Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Thursday, December 13, 2007

Unite for Children, Unite for AIDS: Campaign Fails by Same Mistakes as Previous Campaigns-Trudy Ann Spencer

Everyday, thousands of public health professionals come up with interventions to solve health issues that affect the public. These issues range from chronic diseases to infectious diseases. Among these maladies is AIDS, a fatal disease that has a significant impact on the public. In the United States alone 15,000 infants were infected with HIV through mother-to-child transmission between 1978 and 1994 (1). According to UNAIDS (The Joint United Nations Programme on HIV/AIDS) worldwide statistics, an estimated 2.5 million children under 15 were living with HIV/AIDS at the end of 2003. Approximately 500,000 children under 15 had died from the virus or associated causes in that year alone (2). The US Bureau of the Census estimated that by the end of 2000, 15.6 million children around the world would have lost a mother or both parents to AIDS. By 2010, the number of orphaned children is estimated to rise to 44 million (3). Not only do children have to deal with the infection, many of them are forced to deal with the stigma and discrimination associated with the disease. These two factors contribute heavily to the emotional toll of AIDS because society usually keeps its distance from victims for fear of infection (4). The harsh environment in which these children victims live in has led UNICEF to initiate the launching of the worldwide campaign “Unite for Children, Unite for AIDS” (5).
Unite for Children, Unite for AIDS, a project of the United Nations Children’s Fund is a 5 year campaign. Overall, the project is geared towards making the global community aware about the pandemic and how it affects children, as well as stimulate political support towards addressing the problem(6). In attempting to make a real difference in the lives and life chances of children affected by HIV/AIDS, the campaign set up a child-focused framework around the “Four Ps”: preventing mother-to-child HIV transmission by providing antiretroviral drugs to HIV positive mothers, making testing more widely available, encouraging voluntary testing, and providing counseling for children and mothers. In addition, the campaign seeks to prevent infection among adolescents by increasing access and encouraging the use of gender sensitive prevention information and services. The campaign also provides pediatric treatment, protect an support children affected by HIV/AIDS. Furthermore, the campaign sets the stage for child-focused advocacy on global AIDS issues, and places children affected by AIDS at the center of the HIV/AIDS agenda. These goals set by the UNICEF campaign are both noble and noteworthy, yet lack the ability to fully cater to the intended beneficiaries. Despite the campaign’s efforts, Unite for Children, Unite for AIDS fails to take into account the sociocultural and economic factors that affect the HIV/AIDS victims.
Campaign Underestimates The Stigma Associated With HIV/AIDS Victims
“In 1999, nearly 1 in 5 American adults surveyed, said they “feared” persons with AIDS. One in 6 admitted to feelings of “disgust” related to persons with AIDS” (7). HIV/AIDS patients are aware that other individuals within the community harbor repulsive feelings toward them and their condition, and are emotionally affected by this stigma. Most victims fear losing ties with their family, friends, and loved ones. As a result, individuals suffering from the disease are willing to avoid diagnosis and treatment in order to keep their family ties intact. For example, the campaign makes antiretroviral drugs available to the HIV infected mothers. The effort does not however, account for the stigma, and infected mothers are likely to be humiliated by their situation and shy away from treatment altogether. Since these mothers are not willing to receive treatment and the campaign does not create other initiatives, simply providing the antiretroviral drugs is insufficient.
The campaign does not take into account that individuals act on impulses that are shaped by their surroundings. In other words, an HIV/AIDS patient’s social environment (peers), and perception of the environment has a great effect on his/her behavior. This idea is supported by the social cognitive theory, which focuses on the interaction between individuals and their immediate environment. The theory explains that people choose to carry out a certain behavior because of the influence of their environment. Social cognitive theory has two basic factors namely, the internal and external. The internal factor focuses on the individual’s self efficacy, behavioral capabilities, expectations, and emotional coping ability (8). On the other hand the external factor constitutes the social and physical that surrounds and influences the individual (9). In accordance with this theory, mother-to-child HIV transmissions will continue to prevail in affected societies, as long as the campaign continues to underestimate the stigma that plagues the victims.

Campaign Assumes That Intention Leads To Behavior
The campaign focuses on providing basic sex education courses to adolescents. However, simply trying to educate teens is not the most effective way to decrease HIV incidence. When faced with the decision to engage in sexual activity, teens may not adhere to information they learned during sex education. Moreover, teens are also vulnerable to peer pressure, and are likely to be influenced into making unwise decisions despite education efforts. While sitting in a sex education class, it is easier for adolescents to imagine themselves using protection during sexual activity. However statistics show that this intention does not always lead to. In a study maintained by Congress, teenagers who were sexually active reported having had sex for the first time when they were 15 years old. More than one-third of both groups had two or more sexual partners, the study found. Twenty-three percent of both groups reported having had sex and always using a condom; 17% of both groups reported having had sex and only sometimes using a condom; and 4% of the students in both groups reported having had sex and never using a condom, according to the report” (10). While the campaign provides the basic education it fails to consider the sexual reality most teens face, and that sex education can only do so much for the youth.
The health belief model states that there are four main components that influence behavior. The model states that the individual will weigh the perceived susceptibility and severity versus the perceived cost of an action. If the perceived susceptibility and severity out weighs the cost, the individual will have the intention to act, and the intention will fuel the action. However, the aforementioned statistics disproves this theory because intentions do not always lead to action. Adolescents may intend to practice safer sex, but may not always do so due to external factors such as peer pressure from their partner. The argument that a link between intention and action exists is invalid, and the campaign needs to be aware of that.

Campaign Does Not Provide Free Antiretroviral Drugs

Unite for Children, Unite for AIDS provides pediatric treatment to children affected by HIV/AIDS. This treatment, however, is at an “affordable” cost and is not free to the victims (11). The majority of the AIDS/ HIV victims live in poverty-stricken regions where they can barely afford the drugs, even at a low affordable cost. In her article The Scandals of Poor People’s Diseases, Tina Rosenberg affirms that poor people and poor countries have no hope of buying them [antiretroviral drugs] (12). The campaign needs to realize that an affordable drug is not sufficient to help these individuals in poor communities, and needs to determine new ways of providing these important drugs for free.
It is hard to imagine how a Rwandan woman with AIDS might be considered lucky, but in a way, she is…Poor countries like Rwanda are scrambling to provide free treatment to all who need it. ” (13) The Medecins Sans Frontieres, also known as Doctors Without Borders were able to successfully treat underprivileged and low income individuals with AIDS through their Triple Therapy Program. A key component of their program was to offer free anonymous treatment to patients (14). Undoubtedly, having individuals seek medical care anonymously and free of charge is a better solution that Unite for Children, Unite for AIDS should adopt over their current program.

The Unite for Children, Unite for AIDS campaign may have great intentions. However, they fall short of realizing how stigma has a behavioral affect on HIV/AIDS victims. In order for the campaign to reduce the incidence of HIV, it is vital that they understand what a profound effect stigma can have on an individual and his behavior. A stigma associated with HIV/AIDS alone can cause an individual to refrain from receiving treatment. The campaign also fails to learn from the mistakes of the health belief model by ignoring the notion that intentions do not always leads to behavior. In addition, Unite for Children, Unite for AIDS is unaware of the importance of free antiretroviral drugs. Providing free antiretroviral drugs to patients will dissolve the economic boundary that causes individuals to not seek treatment.
An ideal intervention would take the sociocultural and economic factors into account. It would direct its focus and resources into ensuring that society does not condemn and fear HIV/AIDS patients. Addressing this issue would make it easier for mothers to seek treatment so as to prevent mother-to-child transmission of the disease. Furthermore, the campaign should create programs that would make the patient comfortable when visiting the health facility without having to worry about any stigmas. Clients are more likely to seek and follow through with HIV testing services if the perception is that it is non-threatening, nonjudgmental, and responsive to their individual needs and circumstances (15). If Unite for Children, Unite for Aids adopted the above initiatives, the campaign will be more successful in preventing new incidence of HIV/AIDS in children.

1.Vazquez E. Disturbing HIV stats for young men. Posit Aware. 1996 Jan-Feb;7(1):9
2. National Insitute of Allergy and Infectious Diseases. National Insitute of Health. U.S. Department of Health and Human Services. HIV Infection in Infants and Children 2004.
3.Gilborn, Laelia Zoe. Beyond our Borders: The effects of HIV infection and AIDS on children in Africa. West J med. 2002 January; 176(1): 12-14
4. Gilborn, Laelia Zoe. Beyond our Borders: The effects of HIV infection and AIDS on children in Africa. West J med. 2002 January; 176(1): 12-14
5. UNICEF- Unite for Chrildren, Unite for Aids,
6. UNICEF- Unite for Chrildren, Unite for Aids,
7. Freking, Kevin. Sex-ed approach is faulted in study Abstinence classes don’t stop youths. Associated Press, April 14, 2007
8. UNICEF- Unite for Chrildren, Unite for Aids,
9. Freking, Kevin. Sex-ed approach is faulted in study Abstinence classes don’t stop youths. Associated Press, April 14, 2007
10. Freking, Kevin. Sex-ed approach is faulted in study Abstinence classes don’t stop youths. Associated Press, April 14, 2007
11. Rosenberg, Tina, The Scandal of ‘Poor People’s Diseases’. New York Times, March 29, 2006.
12. Rosenberg, Tina, The Scandal of ‘Poor People’s Diseases’. New York Times, March 29, 2006
13. Rosenberg, Tina, The Scandal of ‘Poor People’s Diseases’. New York Times, March 29, 2006
14. Doctor’s Without Borders. Triple Threat Campaign .
15. Gilborn, Laelia Zoe. Beyond our Borders: The effects of HIV infection and AIDS on children in Africa. West J med. 2002 January; 176(1): 12-14

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