Homosexual Males and HIV Contraction

Social Context

HIV/AIDS is an epidemic that existed since the 1980s or even Earlier. Because of its infectious nature and the severity of the disease it has become a social problem. Primarily the disease was accompanying by the stereotype of the Gay community being the carrier of the disease. The phenomena was un-explainable, therefore most religious or homophobic groups were associating the Virus with God's way of punishing the Gay community for their so called immoral behavior (Harden, 2008). The disease was referred to as the Gay Related Immune Deficiency or GRID (Peebles & Roundtree, 2014). This was before it was discovered that other populations of people like women could contract the disease. There was a lot of confusion as to what was causing the disease. Two years after several cases of AIDS was recognized in 1983, HIV was identified as the cause of AIDS (Peebles & Rountree, 2014). By 1985, a blood test was developed to determine the presence of HIV (Peebles & Rountree, 2014).

        Initially there was not a lot of acknowledgement by the federal government in terms of the wide spreading auto immune disease (Peebles & Rountree, 2014). In the 1980s activist in the gay community set out on a mission to bring awareness to the epidemic (Harden, 2008). Ronald Regan did not publically speak up about HIV/AIDS until 1985 (Peebles & Rountree, 2014). In 1987 the Presidential Commission on HIV was created and it issued recommendation for anti-bias laws, increased access to drug treatment and additional funding for research (Peebles & Rountree, 2014). Also in 1987 AIDS Coalition to Unleash Power (ACT UP) was created as an advocacy group (Harden, 2008). There has been a lot of advances in the field of HIV/AIDS but the social problem is still around and affecting a lot of communities.

        Approximately 1.1 million individuals in the United States are living with HIV infection in the twenty-first century (Peebles & Rountree, 2014). There are 50,000 accumulated infections in the United States every year (Peebles & Rountree, 2014). In 2011 there were 2.5 million additional cases of HIV worldwide (Peebles & Rountree, 2014). An issue that is evident in this epidemic are the unknown status of those individuals. There are several individuals who are living without knowing they are HIV positive, further spreading the disease. One in five people are not aware of the infection (Peebles & Rountree, 2014). In 2009, among those initially diagnosed with HIV 32% were diagnosed with AIDS within 12 months (Peebles & Rountree, 2014).  Indicating that these people were infected with the disease for many years without knowing. This might because, only 37% of people with HIV in the United States are retained in regular care (Peebles & Rountree, 2014).

        Even though anyone can contract HIV, some populations are at a greater risk than others. The groups that are most affected by HIV/AIDS include: gay and bisexual men of all races and ethnicities, African-American Men and Women, Latinos and Latinas, and people struggling with addiction (which includes injection users) (Valentine, 2013). In terms of the social problem I will be focusing on the high HIV/AIDS rate amongst men who have sex with men (MSM). The term MSM is used instead of gay as an attempt to not label and focus on the action itself instead of sexuality (Peebles & Rountree, 2014). In 2010 the estimated number of new HIV infections among men who have sex with men was 29,800, which was a 12% increase since 2008 (A Statistical Overview, 2011). MSM represent about 4% of the male population living in the United States but in 2010, they accounted 63% of the new HIV infections and 78% of HIV among men (A Statistical Overview, 2011). Since the beginning of the epidemic, more than 274,000 MSM with AIDS have died (Men Who Have, 2011).

        There have been some discussions to why the HIV/AIDS rates are so high in the MSM community. Some attribute it to the lack of knowledge of HIV status. Others say it is because of social discrimination and the stigma associated with HIV/AIDS. Some underestimate their personal risk and assume because of advances in treatment HIV is no longer a deadly health threat. Social and economic factors including homophobia, stigma and lack of access to healthcare risk behaviors can be a barrier to receiving HIV prevention services (Men Who Have, 2011).

        As more light was being shed on the HIV/AIDS epidemic more was being done in terms of the medical field and in legislation. In 1990 the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act was enacted by the U.S. Congress (Peebles & Rountree, 2014). This act was a result of what happened to Ryan White. Ryan White was a hemophiliac diagnosed with AIDS in 1984. He was not allowed to attend school because he had AIDS. He was one of the multiple hemophiliacs with AIDS that were prevented from going to school. Shortly after Ryan died, the Ryan White CARE Act was enacted in his honor. This legislation was established to improve the availability of health care for people affected by HIV/AIDS (Peebles & Rountree, 2014). Another effort made to help people living with HIV/AIDS (PLWHA) was HOPWA. People living with HIV/AIDS are at risk of being homeless due to a number of factors. In 1992 the AIDS Housing Opportunity Act, which is part of the National Affordable Housing Act of 1990 established the Housing Opportunity for Persons with AIDS (HOPWA) program (Peebles & Rountree, 2014). The goal of the program was to decrease the risk of homelessness and unstable housing situations for people living with AIDS (Peebles & Rountree, 2014) keeping them off the streets decreases the likelihood of it spreading rapidly.

        Another factor to consider is the Patient Protection and Affordable Care Act, also known as ACA is a federal healthcare legislation that has the potential to effect the way medical care is accessed by PLWHA (Peebles & Rountree, 2014). The aim of the legislation is to improve insurance plans making it more affordable for all. ACA eliminated the pre-existing clauses. The pre-existing clauses made the cost of insurance either too expensive for PLWHA or prevented them from purchasing health insurance (Peebles & Rountree, 2014). ACA also included no cost preventive services for many routine screenings (Peebles & Rountree, 2014).

Methods to Repair the Problem

The most recent HIV/AIDS policy is the National HIV/AIDS Strategy also known as NHAS. This strategy was originally released by the White House Office of National Policy (ONAP) in July of 2010. NHAS was a comprehensive plan to address HIV/AIDS with targets that were supposed to be achieved over a five year period (Peebles & Rountree, 2014). In 2015 the National HIV/AIDS Strategy was updated to 2020. This took into account the medical advances that were made and extended the strategy goals to 2020. NHAS has four primary goals that included: reduce new HIV infections, increase access to care and optimize health outcomes for people living with HIV, reduce HIV-related disparities/health inequities and achieve a more health coordinated national response to the HIV epidemic (Valentine, 2013). With the goal of reducing new HIV infections, the strategy is focused on improving prevention methods. NHAS makes it evident that with better prevention methods the disease can be contained. Another goal of the NHAS is to increase the accessibility to healthcare. This is important because there are a lot of MSM with HIV who have limited access to healthcare resources. Healthcare resources would help with the prevention of new infections and treatment for those who are HIV positive. It is important that PLWHA are well supported in a regular system of care (Valentine, 2013).

In the third goal about reducing health disparities the strategy brings up certain issues surrounding why certain communities are not as focused on the HIV/AIDS epidemic. Some communities have other priorities like employment and finding sustainable housing. More community-level approaches are needed to reduce stigma and discrimination against PLWHA and reduce the HIV-relates mortality in communities (Valentine, 2013). The final goal of the National HIV/AIDS Strategy talks about how the strategy is supposed to complement other related efforts across administrations. HIV/AIDS should be combated as a nation. One specific person is not in charge of the social problem. Collective efforts need to be made by the nation. The ACA together with the NHAS provides opportunities to improve access to the effective HIV model developed by the Ryan White Program (Adimora et al., 2011).

Program Goals and Objectives

        The Ryan White HIV/AIDS Program is the third largest funder of HIV care in the United States, after Medicare and Medicaid (Adimora et al., 2011). The Ryan White HIV/AIDS Program is a federal program that provides medical care for PLWHA who lack health insurance due to the lack of financial resources (Peebles & Rountree, 2014). The program was reauthorized four times between 1990 and 2009. The program has been funded through 2013 (Peebles & Rountree, 2014). In 2009 congress passed the Ryan White HIV/AIDS Treatment Extension Act that extended the program for four more years (Peebles & Rountree, 2014). The program is divided into different parts. Part A of the program was created to help areas with a high burden of the disease (Peebles & Rountree, 2014). Part A is involved in funding community-based efforts like outpatient healthcare and case management. This section of the program aligns with the National HIV/AIDS strategy's goal to increase accessibility to healthcare. Part B of the program provides funding to the states to provide services to PLWHA. The AIDS Drug Assistance Program (ADAP) is part of Part B. ADAP provides support in terms of the cost of HIV/AIDS drugs (Peebles & Rountree, 2014). Part C of the Ryan White HIV/AIDS Program increases the availability of early-intervention services in healthcare agencies. Some of these interventions include counseling, referral services and testing (Peebles & Rountree, 2014).

One of the reasons why HIV/AIDS is deadly is due to late detection. With early intervention PLWHA can receive the help they truly need and have a better healthcare outcome. Part D established services for women, infants and children effected by HIV/AIDS (Peebles & Rountree, 2014). Part F was added in the 2006 reauthorization of the Ryan White HIV/AIDS Program (Peebles & Rountree, 2014). Part F includes AIDS Education and Training Centers, Special Projects of National Significance Programs and Dental Programs (Peebles & Rountree, 2014). The AIDS Education medical advances and targeted assistance for special populations. Healthcare providers need to be kept updated so that they can best help their patients especially in a field that is increasingly advancing. The Special Project of National Significance Program provided funding for initiative targeting specific population. This part of the program is important because of the difference in risk levels depending on the population. Initiatives are especially needed for populations with high HIV infection rates. The dental portion of the program helps PLWHA to gain access to dental care providers and educate dental providers on information surrounding HIV/AIDS. The NHAS aimed to increase the number of Ryan White HIV/AIDS Program clients because of the success of the program in engaging PLWHA (Peebles & Rountree, 2014). This program has done a lot to battle HIV/AIDS in terms of providing affordable healthcare, HIV/AIDS resources and interventions for PLWHA.

In all, HIV has been around for a long period of time. Since the 1980s the discoveries of how AIDS came into existence to who can contract the disease has had a significant turn over which eliminated the myth. Because homosexual's males are sometimes still victimized by their choice I utilized that factor to create my research. Examining this subject established understanding of the different policies that were implemented to help people with the virus. Providing them with shelters and health insurance to help aide their problem rather than creating a genocide. Because going back in history Americans habit were to create a genocide when a specific group of individuals became a threat. Through the last portion of the research we discussed the actual means of fixing and the main objective. They attempt to detect the virus prior to it becoming AIDS. And during these interventions they allow the clients to receive mental health help through consoling

Reference Page

1. Adimora, A. A., Carmichael, J. K., Gallant, J. E., Horberg, M., Kitahata, M., Quinlivan, E. B., et (2011). Essential components of effective hiv care a policy paper of the hiv medicine iiiiiiassociation of the infectious disease society of America and the ryan white medical providers iiiiiicoalition. Clinical Infectious Disease, 53, 1043-1050. Retrieved March 2, 2017 from Oxford iiiiiiAcademic
2. Harden, A. V. (2008). Aids in the united states. Encyclopedia of Pestilence, Pandemics and Plagues, 1, 7-13. Retrieved February 23, 2017 from Gale Virtual Reference Library Database
3. Men who have sex with men. (2011) AIDS Sourcebook. 6, 159-162. Retrieved March 1, 2017 from Gale Virtual Reference Library Database

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