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Social Determinants Of Health – Gender, Stigmatism And Discrimination Of Women In Swaziland Vs. Australia

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Introduction

This essay will explore the impacts of the social determinants of health in the context of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS), comparing the impacts of gender, stigmatism and discrimination of women in Swaziland vs. Australia. HIV is a virus that causes AIDS by damaging the immune system making the host more vulnerable to disease and infections. It is expected that around, 0. 14% of the adult population in Australia is living with HIV/Aids (HIV in Australia: 2017, 2017). Aboriginal and Torres Strait Islanders (ATSI) represent 3% of the Australian population (University of New South Wales, 2016) With roughly 0. 11% of the indigenous ATSI populations living with HIV/Aids (HIV in Australia: 2017, 2017), of which 24% infected are women (University of New South Wales, 2016).

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According to the Joint United Nations Programme on HIV/ AIDS 2008 report, there 130,000 women infected with HIV living in Swaziland, it is also stated that Swaziland has the highest HIV prevalence rate in the world despite its small population size, with a population of 1. 17 million people, it is estimated that 210,000 are living with HIV (Unaids, 2018). This vast health gap has been connected to poverty which indicates to a lack of local medical care and health awareness and disease prevention services. The fact that in wealthy countries such as Australia, indigenous people are experiencing considerable discrepancies in HIV/Aids infections, are indicative that there are social factors involved. There needs to be an increase in awareness of these severe and complex issues by a larger spectrum including training, involvement of communities and empowerment women of Swaziland and ATSI women to overcoming these challenges and obstacles.

HIV/AIDS and women Swaziland Vs. Australia – the situation

Women of Swaziland and ATSI women are becoming increasingly affected by HIV. The primary mode of exposure for ATSI women is through intercourse and intravenous drug use with a 3% to 16% rise between 2011 and 2015 (HIV statistics in Australia, 2016). 34. 7% of Swazi women are living with HIV with the leading causes being intercourse and mother to child transmission (MTCT), HIV occurrence among pregnant woman increased from 4% to 41% between 1999 and 2010 (Swaziland Ministry of Health, 2014). It is estimated in 2105 that the life expectancy is 31 years for women of Swaziland with adolescent girls and young women particularly affected by (Whiteside and Whalley 2007). While ATSI women have almost four times the diagnosis rate of white Australian women (HIV statistics in Australia, 2016).

Social determinant – Impact of Stigma and Discrimination

ATSI and women of Swaziland suffering from HIV/AIDS are particularly impacted by stigma, unequal opportunities, discrimination along with many other factors and health determinants. One of the paramount social determinants of health surrounding HIV/AIDS is stigma and the absence of conversation connected with it. Stigma associated with HIV and AIDS averts many women from being tested for HIV or disclosing their HIV status. HIV is viewed to be linked with sexual promiscuity, and often causes HIV-positive people to be excluded from family settings. The 2011 Stigma and Discrimination Index found self-stigma among people living with HIV remains high while the results of a word-wide survey stated that over half reported discriminatory attitudes towards people with HIV (“HIV Stigma and Discrimination”, 2017). Women living in Swaziland are unable to own property or inherit goods, they also have a very limited choice in marital partners, and physical and sexual abuse of women is not uncommon which leads for the women to be marked as unfaithful and rejected, causing financial hardships which often leads the women to having intercourse with me 10 years or so older than they are for financial support (Swaziland Ministry of Health, 2014).

Contrariwise, ATSI women do not have this problem as the Australian Government provides financial support for those affected with HIV. However, discrimination may be associated with stigma attached to being an HIV positive woman in Australia, as they are more likely to have contracted HIV through intravenous drug use, which is a factor that is associated with stigma. Although it is noted, that a third of ATSI women whom are recently diagnosed with HIV are likely to have contracted the infection for at least 4 years previously. A delay in testing can lead to higher mortality rates and contributes to poorer health outcomes (Negin, Aspin, Gadsden & Reading, 2015). The responses to HIV/AIDS in Australian societies have changed dramatically since its emergence in the early 1980’s; Australian society was prevalent with prejudice and prevalent stigma (Robinson, 2017). Although in present times, the nationwide response is where the difference in approaches from both countries to HIV/AIDS differs among indigenous and Swaziland women.

In Australia, there has been focus on improving safer injecting practises for ATSI women through introducing needle programs with community based health services. These programs attempt to reduce stigma, discrimination and shame while reducing socio-economic and physical barriers. Sex educations in schools with the focus being safer sexual practises have also been introduced and condoms are being made accessible to ATSI populations. Whilst HIV/AIDS is still such a large issue in Swaziland however the President’s Emergency Plan For AIDS Relief (PEPFAR) is the main supporter of prevention programming including condom supply and distribution followed by the Swaziland government and other resources attempting to aid in the crisis (Swaziland Ministry of Health, 2014).

Social determinant – Gender

Increased vulnerability of women in Swaziland to HIV stems from gender inequality within the society of Swaziland. Women are often viewed as secondary to men and gender-based violence is prevalent with 1 out of 3 women report experiencing some form of sexual abuse by the time they are 18 (Women together et al, 2004) As is levels of men engaged in multi-concurrent partnerships. Recent data from 2010 show that 2. 7% of women had more than one sexual partner in the last year, while this figure stood at 16% for men. Swaziland is a male-controlled society with great levels of gender inequality. A women’s reproductive and sexual health are often dictated by men and as is child marriage and polygamy (yang et al, 2007). Due to the subordinate status of women, this places them at an increased risk of sexual violence and health information and the ability to access to education. ATSI do not seem to have the same gender problems as the women of Swaziland to an extent however ATSI Women reported higher rates of discrimination at health services than men, in 2001, 58. 1% of women reported having ever had experienced a feeling of discrimination in compared with 35. 9% of men hence making treatment seeking low (Swaziland Ministry of Health, 2014).

Recommendations:

Both countries need to address many of the social and cultural factors that hinder the response such as poverty, living environments, economics, gender inequality and risky cultural practices whilst imploring greater focus on improving access to HIV testing facilities and medical services. Better education and health promotions and funding may also aid in the underlying issues. Conclusion: Indigenous female Australians and women of Swaziland share the same trait in which their initial means of contracting HIV/AIDS is mainly through sexual intercourse; however ATSI women’s rates of contracting HIV/AIDS are higher in intravenous drug use whilst mother to child transmission is much higher for the women of Swaziland. Equally vulnerable groups are over represented and becoming increasingly affected with HIV/AIDS. Social determinants of health factor heavily in the origins, foundation, development and ability to overcome such illnesses. Stigma and discrimination leads to a reduce willingness to seek any form of assistance and Low incomes and poor education often impact on healthy sex choices or drug use. Gender, stigma and discrimination as social determinants will have profound and ongoing impact on the health outcomes of HIV/AIDS affected women living in Swaziland and ATSI women.

The Australian government and the Swaziland government have differing approaches concerning the matter. Australia now mainly focuses on safer injecting practices and programs to reduce stigma and promote safe sex through community, health promotion and education along with regular HIV testing and supplying condoms, or formal monitoring structures. Whereas Swaziland still has a long way to go as the prevalence of HIV/AIDS is still extremely high among the country, PEPFAR is the largest contributor of funding for Swaziland’s HIV response, followed by the Swaziland government, PEPFAR is the main supporter of prevention programming including condom supply and distribution. domestic funding has been granted to covered the supply of antiretrovirals and HIV test kits.

18 May 2020

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