Research Topics: Antiretroviral Adherence

Women Living with HIV in Africa

Introduction to gender and HIV in Africa Include the following: – HIV in Africa (Facts and Figures) – the spread of HIV Women living with HIV in Africa – women dependence on men in the household – social subordination of women – women as primary caregivers – women health issues in Africa (examples in Zambia, South Africa and Nigeria) – women: access to treatment and the availability of care that is provided for them (give example of Zambia, Nigeria and South Africa) – Reproductive choices – Household roles between men and women in developing countries Issues of Gender and HIV Treatment – Gender and Accessibility (Mobility, cost, information) give examples of an African countries and Facts and Figures. – Appropriate services – Discrimination to marginalized Groups ( give example of African country) Stigma and Prejudice – Women fear of testing – Discrimination against affected groups – Fear of disclosure – Unsafe sex Why is HIV A gender issue in Africa (GREAT DEAL OF EXAMPLES IN AFRICAN COUNTRIES AND FACTS AND FIGURES) Poverty, gender and H IV (examples of an African country) The strategies that need to be in place for HIV prevention General gender policies and relevant to HIV (in Africa) – equality in law (examples of an African country) – rights to contraception and abortion (example of an African country) – education (facts and figures of African country) – equity of health system Gender policy and HIV prevention in developing countries (include facts and figures) – sexuality education – combating gender based violence both as prevention and care issue – involving men into the HIV prevention Gender policy and HIV treatment in developing countries – development of supportive policy – overcoming obstacles to equitable access – indicators to monitor progress Conclusion: Gender equity and poverty at the heart of HIV prevention Please re-visit the question and briefly answer the question using what is cover in the assignment. References: Include in the references – WHO/UNPAID, 2004, ensuring equitable access to antiretroviral treatment for women – World Health Organisation report – UNAIDS,2005, essential policy actions for HIV Prevention, UNPAID – UNPAID, 2006, report on global HIV/AIDS Credit:ivythesis.typepad.com

Women Living with HIV in Africa

Introduction to gender and HIV in Africa Include the following: – HIV in Africa (Facts and Figures) – the spread of HIV Women living wi...

GREAT DEAL OF EXAMPLES IN AFRICAN COUNTRIES

Introduction to gender and HIV in Africa Include the following: – HIV in Africa (Facts and Figures) – the spread of HIV Women living with HIV in Africa – women dependence on men in the household – social subordination of women – women as primary caregivers – women€™s health issues in Africa (examples in Zambia, South Africa and Nigeria) – women: access to treatment and the availability of care that is provided for them (give example of Zambia, Nigeria and South Africa) – Reproductive choices – Household roles between men and women in developing countries Issues of Gender and HIV Treatment – Gender and Accessibility (Mobility, cost, information) give examples of an African countries and Facts and Figures. – Appropriate services – Discrimination to marginalized Groups ( give example of African country) Stigma and Prejudice – Women fear of testing – Discrimination against affected groups – Fear of disclosure – Unsafe sex Why is HIV A gender issue in Africa (GREAT DEAL OF EXAMPLES IN AFRICAN COUNTRIES AND FACTS AND FIGURES) Poverty, gender and H IV (examples of an African country) The strategies that need to be in place for HIV prevention General gender policies and relevant to HIV (in Africa) – equality in law (examples of an African country) – rights to contraception and abortion (example of an African country) – education (facts and figures of African country) – equity of health system Gender policy and HIV prevention in developing countries (include facts and figures) – sexuality education – combating gender based violence both as prevention and care issue – involving men into the HIV prevention Gender policy and HIV treatment in developing countries – development of supportive policy – overcoming obstacles to equitable access – indicators to monitor progress Conclusion: Gender equity and poverty at the heart of HIV prevention Please re-visit the question and briefly answer the question using what is cover in the assignment. References: Include in the references – WHO/UNPAID, 2004, ensuring equitable access to antiretroviral treatment for women – World Health Organisation report – UNAIDS,2005, essential policy actions for HIV Prevention, UNPAID – UNPAID, 2006, report on global HIV/AIDS Credit:ivythesis.typepad.com

GREAT DEAL OF EXAMPLES IN AFRICAN COUNTRIES

Introduction to gender and HIV in Africa Include the following: – HIV in Africa (Facts and Figures) – the spread of HIV Women living wi...

HIV Treatment Strategy

NOTE: additional Literature Review   Indeed, literature studies pertaining to HAART adherence behaviors of African American involves certain degree of useful and imperative factors such as culture, education and motivation incurring the situation that affected the population as being known, the various support studies determined in such medicine related journals and articles served crucial points for the study as integrated to provide an overview of experiences of HIV-infected patients and the processes underlying the factors identified in literature as organized in below points. In general, some background variables such as educational levels and age were found to be significant variables affecting treatment adherence, in addition to some religious support variables. The imperative sense have to be the interventions needed by the African American in order to help them recover from low literacy adherence related to HAART behavior.   (a) Culture, Religion, and Ethnicity Using data from the second follow-up of the HIV Cost and Services Utilization Study, there investigated the influence of culture and religious support from treatment adherence for the African American as HIV patients. The study outcomes does show differential effects of social, religious support and background variables on treatment adherence. On the other hand, for African Americans as well as the Hispanics, religious and ethnic support variables were influential (1). Results then, suggest that strategies to improve treatment adherence may vary for different race/ethnic groups. There maybe importance of working with and involving religious organizations in an effort to increase adherence and support to HIV-infected members, particularly among African Americans and Hispanic communities. (2)     (b) Literacy skills and educational level Thus, information appropriate to a patient’s level of understanding will lead to the patient having correct knowledge of what constitutes good adherence practice. Because a patient’s personal interpretation of good adherence practice may be based on misconceptions that are used to justify risky behaviour, it is important to ask patients to describe their behaviour and if necessary to repeat instructions that need attention in order to improve adherence. Attention should be given to literacy skills and education such as the capacity to organize better career life and one’s activities and the ability to anticipate risk situations. (1) Furthermore, there involves health literacy relevance within the adherence to treatment for HIV and AIDS. The study presented multiple logistic regression showed that education and health literacy were significant and independent predictors of two days treatment adherence after controlling for age, ethnicity, income, HIV symptoms, substance abuse, social support, emotional distress, and attitudes toward primary care providers. Persons of low literacy were more likely to miss treatment doses because of confusion, depression, and desire to cleanse their body than were participants with higher health literacy. (3) (c) Patient-Provider Relationship In addition, there were four studies completed from the year 2005 up to the present that have highlighted the importance of the relationship between the provider and the patient in enhancing adherence behavior. The literature does extend certain work by comparing adherent and nonadherent clients in one high-volume HIV clinic in which the majority of care is provided by nursing staff. (5) The indicator of the patient-provider relationship was satisfaction with the care provider as measured within the Patient Satisfaction Questionnaire. Client groups differed significantly on perception of interpersonal manner of care provider (p = .018), care provider conduct total (p < .001), and quality total (p = .017). These findings are consistent with earlier work and underscore the potential importance of the patient-provider relationship as a focus of care for nurses. (5) The problem of inadequate adherence to prescribed highly active antiretroviral therapy (HAART) drug regimens to treat HIV infection and AIDS can be too ubiquitous. Adherence can be inadequate despite both provider and patient understanding of the consequences of nonadherence. Successful long-term treatment of HIV/AIDS requires at least 95 percent adherence to HAART in order to prevent emergence of drug-resistant HIV variants that lead to regimen failure and limit options for future therapy. Despite the prevalence of inadequate adherence, many patients succeed and HAART has transformed HIV infection into a chronic illness increasingly managed in primary care. The barriers to adherence observed in HIV treatment resemble barriers to the successful treatment of some chronic diseases resulting in patient-provider relationships. (4) Treatment of HIV infection shown patient provider collaboration can result in the selection of lifestyle-tailored regimen characterized by convenient dosing, low pill burden and tolerable side effects that enhances adherence, effectiveness and the patient’s willingness to remain on anti-HIV therapy long term. Literature studies in review focuses on the current understanding of adherence reporting, improvement of adherence, and, hence, improvement of treatment outcomes in HIV infection and AIDS. (3)   (d) Motivational Interventions There was one study which sought to uncover the prevalence of continued drug use and statements about everyday adherence decision-making from community sample of HIVseropositive individuals with history of substance use. Ninety participants attended one of three focus groups and, collectively, generated 100 statements describing their day-to-day motivations and barriers to HIV-medical adherence. In addition, participants’ self-reported substance use revealed that just under 40% (n = 33) were juggling substance use and their HIV medication regimens within the past 30 days. (2,3) The statements reveal varied and complex adherence factors, which included relatively more non-drug-related than drug-related factors. Furthermore, some respondents non-drug-related statements covered broad range of reasons related to adherence that tended to fall into the same major categories as those found across motivation system from within individual factors. The authors discuss the need for providers to consider the breath and complexity of adherence factors that impact readiness to initiate and adhere to HAART behaviors for the African American population. (4)   (e) Socioeconomic factors In addition, acquiring insight into patient’s social support systems and counseling on how to use them is a valuable strategy in optimizing adherence. Social support has to be substantial and practical, such as reminders to take medication. Attention should also be paid to possible negative influences on adherence in the patient’s environment, perhaps coordinating the schedules of partners or dealing with discouraging influence as for instance, African mothers of young children may need help to fit the medication into the family’s hectic schedule. HAART’s potential for long-term effectiveness is dependent upon maximum and durable suppression of socio economic  stance from within societal representations. There has been logistic regression analysis was conducted to determine associations of sociodemographic and psychosocial variables with adherence to antiretroviral regimen. Results indicated that heterosexual participants and participants of Latino ethnicity are significantly more likely to report missed medications. Perceived satisfaction with support from a partner was associated with taking antiretroviral therapy as prescribed, whereas satisfaction with support from friends and from family was not significantly related to adherence. (4)   (f) Social Support The relationship of adherence to antiretroviral treatment with types of social support such as partner, friends, and family as one study indicated that, from the inclusion criteria, parent trial participants taking antiretroviral therapies, and those with complete data on self-reported measures of adherence were considered eligible for the present study. Overall, 26 percent of participants were found to be nonadherent, which was defined as one or more missed doses of treatment in the prior 4-day period. Examination of coping strategies showed that participants reporting drug and alcohol use to cope with HIV-related stress were more likely to be nonadherent. (5) These findings call for adherence interventions designed to address barriers and strengths, such as community norms and or traditional cultural values, specific to certain populations. Furthermore, couple based approaches enlisting partner support may help persons living with HIV to adhere to antiretroviral regimens. There is also trusting relationship with the healthcare provider is essential. This relationship is built on support and open communication. Providers should give clear instructions on how to take medication, explain the relationship between adherence and viral load and offer good medical follow-up. Supplementing the adherence support efforts by physicians, nurses, and pharmacists, clinicians in a range of disciplines and settings can assess and intervene on psychosocial risk factors and thereby reduce adherence problems regardless of their level of knowledge about HIV medication and for this review, those with higher levels of social support from partners demonstrated higher rates of medication adherence. Those who received more social support from their families, reported significantly lower adherence rates as there suggest that efforts to improve medication adherence need to address the diverse types of social support networks of people diagnosed with HIV/AIDS. (5)   (g) Drug use High levels of medication adherence are crucial to the success of HIV treatment. Consequently, substance abuse counselors (SACs), social service and other care providers can best support their HIV positive clients when they understand adherence and related interventions. This paper describes a training program that was designed to increase counselor knowledge of HIV medications, adherence strategies and enhance counseling skills specific to HIV adherence. For substance abuse counselors the training needs included: better understanding of medication interactions, relapse, recovery, and interdisciplinary communication. Thirty-six SACsfrom three agencies completed the 1 1/2-day training, which included lecture discussions, case discussion and interactive client case simulations. Success in accomplishing training objectives was evaluated at three points: pre-intervention training, post-intervention as well as six month follow-up to determine changes in participants’ knowledge, attitudes and behaviors related to adherence counseling. Three case scenarios measuring counselor comfort levels indicated SACs felt significantly more comfortable discussing relapse and medication issues with their HIV affected clients than they would in discussing medication issues with the client’s physician. However, they felt slightly more comfortable about physician discussions after training. Open-ended comments by SACs at six-month follow-up provided insights into recovery issues their clients faced. The findings suggest ways medication adherence could fit the reality of serving clients with co-occurring HIV and substance use to better meet their health and support needs. (6)   It has also been hypothesized that HIV-positive individuals who have a history of using drugs, may be less adherent to AR therapy than those without this behavior or history. In a large sample of 727 individuals, 56.8% reporting never using injection drugs and 39.3% reporting being a former or current user, injecting drug use was not related to keeping appointments or following healthcare advice and instruction. Having certain positive attitude toward the future, a good relationship with one’s medical team, belief that ARs improve survival and help compliance with heroin free state, and being in prison were factors positively affecting continuance of therapy. Though race overall may not be an indicator, there may be characteristics or confounding factors within different racial groups that affect levels of adherence. For example, in a cross-sectional study of 158 outpatient HIV clinic patients, African Americans were no less likely to adhere to ARs than Caucasians (race OR=1.06). Caucasians reported inconvenience of medications (p=0.02) and taking more medication as directed as barriers to adherence; whereas, African-Americans reported that no storage place for medications (p=0.024), ceasing medication use because of feeling better (p=0.033), not taking medication away from home (p=0.014), and being to embarrassed to get refills (p=0.019) (7) were barriers.90 In a study of 74 HIV-infected patients that investigated the association of literacy with AR adherence regimens among African-Americans and Caucasians. African-Americans were found to be significantly less adherent to ARs (31% vs. 11%, p<.05), understood less the meaning of CD4 lymphocyte counts (56.3% vs. 77.1%, p<0.0001), and were less likely to understand the meaning of HIV-viral load measurement (87.5% vs. 28.6%, p<0.0001). Over three-quarters (83.3%) of Caucasian patients were always adherent to ARs compared to 66.7% of African-Americans with high literacy; only 34.1% of African-Americans with less than a 6th grade reading level adhered to ARs (p<0.0001). Thus, for one, in substance use, it is important to find a way to minimize the risk that substance use will remain the first priority in life. Professional support or daily observed therapy can be an option. (7)   Aside, quality adherence to behavior therapy is an ongoing process in which the patient needs to be directly involved, it is not something an individual naturally possesses or lacks. Interventions to increase adherence must address cultural differences within race, gender, sexual orientation, and even religion. They must be tailored to meet culturally relevant barriers, including differences in language. Efforts must continue that help patients complete treatment, paying close attention to socio-cultural circumstances as well as the psychological and economic factors that may impede upon adherence. Physicians should not automatically assume a future of poor adherence by their patients on the basis of demographic and behavioral characteristics. These assumptions, on the part of the clinician, could stigmatize the clinician-patient relationship, thereby possibly introducing an additional impediment to adherence. An emphasis on language that stresses the inability of the patient to adhere to the devised medication regimen should be dropped and supplemented with language that stresses the role of the patient in devising and implementing an individualized treatment plan. Such language should be as elementary as possible with no reference to medical jargon.. Further study of the factors in HAART adherence is needed. Evaluations of adherence intervention tools, including counseling programs, DOT, methods to assist patients in deciding whether to start antiretroviral therapy, and educational materials are also needed. The success or failure of HAART, both as a treatment strategy for patients and a public health strategy to prevent the spread of multi-drug resistant HIV, is dependent upon the ability of patients to adhere to therapy. Support to assist patients in their adherence efforts should be comprehensive and considered a high priority in the delivery of HIV primary care and social services.       ________________ Credit:ivythesis.typepad.com

HIV Treatment Strategy

NOTE: additional Literature Review Indeed, literature studies pertaining to HAART adherence behaviors of African American involves ce...

International Business

Case 1   International business operates in an interdependent global economy where market functions are influenced by national political and cultural diversity. Ethics focuses attention on the choice of values. Ethics concerns the nature and the justification of right actions. Prospectively, ethical norms are prescriptive, identifying values to guide actions now or in the future. Ethical norms may also provide standards for judgment of current or past actions. These uses apply to the fields of politics, economics and business.  Legitimate businesses, including international enterprises, need a societal foundation of ethical values in order to operate efficiently and effectively.             However, ethical obligations of Multinational Corporation toward employment conditions, human rights, corruption, environmental pollution, and the use of power are not always clear. There has been no agreement on ethical principles accepted. From an international business perspective, some argue that what is ethical depends upon one’s cultural perspective. In the developing world, such as the South Africa, poverty, poor sanitation and lack of adequate medicine conspire to make infectious diseases like HIV/AIDS and malaria commonplace and deadly, accounting for about 25 percent of all deaths ( 2005). Meanwhile, in developed countries such as the United States, these same diseases can be prevented, treated or cured. Much of this disparity can be attributed to one thing: drugs. However, mostly essential drugs that are able to treat these diseases are patent protected by drug companies making the prices unaffordable in the developing countries. A patent, as embodied in American law, is a government-issued grant that confers upon the patent owner “the right to exclude others from making, using, offering for sale, or selling the invention throughout the United States or importing the invention into the United States” for a period of twenty years beginning from the filing date of the patent application. A patent effectively grants the patent owner a limited monopoly on the patented invention (1998). While the inventor can collect monopoly rents on sales of her product until the time of patent expiration, this inefficiency is justified on utilitarian or consequentialist grounds–that is, without patent protection, inventors would not invent, or would invent only to a level that would be considered sub-optimal. This concern is particularly salient in the world of medicines, where a substantial capital investment is required to bring products to market (2003). Significant funds are needed for drug research for two reasons: first, new drugs are exposed to extensive regulatory scrutiny and must be tested in expensive clinical trials in order to prove their safety and efficacy; and second, medical research is inherently uncertain and risky in nature, with a number of failures typically preceding any valuable breakthroughs (). Without the prospect of a limited monopoly, it appears unlikely that many investors would be willing to place tens or even hundreds of millions of dollars at risk on early-stage biomedical research. The drug companies argued that because drug development is a very expensive, time consuming and risky process, they need the protection of intellectual property laws maintain the incentive to innovate. It can take 0 million and 12 years to develop a drug and bring it to market. Less than one in five compounds that enter clinical trials actually become marketed drugs- the rest fail in trails due to poor efficacy or unfavorable side effects-and of those that make it to market, only 3 out of 10 earn profits that exceed their costs of capital. If drug companies could not cont on high prices for their few successful products, the drug development process would dry up.   With these high prices, the deadly possibilities have shown themselves most starkly in the case of HIV/AIDS. In the developed world, modern antiretroviral drugs help patients to live an average of 11 years after contracting HIV. Yet 45 million infected people worldwide remain untreated, with five million new cases and two million deaths each year–in part because many antiretroviral drugs are relatively new, patent-protected inventions. That puts them far beyond the means of patients in the poorest countries ( 2005). The current patent system means raising prices and patents deny life-saving drugs to the ill. But in wealthy nations, the case in favor of IP rights is equally simple: the ability to charge more for patented drugs is what gives pharmaceutical companies a financial incentive to develop new, life-saving drugs in the first place. And money is critical because research and development are costly; by some estimates, fewer than one in 10 thousand compounds tested ever reaches the market. But developing countries are poor, so there is little profit to be made in selling drugs to them, let alone in developing new ones for diseases unique to the developing world.             Tropical diseases are notably increasing which includes sleeping disorder, dengue fever, river blindness and malaria. However, there is a little effort has gone to research and development of tropical diseases. Instead, the patent system continues to produce anti-balding and the like. It is as if the balding of men are more important to solve than treating a dying men, after all, the dying men are poor and the balding men is rich. However, in contrary to the argument of the drug companies, significant amount of research is now primarily funded by government grants.   Global patent rules raise the price of medicines in developing countries and bring no benefits, and that poor countries should therefore limit patent protection. It also suggested that they encourage local production of generic versions of vital medicines, consider the compulsory licensing of “essential” drugs by overruling drug companies market exclusivities, and import patented medicines if they can buy them more cheaply elsewhere.     Case 2   International trade has grown rapidly in recent years, thanks to the progressive reduction of tariffs and quotas through successive rounds of multilateral trade liberalization. Globalization and international competition encourage international corporations to use a variety of locations for the manufacture and sourcing of components and final products.  argued that trade is beneficial because of differences between countries in the costs of producing different goods (2000). According to  (2000), like all of his contemporaries, Smith held to a labor theory of value, according to which the cost of producing a good was given by the labor time required to produce it. Therefore, differences in the costs of producing a certain good in different countries reflected differences in labor efficiencies in each country. However, rather than each country striving to produce all the products which they could, each should concentrate on those products in which they enjoy a cost advantage over other countries. The result will be that all are better off. It is argued that countries differ in their ability to produce goods efficiently, and should therefore engage in the practice of international trade. According to Smith, such countries should specialize in the production of goods for which they have an absolute advantage and then trade for the goods produced more efficiently by other countries (2001). Increased trade also benefits consumers and efficient producers, through lower prices and access to a wider variety of goods. This is because trade encourages greater specialization—which dramatically lowers costs—and more intense competition, which is central to innovation. Without trade the prices of Logitech’s Price may be at high price because costs of producing the products is also high if they have just concentrated in a geographical area in which the costs of the producing the product is high.  demonstrated that the reason why it pays countries to trade is the existence of different relative or comparative costs in the production of different goods (1998). So long as each country possesses a comparative advantage in at least one activity, it pays to specialize in that activity and engage in trade. Differences in comparative costs are given by comparing the relative cost ratios existing in the two countries before trade. These express the cost of producing one unit of a particular good in terms of the number of units of the other good that must be forgone in order to do so. If we assume that all labor is employed in one or other activity, an extra unit of one good can only be produced by reducing output of the other. This way of expressing cost is what economists call ‘opportunity cost’ or the cost of something expressed in terms of opportunities foregone. Specifically, comparative advantage draws upon the idea that specialization is efficient in order to forcefully establish the broader generalization that free trade must be in the best interest of all trading countries. Comparative advantage argues that unlimited trade between countries will increase the total amount of goods produced if countries specialize in specific products and offer them at lower prices. Each country then will trade some of those lower-cost goods with other nations for goods that can be produced elsewhere more cheaply than at home. At the end of the day, with free trade among nations, all countries will find that their consumption possibilities lie outside their domestic production possibilities. Ricardo suggested that countries should specialize in the goods it produces most efficiently and trade for goods it produces less efficiently, even if they could produce the second product more efficiently than the country with which they are trading (1998). Even more than the concept of absolute advantage, the theory of comparative advantage suggests that trade is a positive-sum game in which all gain (1998). Based on the theory of comparative advantage, international trade is designed to lessen the scarcity problem through specialization, focusing on the production of a limited variety of goods and services. By concentrating on one activity or task, resources can be used more efficiently, and more efficient production leads to greater output without greater costs. In addition, based on the theory of comparative advantage, Logitech found a way to improve maintain its core competence in differentiating themselves from competitors while lowering production costs. The company’s decision on its operations has continually guided by the comparative theory. Manufacturing is done in China and Taiwan since these countries offer low direct costs. They can hire many people in lower cost.  Overhead costs are also low in these countries. Costs of production would also cost Logitech a little percent of their returns. R&D works are done in Switzerland and Fremont because these places are close to high technology enterprises. Design is done in Ireland because this is what that country is good at. Logitech employs a total of 650 people in Fremont and Switzerland and 4,000 factory workers in China. Although a less number of employees are employed in Fremont and Switzerland, they create more value for the company since they are the ones doing the mind work while the workers in China are doing labor work or assembling of the R&D group has invented. With Fremont’s geographical site, it is more accessible to high technology enterprises which are needed by the company thus making the company decide to shift its headquarters in Fremont. Taiwan, on the other hand has been chosen to be the major manufacturing site of Logitech because supplier has less bargaining power. Suppliers include those who provide the direct labor and materials. The country provided well developed supply base for parts, qualified people and factory space in the low cost. Customers has no bargaining power because there are no direct customers in the country since the Taiwanese factory was only out producing U.S. facility. In addition there are no threats of new entrants since the country is still expanding in the local computer industry. Competitive advantage of the company is its continuing innovations. A growing number of tech companies are looking at China as the next huge business frontier, both as a way of tapping into its growing consumer market and for manufacturing goods at cheaper costs. China’s increasing integration with the global economy has contributed to sustained growth in international trade. Its exports have become more diversified, and greater penetration of industrial country markets has been accompanied by a surge in China’s imports from all regions—especially Asia, where China plays an increasingly central role in regional specialization.                                                                         Credit:ivythesis.typepad.com

International Business

Case 1 International business operates in an interdependent global economy where market functions are influenced by national politi...

Combating Gender Inequality Needs to be at the Heart of HIV Prevention Strategies in Developing Countries

Combating Gender Inequality Needs to be at the Heart of HIV Prevention Strategies in Developing Countries   Introduction             HIV/AIDS is one of the most fatal diseases know to man today. Globally, not less than 200,000 people lived with HIV/AIDS was recorded in 1980, and this number soared to 3 million by mid 1980s, and further rose to 8 million by the end of the decade. However, the increase with the rate of infected individuals rose in the 1990s enormously, bringing it to 40 million people living with HIV/AIDS in 2001. In Sub-Saharan Africa, it has been reported that it has less than 11% of the world population infected with the disease, thus, containing more than 70% of all HIV infected people in the world. In addition, more than 28 million infected people live in Sub-Saharan Africa, 7 million in Asia, 2 million in Latin America and the Caribbean, and 3 million in other regions of the world (2007). From the figures given above, it can be perceived that the African continent serves to have the most number of HIV/AIDS infected individuals. Given such figures, its relevance and incidence would be emphasized in relation to gender inequality in the continent.             The question of why a disease like HIV/AIDS follows a different epidemiological pattern in Africa compared to Western counties lies on the historical, political, economic, and sociocutlural environments of the continent. It has been reported that the African continent had been exposed to the increasing rate of infection of the disease due to the disruption of the traditional family, social, and environmental structures by European hegemonic adventures (2005). In the early stages of the pandemic, HIV infection was predominantly among men in many industrialized and some developing countries. However, as of the end of 2002, almost 50% or 19.2 million of the 38.6 million adults living with HIV/AIDS globally are women. In Sub-Saharan Africa, 58% of HIV-positive adults are now women. The differences in the rates of HIV/AIDS infection in Africa leads to the determination and evaluation of important differences between men and women in terms of biology, sexual behavior, and socially constructed ‘gender’ differences in roles and responsibilities, access to resources, and decision-making power (  2003). The increase in the infection rates in Africa may stem from the economic and patriarchal structure in its society. Among sub-Saharan Africans, women have become a particular class of victims of the HIV/AIDS pandemic. Since African societies are patriarchal, girls are socialized from very young ages to play subordinate roles, making them desirable women for marriage. They could be rewarded for enhancing family honor and image, and thus, years of “hand-me-down” conditioning of women have accounted for gender inequality. In this generation, the generation of HIV/AIDS, this power imbalance between the sexes in Africa is particularly significant, as women have become especially susceptible to the disease due to their limited power in sexual encounters. In one estimate, 6-11% of young women aged 15-24 years old were HIV positive compared to 3-6% of their male counterparts (2005). Such figures are related to the early initiation of sexual activity among girls, which is directly related to the practice of early marriage in African societies. Early marriage exposes girls to an increased risk of HIV/AIDS infection, especially if their partners are older and have had more sexual exposure. In Sub-Saharan African societies, the sexual partners of young women are often much older than the women themselves, indicating that in 16 countries, husbands of 15-19 year old girls are on average ten years older than their wives ( 2003). Thus, this situation suggests that women may be more susceptible to HIV/AIDS infection due to gender inequality, subordination, and powerlessness. In addition, the dependence and subordination of women in a patriarchal society account for African women’s vulnerability to the disease. The desire of African men to have many children and to commit polygamous relationships contributes to the spread of the disease. In fact, in rural Tanzania, 40% of married men were reported to have non-marital sexual partners, thus, infecting their spouses in the process. In Zimbabwe, women may be under pressure from their spouses or sexual partners not only to reproduce, but also to achieve a desired number of children. Thus, in this sense, it can be observed that the women in traditional African societies lack the power to deny sexual intercourse from their partners even when marital infidelity can be proven (2005). Moreover, the patriarchal society that Africa has produces high risks for both young and adult women to become victims of rape and sexual coercion, thus, exposing them to threats in acquiring the disease. This is most evident during conflict situations, such as the Balkan conflict. In Rwanda, 3% of all women were raped during the genocide, and during HIV testing, it was found out that 17% of the women tested for HIV were positive, compared to 11% who were not raped ( 2003). Aside from sexual subordination of women in African societies, their dependence and lack of bargaining power can also be attributed to their poverty, low economic status, and lack of education. In South Africa, women make only 70% of what men earn, which already puts them at a disadvantage for attaining self-sufficiency. Women’s vulnerability often forces them into engaging in sexual relationships outside marriage, thus, giving men more leverage for taking multiple wives. Inequality being experienced by women in Africa also leads to unequal environments in academic institutions. There have been reports that girls are being forced by their teachers to engage in sexual activity as a punishment for being late or in exchange for food at lunchtime ( 2006). From such facts and figures, it can be perceived that the African society, more particularly its women are burdened with grave issues in relation to their health and welfare in relation to acquiring HIV/AIDS infection. Primarily, many countries in Africa have no effective access to relevant information regarding HIV/AIDS prevention. In terms of access to treatment or availability of care, it has been stressed that in many countries in Africa, HIV/AIDS information and services are provided primarily through family planning, prenatal and child health clinics, which are basically not designed to reach men or meet their needs. Consequently, men may be less likely than women to receive HIV/AIDS information, counseling, and treatment services (2003). Second, the male condom is often not a realistic option for women who live in patriarchal families and communities, such as in South Africa. This is because the use of condoms is a contentious issue ( 2006), and may practically lead for them to experience threat or physical violence when attempting to negotiate safer sex through the use of condoms ( 2003). In relation to this, another dilemma being faced by women is the fact that female condoms are not available in South African clinics, and microbicides, a clear gel that a woman can use before sexual intercourse are still undergoing testing in Africa and have not been properly or effectively distributed. In addition, as primary care givers, uninfected women in Africa faces the burden of taking care of orphaned children of HIV/AIDS victims. In South Africa alone, there are 1.1 million AIDS orphans and by 2010, the number is estimated to increase to approximately 3 million (Suich 2006). Moreover, another issue to be taken note of is that the huge statistics of individuals who need treatment from the disease pose not only a huge challenge to medical care, social resources, and state finances and policies, but also in confronting the present ethics and human rights debate with a serious moral dilemma. Such issues include the stigmatization of HIV infected individuals and their discrimination (2003). These issues then decreases the chances for HIV/AIDS infected individuals, especially of women to seek help and treatment. Given such issues, it can be distinguished and emphasized that the status of women in the African society presents grave threats to their increased risk of acquiring the HIV/AIDS infection. This statement can be deduced from the different facts and figures presented above, which aim to describe the present situation of African women in the African society. As such, this paper would be discussing the view that gender inequality in the African society must be surmounted in order to make HIV prevention strategies effective and efficient in different developing countries, such as the many African countries.   Issues of Gender and HIV Treatment             HIV/AIDS is now said to be the leading cause of death in Sub-Saharan Africa and has drastically reduced life expectancy. Life expectancy in Botswana, one of Southern Africa’s wealthiest countries, plunged to 50 years. South African life expectancy is now 48 years, and Zimbabwe’s life expectancy is now 37 years. Thus, the pandemic in Africa is limiting the economic growth and eroding social and political structures, depriving children of parents, schools of teachers, and governments of personnel ( 2002). Based on the above discussion, it can be understood that the gender of women in African societies in itself largely contribute to their increased risk in acquiring the HIV/AIDS infection. Thus, in this sense, the issue of gender inequality in most African societies participates in the increased risk of acquiring the disease and the decrease of life expectancies of the region’s peoples.             HIV/AIDS is considered a gender issue in African societies based on their own sexual behaviors and socially constructed gender practices and beliefs that are innate to their ways of life. In addition, the issue of disease acquisition is also a gender-related issue given their social structure that is far from different with the social structure being observed in other societies in other parts of the world. In this sense, their own beliefs and practices may contribute in jeopardizing their present situation and their future. The increase in the risk of HIV/AIDS acquisition in the African continent remains and would remain a gender-related issue, if the following number of factors would not be addressed by the African government (2007): 1) Unequal power relationship in sexual interaction – In Nigeria, it has been reported that adolescents’ sexual interaction is usually characterized by unequal power relationship between the male and female, which is due to the fact that girls are usually socialized in early life to defer to the boys, even when they are in a relationship. This in turn led the boys to learn that as boys, they most be more aggressive, and the girls more receptive with its attendant implications for spreading the disease. 2) Gender inequality in terms of decision-making – Many African societies have cultures that show women having less power than men in terms of decision-making, thus, preventing them from using preventive measures and even discussing it with their sex partners. In most African cultures, women are expected and taught to subordinate their own interests to those of their partners, thus, often making them feel powerless to protect themselves against the disease and intended pregnancies. 3) Sexual behavior and motives – A certain study in Nigeria indicates that women were more likely to have relationship with older partners, for monetary gains, maturity, understanding, and security. 4) Age and Gender-related behavior – Young people are vulnerable because they are likely to engage in high-risk behavior, by having multiple sex partners, unprotected sexual intercourse among others. 5) Level of awareness and education – In Nigeria, it was found out that males have a higher level of awareness than the females. The amount of education, information, and awareness of women in Africa depends upon the level of their education. However, most African women are not educated, based upon their socioeconomic status. 6) Social status of women – From birth, women are seen as helping mates to men, thus, in certain parts of Nigeria, women are made to be subject to men, such that during their marriage, a woman will be informed of her husband’s and his family’s right over her. 7) Socioeconomic status of women – It has been reported that economic needs and dependency put women at further risk of HIV. Sex in many places is widely viewed as a resource for women. Economic vulnerability reduces women’s ability to influence the terms of this exchange and to leave relationships that they perceive to be risky. Students are vulnerable to sexual harassment and exploitation by their teachers, especially in situations where the cost of fees is prohibitive for their parents (2003).  8) Unequal share of resources – Upon entering marriage, a Nigerian woman has no share from the belongings of the man, and has to undergo dehumanizing experiences, for example after the death of her husband. This intensifies the risks of acquiring the disease, as women are left with nothing, thus, in order to make ends meet, the situation could aggravate multiple sex partners. 9) Discriminatory practices in religion – Several religions and traditions teach women to be subordinate over men, emphasizing the fact that women are mere sexual objects of men. This perception instills in men that they have power over women, thus, giving them the “right” to abuse them. 10) Pressures of childbearing – The African society places pressures on women, who must be able to bear children for the survival of the household. Given the polygamous nature of African women, Nigerian women are more exposed to the variables that transmit HIV/AIDS. 11) Violence – (2005) indicates that gender disparities and patriarchal institutions circumscribe the extent of men’s license to use violence against their partners. Patriarchy also limits women’s agency to abandon an abusive husband. Thus, gender inequality in Tanzanian marriages or relationships may create a kind of “sexual contract” that places women at a distinct disadvantage, setting the stage for intimate partner violence. 12) Burden of increased orphans – Studies made in Zimbabwe, Cote d’Ivoire, and Zambia indicate that HIV-positive women are most unaware that they should cease childbearing because of the risk of vertical transmission to the prospective child and of adding to the number of future orphans (2002). 13) Contraceptive behavior – Knowledge of HIV-positive status in Kenya, Rwanda, Cote d’Ivoire, and Uganda of both men and women does not lead to increased condom use (2002). The powerlessness of women and their neglect in acquiring the disease in such countries in Africa contribute to their increased risk in becoming infected.             Given the fact that HIV/AIDS acquisition in African societies is a gender-related issue, the accessibility of treatment and healthcare of the victims, most especially the victims of the disease must be analyzed. It can be assumed that today’s generation and advancement in science and technology would have provided HIV/AIDS infected persons with an increase access for treatment and healthcare, due to increased awareness of the issue. However, if such treatments and healthcare strategies were visible, then the number of HIV/AIDS victims would have decreased. In this sense, accessibility to treatment and healthcare would be discussed. It has been reported by the UN Population Division that about 40% of Africa’s population currently live in towns and cities, and although presently, Africa is the least urbanized region in the world, by 2030, its urban population is expected to exceed the total population of Europe. Typically, average urban incomes are no doubt higher than average rural incomes, wherein the proportion of people living in poverty is smaller and the standards of service provision per person are higher. However, evidence indicates that income and consumption inequality is generally greater within urban areas. While economic growth has picked up some African countries since the 1990s and national trends show some decrease in the incidence of poverty, many urban dwellers continue to live in extreme poverty. The presence of services does not mean that the poor can access them. Poor urban people have incomes insufficient to meet basic needs, lack assets and secure tenure, live in poor and overcrowded housing conditions, have inadequate access to infrastructure and services, have no social safety net, and are powerless to influence decision-making. Such issues worsen the HIV/AIDS epidemic, the prevalence of which is invariably higher in urban than in rural areas. In high prevalence locations, the increase in the risk for acquiring the disease affects every family directly or indirectly through illness, death, or an increased burden of care for orphans and the sick. In addition, the desolate conditions being experienced by urban residents in Africa reinforce the acquisition of HIV/AIDS of women, through their risky sexual behavior. In Nairobi, it has been found out that the poor women living in slums engage in sexual activity at an earlier age, and with a larger number of partners due to high unemployment and low and unstable incomes (2006). With such conditions, it must be assumed that the society should be concerned with providing effective healthcare, treatment, and awareness to infected persons, most especially with women. However, it has been stated that gender inequality in healthcare remains a significant factor in the disproportionate burden of HIV/AIDS among women in Sub-Saharan Africa. Women are less likely to seek healthcare or be cared for in healthcare settings compared to men. Socioeconomic status and low literacy are major factors influencing this outcome. Low literacy rates tend to hamper the knowledge of women about prevention strategies. In addition, many women are less likely to benefit from anti-HIV/AIDS campaigns channeled through the print media. Men mostly own radios and televisions, while women in rural settings are worse off in this regard. Furthermore, women are more likely to delay seeking healthcare either because symptoms were not considered severe, had disappeared or for lack of money. Even when women sought care, they were more likely to turn to public healthcare facilities wherein marginal care is the norm. To worsen the situation, most Africans believe in the power of traditional healers, who initiate the reuse of unsterilized needles and cross contamination with the body fluids of patients. It has been reported that 60% of Nigerians believe the powers of traditional healers, which must be considered a public concern, as such, patronage delays prompt appropriate medical interventions for HIV/AIDS patients (2005). Another factor to consider in terms of the delay of treatment for HIV/AIDS infected individuals is the stigma of having the disease. Stigma due to AIDS is a reality in many African countries, but it is made particularly bitter in South Africa due to the country’s conflicted history with the illness (2006). It has been emphasized that HIV-positive individuals are still stigmatized in the modern-day society, and they are the victims of all forms of discrimination in work places, educational institutions, and even in religious communities. The main reason for this reality is that the disease is perceived to be the result of unacceptable sexual and moral behavior and other bad habits. Thus, in this regard, the stigmatization and discrimination of HIV-infected persons are the most inhibiting factor in the prevention and treatment of the disease (2003). From this, it can be perceived that poverty, ignorance, discrimination and stigmatization, and risky sexual behavior contributes to the delay and decreased access of HIV/AIDS infected individuals with treatment and healthcare.             The decreased access to treatment and healthcare must prompt the design and implementation of strategies for the prevention of HIV/AIDS. This is because better prevention without better treatment would leave millions of HIV-infected adults and children without the alleviation of their suffering and prolongation of their lives made possible by modern medicine, and unless prevention efforts improve, the pandemic will continue to worsen (2002). The most important strategy for the prevention of HIV/AIDS in the African region includes strategies that would emphasize equality between men and women in African societies. Equality between men and women does not only mean equality in terms of decision-making in the family, sexual matters, and marriage, but also involves equal opportunity in terms of work and social status. The “Conscientizing Male Adolescents” program in Nigeria participated in this strategy, by allowing adolescent males to empathize with women’s experiences of patriarchy and by understanding how women are oppressed (2003). In addition, the national Constitution in Cote d’Ivoire has now improved the situation of women, as it stipulates on the equality of both genders (2001). Another useful strategy includes rights to contraception and abortion, which can be employed to protect one’s self, one’s partner, and one’s future children. Recent studies provide a more encouraging picture in terms of women’s ability to influence men’s sense of sexual risk and condom use. One study has shown that married women play an important role in condom use, which depended on the woman’s subjective sense of HIV risk. Some authors have concluded that men’s resistance to condom use can be overcome more easily than has been presumed. This is confirmed by a recent qualitative study in Uganda, among married couples who used condoms consistently for gender-specific reasons, implying that differentiated strategies targeting men and women when promoting dual protection ( 2007).             From this, it can be perceived that the education of both men and women regarding HIV/AIDS is needed. Therefore, strategies in providing sexuality education to many African societies must be evoked in order to allow persons to become aware of the risks in HIV/AIDS acquisition. This must not be focused only with women, but with men as well, as they are said to be one of the factors why women have high risks in acquiring the disease. This also involves combating the issue of violence, which puts women at higher risks. In Senegal, it has been stated that approximately 78% of women are illiterate. This is why it has been proposed that the best way to assist them would be to include functional literacy components in development projects (2001), which would not only empower them as individuals, but also provide them the necessary means to earn money for their families. Most importantly, equity in the health system, regardless of gender or class, must be done in order to provide more preventive measures in the African society. As a response, several African countries like Cameroon, South Africa and Malawi opted to implement medical rationing, which involves policies or practices that balance medical supply and demand by causing patients to forgo medically beneficial treatment within a system of healthcare provision that is collectively financed. This was done by comparing the targets of current national treatment initiatives in Sub-Saharan Africa with the estimated numbers of people in those countries who need AIDS treatment (2006).             However, despite the number of strategies and opportunities open for further increasing HIV/AIDS-related casualties in the African region, a number of obstacles can also be distinguished, being hindrance to implementing such strategies. The primary obstacle is that the implementation of such strategies highly depends on international funding. For example, the U.S. PEPFAR program aims to distribute billion for AIDS prevention, care, and treatment, but it does so unilaterally to only 15 countries, and the choice of countries seems either arbitrary or politically motivated. Another obstacle is the halting in the distribution of antiretroviral drugs, due to patent and approval issues, thus, limiting the number of individuals to be treated in the African region. The third obstacle involves the implementation of policies by the IMF, which hinders the smooth provision of healthcare to HIV/AIDS victims, as economic issues are being raised, thus, complicating the process ( 2006). Obstacles also include an unfair process of considering and providing treatment and care for victims, due to racial, gender, and class discrimination. In this sense, the gender of women, their ignorance, poverty, social status, and traditional beliefs may serve to be significant obstacles for their own treatment and improved welfare.   Conclusion             From the discussion, it can be understood that several factors contribute to the increased risk of African women for acquiring HIV/AIDS. From pointing out the different factors, it can be perceived that gender inequality must be the most important aspect in terms of designing and implementing HIV prevention strategies in developing countries, most especially in the African continent. This is because gender inequality seems to be the root of the many problems that African women face in the African society. Being women, they have the increased opportunity for becoming oppressed due to their low socioeconomic status, ignorance, lack of education, and irrational traditional beliefs, which were handed down to them through their tradition and culture. In this regard, their increased risk of acquiring HIV/AIDS can be blamed for belonging to the female gender. However, blaming a person for becoming a female is sign of idiosyncrasy, which places a certain society or community in danger. This is because they blame a particular effect with the wrong cause. Thus, in this sense, the society would not be able to determine the real causes of problems. Therefore, the essence of this paper is to point out and emphasize that the upsurge of HIV/AIDS cases in African countries indicates the gender inequality that women suffers from. Thus, gender inequality must be initially and primarily be scratched from the list of behaviors of the African society in order to survive.       Credit:ivythesis.typepad.com

Combating Gender Inequality Needs to be at the Heart of HIV Prevention Strategies in Developing Countries

Combating Gender Inequality Needs to be at the Heart of HIV Prevention Strategies in Developing Countries Introduction ...

The impact of HIV/AIDS

The impact of HIV/AIDS. In almost 3 decades nearly 25 million people have died from Acquired Immune Deficiency Syndrome (AIDS).  (Impact of HIV/AIDS. http://www.globalhealth.org/hiv_aids/, retrieved 13 April, 2011)  Human immunodeficiency virus (HIV) is a lentvirus that causes acquired immunodeficiency syndrome (AIDS).  AIDS is a condition in the humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune. The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (prenatal transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world. (HIV.  http://en.wikipedia.org/wiki/HIV, retrieved 13 April, 2011.) “HIV infects primarily vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells.[10] HIV infection leads to low levels of CD4+ T cells through three main mechanisms: First, direct viral killing of infected cells; second, increased rates of apoptosis in infected cells; and third, killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections. Most untreated people infected with HIV-1 eventually develop AIDS.[11] These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[12] HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some will take much longer.[13][14] Treatment with anti-retrovirals increases the life expectancy of people infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with antiretroviral therapy was estimated to be more than 5 years as of 2005.[15] Without antiretroviral therapy, someone who has AIDS typically dies within a year. (HIV.  http://en.wikipedia.org/wiki/HIV, retrieved 13 April, 2011.) HIV/AIDS has complicated the fight against poverty, health improvement and development by the following: <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="line-height: 200%"> 	 	“Diminishing 	a person’s ability to support, work and provide for his or her family. At 	the same time, treatment and health-care costs related to HIV/AIDS consume 	household incomes. The combined effect of reduced income and increased costs 	impoverishes individuals and households. </li> <li class="MsoNormal" style="line-height: 200%"> 	 	Deepening socioeconomic and gender disparities. Women are at high risk of 	infection and have few options for providing for their families. Children 	affected by HIV/AIDS, due to their own infection or parental illness or 	death, are less likely to receive an education, as they leave school to care 	for ailing parents and younger siblings. </li> <li class="MsoNormal" style="line-height: 200%"> 	 	Straining the resources of communities – hospitals, social services, schools 	and businesses. Health care workers, teachers, and business and government 	leaders have been lost to HIV/AIDS. The impact of diminished productivity is 	felt on a national scale. 	(HIV/AIDS.  	 	 	http://www.globalhealth.org/hiv_aids/, 	retrieved 13 April, 2011.)”</li> </ul> The number of people living with HIV continues to rise despite global attention and intervention efforts.  <ul type="disc" style="margin-bottom: 0in"> <li class="MsoNormal" style="line-height: 200%"> 	 	“In 	2008, globally, about 2 million people died of AIDS, 33.4 million were 	living with HIV and 2.7 million people were newly infected with the virus. </li> <li class="MsoNormal" style="line-height: 200%"> 	 	 	HIV infections and AIDS deaths are unevenly distributed geographically and 	the nature of the epidemics vary by region. Epidemics are abating in some 	countries and burgeoning in others. More than 90 percent of people with HIV 	are living in the developing world.3 </li> <li class="MsoNormal" style="line-height: 200%"> 	 	There is growing recognition that the virus does not discriminate by age, 	race, gender, ethnicity, sexual orientation, or socioeconomic status – 	everyone is susceptible. However, certain 	groups are at particular risk of HIV, 	including men who have sex with men (MSM), injecting drug users (IDUs), and 	commercial sex workers (CSWs). </li> <li class="MsoNormal" style="line-height: 200%"> 	 	 	The impact of HIV/AIDS on women and girls has 	been particularly devastating. Women and girls now comprise 50 percent of 	those aged 15 and older living with HIV.1 </li> <li class="MsoNormal" style="line-height: 200%"> 	 	The impact of HIV/AIDS on children and young 	people is 	a severe and growing problem. In 2008, 430,000 children under age 15 were 	infected with HIV and 280,000 died of AIDS.1, 4 In 	addition, about 15 million children have lost one or both parents due to the 	disease.4  </li> <li class="MsoNormal" style="line-height: 200%"> 	 	There are effective prevention 	and treatment interventions, 	as well as efforts to develop new approaches, medications and vaccines. </li> <li class="MsoNormal" style="line-height: 200%"> 	 	The sixth 	Millennium Development Goal (MDG) focuses 	on stopping and reversing the spread of HIV/AIDS by 2015. </li> </ul> Global funding is increasing, but global need is growing even faster – widening the funding gap. Services and funding are disproportionately available in developed countries. (HIV/AIDS.  http://www.globalhealth.org/hiv_aids/, retrieved 13 April, 2011.)”       Credit:ivythesis.typepad.com

The impact of HIV/AIDS

T he impact of HIV/AIDS. In almost 3 decades nearly 25 million people have died from Acquired Immune Deficiency Syndrome (AIDS). (Imp...