor and at a higher risk of getting AIDS infection, they should be given special considerations. It may be necessary to form a group of health professionals that will focus on reaching out to the Black community, educating them, screening them and offering help with their treatment. Perhaps, programs can also be offered to Black women that will allow for free treatments. Such programs may not cover all Black women but would help one woman at a time. It is important to provide attention and focus on the Black population, especially on Black women because they depict the most disadvantaged members of the society. By lowering new incidences and premature AIDS mortalities, the whole picture of AIDS prevention will also be addressed. Conclusions AIDS is a very debilitating and dangerous disease. The fact that it is easily contracted and that the mode of infection is hard to control makes it even more of a threat to the society. Furthermore, there are still no formidable treatments for this disease. There could only be therapies that help alleviate the quality of life of patients. It is therefore imperative to address certain issues and enforce certain changes in order to help regulate this growing pandemic. This paper has presented statistics with regards to AIDS infection in the U.S. population. Particular attention has been given to the disparity between Black and White women. It was shown that higher incidences and mortalities from AIDS are observable in Black women. The factors that are attributable to this disparity have also been presented. The prime factors identified were racial discrimination and socioeconomic status. The federal laws were also shown not to help in addressing the racial issue, which is very evident in American societies. Furthermore, insurance coverage was shown to have an effect in disparities regarding the way women access AIDS-related medications or therapies. Recommendations as to what the government should do in addressing the racial difference were also raised. Appendix A HIV/AIDS Deaths per 100,000 population in the United States, 1987 – 2005 (a) Whites (b) Blacks (From “Examination of Inequalities in HIV/AIDS Mortality in the United States From a Fundamental Cause Perspective”7) Appendix B Percent Distribution of Newly Diagnosed HIV Infection by Gender and Race/Ethnicity in Massachusetts, 2006 – 2008 (From “Massachusetts STD, HIV/AIDS and Viral Hepatitis Surveillance Report: 2009”6) Appendix C AIDS Female Mortality Rate per 100,000 by race in Maryland (From "Examining Geographic and Temporal Variations of AIDS Mortality: Evidence of Racial Disparities"8) Appendix D AIDS Death Cases in Maryland 1987 – 2003 (From "Examining Geographic and Temporal Variations of AIDS Mortality: Evidence of Racial Disparities"8) Bibliography: Center for Disease Control and Prevention. (2009). Estimated rates of adults and adolescents living with a diagnosis of HIV infection , by area of residence , year-end 2008 — 40 states and 5 U . S . dependent areas with confidential name-based HIV infection reporting. Aids (Vol. 21, pp. 1-79). Georgia. Center for Disease Control and Prevention. (2011). Disparities in Diagnoses of HIV Infection Between Blacks / African Americans and Other Racial / Ethnic Populations - 37 States 2005 - 2008. MMWR. Morbidity and mortality weekly report, 60(4), 93-98. Chiu, Y.-W., Hsu, C. E., Wang, M.-Q., & Nkhoma, E. T. (2008). Examining geographic and temporal variations of AIDS mortality: evidence of racial disparities. Journal of the National Medical Association, 100(7), 788-96. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18672555. Cole, B., Church, D., Fukuda, D., Hsu, K., DeMaria, A. Jr, & Cranston, K. (2010). Massachusetts STD, HIV/AIDS and Viral Hepatitis Surveillance Report: 2009. Public Health (pp. 1-32). Geronimus, A. T., Bound, J., & Colen, C. G. (2011). Excess black mortality in the United States and in selected black and white high-poverty areas, 1980-2000. American journal of public health, 101(4), 720-9. doi: 10.2105/AJPH.2010.195537. Levine, R. S., Rust, G. S., Pisu, M., Agboto, V., Baltrus, P. a, Briggs, N. C., et al. (2010). Increased Black-White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. American journal of public health, 100(11), 2176-84. doi: 10.2105/AJPH.2009.170795. Lillie-Blanton, M., Stone, V. E., Snow Jones, A., Levi, J., Golub, E. T., Cohen, M. H., et al. (2010). Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. American journal of public health, 100(8), 1493-9. doi: 10.2105/AJPH.2008.158949. National Center for HIV/AIDS, Hepatitis, STD, and T. P. (2010). HIV among African Americans. Aids. Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: a test of the theory. Journal of health and social behavior, 45(3), 265-85. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15595507. Powell, T. (2009). Black Woman?s Burden. The Crisis, 48-51. Rubin, M. S., Colen, C. G., & Link, B. G. (2010). Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. American journal of public health, 100(6), 1053-9. doi: 10.2105/AJPH.2009.170241. The Office of Minority Health. (2005). Health Status of African American Women . Retrieved May 8, 2011, from http://minorityhealth.hhs.gov/templates/content.aspx?ID=3723. Vyavaharkar, M., Moneyham, L., Corwin, S., Tavakoli, A., Saunders, R., & Annang, L. (2011). HIV-disclosure, social support, and depression among HIV-infected African American women living in the rural southeastern United States. AIDS education and prevention : official publication of the International Society for AIDS Education, 23(1), 78-90. doi: 10.1521/aeap.2011.23.1.78. Footnotes Center for Disease Control and Prevention. (2009). Estimated rates of adults and adolescents living with a diagnosis of HIV infection , by area of residence , year-end 2008 — 40 states and 5 U . S . dependent areas with confidential name-based HIV infection reporting. Aids (Vol. 21, pp. 1-79). Georgia. 2 Center for Disease Control and Prevention. (2011). Disparities in Diagnoses of HIV Infection Between Blacks / African Americans and Other Racial / Ethnic Populations - 37 States 2005 - 2008. MMWR. Morbidity and mortality weekly report, 60(4), 93-98. 3 National Center for HIV/AIDS, Hepatitis, STD, and T. P. (2010). HIV among African Americans. Aids. 4 Ibid. 5 Ibid. 6 Powell, T. (2009). Black Woman?s Burden. The Crisis, 48-51. 7 Center for Disease Control and Prevention. (2011). Disparities in Diagnoses of HIV Infection Between Blacks / African Americans and Other Racial / Ethnic Populations - 37 States 2005 - 2008. MMWR. Morbidity and mortality weekly report, 60(4), 93-98. 8 Cole, B., Church, D., Fukuda, D., Hsu, K., DeMaria, A. Jr, & Cranston, K. (2010). Massachusetts STD, HIV/AIDS and Viral Hepatitis Surveillance Report: 2009. Public Health (pp. 1-32). 9 Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: a test of the theory. Journal of health and social behavior, 45(3), 265-85. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15595507. 10 National Center for HIV/AIDS, Hepatitis, STD, and T. P. (2010). HIV among African Americans. Aids. 11 Ibid. 12 The Office of Minority Health. (2005). Health Status of African American Women . Retrieved May 8, 2011, from http://minorityhealth.hhs.gov/templates/content.aspx?ID=3723. 13 Center for Disease Control and Prevention. (2009). Estimated rates of adults and adolescents living with a diagnosis of HIV infection , by area of residence , year-end 2008 — 40 states and 5 U . S . dependent areas with confidential name-based HIV infection reporting. Aids (Vol. 21, pp. 1-79). Georgia. 14 Chiu, Y.-W., Hsu, C. E., Wang, M.-Q., & Nkhoma, E. T. (2008). Examining geographic and temporal variations of AIDS mortality: evidence of racial disparities. Journal of the National Medical Association, 100(7), 788-96. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18672555. 15 Ibid. 16 Rubin, M. S., Colen, C. G., & Link, B. G. (2010). Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. American journal of public health, 100(6), 1053-9. doi: 10.2105/AJPH.2009.170241. 17 Ibid. 18 Ibid. 19 Ibid. 20 Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: a test of the theory. Journal of health and social behavior, 45(3), 265-85. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15595507. 21 Ibid. 22 Rubin, M. S., Colen, C. G., & Link, B. G. (2010). Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. American journal of public health, 100(6), 1053-9. doi: 10.2105/AJPH.2009.170241. 23 Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: a test of the theory. Journal of health and social behavior, 45(3), 265-85. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15595507. 24 Ibid. 25 Ibid. 26 Rubin, M. S., Colen, C. G., & Link, B. G. (2010). Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. American journal of public health, 100(6), 1053-9. doi: 10.2105/AJPH.2009.170241. 27 Levine, R. S., Rust, G. S., Pisu, M., Agboto, V., Baltrus, P. a, Briggs, N. C., et al. (2010). Increased Black-White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. American journal of public health, 100(11), 2176-84. doi: 10.2105/AJPH.2009.170795. 28 Ibid. 29 Lillie-Blanton, M., Stone, V. E., Snow Jones, A., Levi, J., Golub, E. T., Cohen, M. H., et al. (2010). Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. American journal of public health, 100(8), 1493-9. doi: 10.2105/AJPH.2008.158949. 30 Ibid. 31 Ibid. 32 Ibid. 33Cook, JA., Grey, DD., Burke-Miller, JK., et al. Illicit drug use, depression, and their association with highly active antiretroviral therapy in HIV-positive women. (2007). Drug Alcohol Depend, 89, 74–81. 34 Lillie-Blanton, M., Stone, V. E., Snow Jones, A., Levi, J., Golub, E. T., Cohen, M. H., et al. (2010). Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. American journal of public health, 100(8), 1493-9. doi: 10.2105/AJPH.2008.158949. 35 Ibid. 36 Ibid. 37 Ibid. 38 Ibid. 39Cook, JA., Grey, DD., Burke-Miller, JK., et al. Illicit drug use, depression, and their association with highly active antiretroviral therapy in HIV-positive women. (2007). Drug Alcohol Depend, 89, 74–81. 40 Levine, R. S., Rust, G. S., Pisu, M., Agboto, V., Baltrus, P. a, Briggs, N. C., et al. (2010). Increased Black-White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. American journal of public health, 100(11), 2176-84. doi: 10.2105/AJPH.2009.170795. 41 Ibid. 42 Lillie-Blanton, M., Stone, V. E., Snow Jones, A., Levi, J., Golub, E. T., Cohen, M. H., et al. (2010). Association of race, substance abuse, and health insurance coverage with use of highly active antiretroviral therapy among HIV-infected women, 2005. American journal of public health, 100(8), 1493-9. doi: 10.2105/AJPH.2008.158949. 43 Levine, R. S., Rust, G. S., Pisu, M., Agboto, V., Baltrus, P. a, Briggs, N. C., et al. (2010). Increased Black-White Disparities in Mortality After the Introduction of Lifesaving Innovations: A Possible Consequence of US Federal Laws. American journal of public health, 100(11), 2176-84. doi: 10.2105/AJPH.2009.170795. Read More