Barcelona 2013
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| Abstract #168 - E-Posters English | ||||
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Session: 50.105: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Dr Samuel Friedman - National Development and Research Institutes, Inc., United States |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: European and many other countries are in dynamic social, economic and political situations that may interact with the HIV epidemic in very harmful ways. Studies of ?big events? and ?complex emergencies? show that such situations are sometimes followed by HIV outbreaks (as now with Greek IDUs)?but also that sometimes they are not. At this time when many are discussing ?AIDS-free generation? concepts, we posit that macro-level social, political, economic and ecological processes pose a risk of snatching defeat from the jaws of victory and of creating rebound epidemics in many communities. We discuss ways to theorize HIV rebound processes that may help us understand and avoid potential increases in HIV transmission, morbidity and mortality. | ||||
| Method / Issue: Macro-level processes that may create rebound epidemics include but are not limited to: Economic troubles, including Homelessness; unstable housing; evictions Unemployment/underemployment; greater inequality Austerity cuts in social spending, drug treatment, medical care Environmental crises including global warming, flooding, droughts, nuclear meltdowns Wars Social and political movements (e.g., movements against global warming; against austerity; insurrections as in Tunisia and Egypt; but also fascist movements and efforts to criminalize sexual minorities) Migration due to the above causes | ||||
| Results / Comments: These in turn pose the strong likelihood that budget cuts in global and national HIV/AIDS programs may restrict health care access; coverage of medication costs; and/or HIV research and prevention funding. Situations of widespread impoverishment, ecologically-induced destruction or migration, or war can create social and individual trauma, generalized hopelessness and/or economic desperation that may change social norms about sex and drugs, about survival sex, and about who appropriate partners are?which can change both behaviors and networks. Increased public and private discourse about economic issues, ecological issues and wars or revolutionary transformations can decrease the salience of HIV as a political issue, media issue, and public health issue?which may reduce the salience of behavioral safety norms and may also reduce the supply of top-quality HIV/AIDS activists and researchers because people choose to address other issues instead. Proximate determinants of HIV transmission and morbidity include (1) availability, funding, quality and effective implementation of medical, social and behavioral interventions; (2) risk behaviors (and normative control over risk behaviors); (3) injection and sexual network patterns, and other mixing pattern variables (group sex, shooting galleries, assortative/disassortative partnering, concurrency, etc.), including network/infection interaction patterns like ?firewalls?; (4) community viral load?in interaction with #3; and (4) prevalence of drug-resistant HIV which increases morbidity, mortality and costs. Clinical and sociobehavioral research funding (to prevent the emergence of, and to keep the menu of cART ahead of the spread of, resistant mutations) may affect the prevalence of drug-resistant HIV. | ||||
| Discussion: We know little about how the macro-level processes discussed above affect these proximate causes of HIV transmission and morbidity. Research is needed to understand the interacting pathways between these macro-level events, how communities respond to them, and the proximate determinants of HIV transmission and morbidity. Based on these findings, we can hope to develop more effective ways to prevent HIV rebound epidemics. | ||||
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