The acquired immunodeficiency syndrome (AIDS) is caused by Human Immunodeficiency virus (HIV). It was first reported in 1981, and statistics show that by the end of 2009, 33.3 million people were infected with HIV worldwide. There are about 2.6 million new HIV infections and 1.8million AIDS deaths every year. The worst affected region is sub-Saharan Africa where some countries have an infection rate of 1 in every 6 adults. The epidemic is spreading most rapidly through Central Asia and Eastern Europe, and these regions have seen a 54.2 % increase in the number of HIV patients between 2001 and 2009. Globally AIDS has become a pandemic, and as such there is widespread debate on how to deal with it effectively.
AIDS has no known cure up to date, and the best form of management at the moment is the use of antiretroviral drugs, which prolong the life of the patient, and enable him/her to live positively with the disease. There is a lot of funding going into the fight against HIV/AIDS and the stakeholders differ on the best way to utilize those funds. There have been many advances in modern medicine, and the biggest challenge now is which areas of research to emphasize on in order to solve the HIV/AIDS menace.
Thomas McKeown in his book “The Role of Medicine” kicked up a huge debate in the medical world that continues up to today. He studied the population of the industrialized nations and postulated that the rapid growth from the late 1700s to the present was not as a result of advances in the field of medicine. Instead, he attributed the growth to overall improvement in living standards, especially nutrition, resulting from better economic conditions (1979). His analysis challenged the common public health measures like vaccination and quarantine. The thesis drew sharp criticism from several quarters but seems to hold true in some cases. It has stirred debate over the appropriate allocation of medical resources and the relevant areas of focus. In relation to HIV/AIDS, a lot of resources have gone into the search for a cure or vaccine with very little success. The best results so far come from antiretroviral drugs, which are used only for management. Should we adopt McKeown’s thinking and channel more resources elsewhere? The leading mode of transmission of HIV/AIDS is heterosexual intercourse. More focus on prevention would mean educating the public on responsible sexual behavior and provision of condoms for protection. This may not be widely acceptable since institutions like the Catholic Church believe the use of condoms encourages sexual immorality in the first place. Other church-based organizations in the United States that provide aid to African countries are also not keen on the use of condoms. Yet condoms have proven to be very effective in preventing the spread of the disease. McKeon’s approach also leaves out those who are already infected. These people need treatment which can only come from medical research.
Since the disease is most prevalent amongst the poor, should more effort be put in empowering them economically as a long term measure to curbing the menace? As McKeown would want as to believe, economic empowerment would lead to better education and improved standards of living. Would these be sufficient in stopping the epidemic? I do not think so. So far HIV/AIDS spreads even amongst those who are well-informed and live good lives. The best course of action is still more investment in the field of medical research. The virus mutates constantly and incorporates itself into human DNA to facilitate its continued survival. This has made it difficult to come up with a vaccine or cure. Scientists are trying various approaches and making slow but significant improvements. The virus also seems to affect people differently. Some people known as carriers are able to continue living normally with the virus in their bodies. Studies on how these people are able to survive should be emphasized to give us an insight into how the body can fight the disease. There is also a small group of people who seem immune to the virus despite constant exposure. Examples include commercial sex-workers in the slums of Nairobi, Kenya, who despite constant exposure to the virus, have not been infected. It would be very important if scientists were able to understand fully what gives them this vital protection, and how it can be applied to others. When it comes to the fight against HIV/AIDS, McKeown’s approach is not the answer. Instead, more effort and resources need to be focused on medical research.
Stanley Joel Reiser has extensively studied how technology affects the delivery of medical services in the United States. He holds the view that technology and specialization are eroding the diagnostic skills of physicians. I am of the opinion that technology and specialization have enhanced the physicians’ ability to diagnose diseases. Special techniques like Magnetic Resonance Imaging (MRI) have enabled doctors to do quick diagnoses without invading the body of the patient. Technology helps save time which is vital in handling some diseases which can cause extensive damage and even death if not caught early. Many procedures have been simplified, and as a result, the patient suffers less pain and fewer procedures. Modern technology allows for preventive measures to be taken in some areas instead of waiting for the disease to manifest first. Many patients nowadays are able to live normal, productive lives with conditions like diabetes and cancer thanks to advances in modern medicine. Reiser claims that “In modern medicine we always treat the disease fully and the patient partially.” He says that modern doctors have become “geographers” who explore the body seeking particular areas with evidence of disease. Modern tools and procedures have enabled doctors to zero in on the specific location of the disease and concentrate there while ignoring the patient as a whole (1981). Reiser proposes an alternative approach that looks at illness as interaction between the patient and his/her environment- both home and the work place. He stresses that each individual responds in a unique way to a particular disease in relation to several factors like the daily stresses of work, school and family.
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Reiser’s views are very applicable in the management of HIV/AIDS. The infection weakens the body’s immune system, making it susceptible to opportunistic infections and diseases of several different organs. As a result, a specialist may not be the best healthcare giver since there will be pathology affecting other organs not within his/her specialty. There are also several human factors like poverty and illiteracy which affect the patients’ response to any intervention measures. The physician must consider the patient as a whole and take into consideration any other factors that may affect the patient’s well being. Rothman and Barber point out that the modern doctor has become insensitive to his/her patients (1991). The situation is mainly due to external factors, most of which are out of the doctors’ control. Most of the health policies are formulated at levels high above the doctors, and what is left of them is to follow the given guidelines. In the public health sector, sometimes the doctor to patient ratio is very high, and doctors have very little time per patient. Shilts is right to point out that the individuals dominating medical research pay more attention to acquiring funds rather than alleviating human suffering. It should be noted that there are those who finance medical research as an investment and are hoping to reap the rewards later. That is why they sometimes influence policy in ways that may not be friendly to patients in the long run. Most of these investors are not medical practitioners yet the decisions they make are usually blamed on the doctors on the ground. Most medical research institutions also rely on grants from the government, and as such, they have to follow the policies laid down by the government departments concerned.
The HIV/AIDS pandemic has elicited a lot of debate that attracts many stakeholders from various sectors. Opinions vary widely on how to handle the situation in the best way. Some people blame the multinational companies for not doing enough to come up with a cure or vaccine. The companies on their part point out that research is expensive and time consuming hence the need to concentrate on viable areas. With HIV/AIDS such a sensitive issue, even if a company were to come up with a cure they would certainly not recoup the costs of production; leave alone make any profit from it. There would be public pressure to have them avail the drugs for free or cheaply especially to the third world. Many generics would also be quickly licensed to make the drug affordable to the poor masses most affected by the disease. Medical practitioners feel that their field is being invaded by other professionals who are increasingly playing major roles in policy formulations and health sector regulations. We are seeing a situation in which physicians are losing control of their field, yet they are the ones who bear the blame when things go wrong. The HIV/AIDS epidemic could have been handled well if it were treated primarily as a medical issue and doctors left to do their work. Instead, it has become a social issue that is now handled by non-medical professionals. Increased funding in medical research is the key to solving the problem in the long run because after all once the illness can be cured, all the social issue related to it will no longer arise. Of course, this does not mean ruling out other vital measures like public health education and the preventive measures like the use of condoms.
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