PHE1SDH: Social Determinants of Health & HIV/AIDS - USA & Australia

This essay compares and contrasts the impacts of social determinants of health, specifically stigma and discrimination, and social justice, on HIV/AIDS among injecting drug users in the USA and Australia. It highlights the differing rates of HIV/AIDS transmission in both countries and attributes these differences to varying approaches in addressing stigma, discrimination, and social justice issues. The essay discusses how stigma and discrimination affect access to healthcare and adherence to medication, while social justice initiatives, such as safe injection sites and access to sterile equipment, play a crucial role in preventing the spread of HIV. The analysis reveals that Australia's proactive strategies and comprehensive healthcare system contribute to lower HIV infection rates compared to the USA. The essay concludes by recommending the implementation of pre-exposure prophylaxis and harm reduction programs, including free syringe distribution and safe injection sites, in both countries to further mitigate the impact of HIV/AIDS among injecting drug users.

Running head: SOCIAL DETERMINANTS OF HEALTH 1
Social Determinants of Health
Student’s Name
Institutional Affiliation

SOCIAL DETERMINANTS OF HEALTH 2
Compare and contrast the impacts of social determinants of health in the context of
HIV/AIDS using stigma and discrimination and social justice among injecting drug users
of the USA versus Australia.
Introduction
Social determinants of health refer to factors in human economic and social environment
which affect the health status of a person or a group of individuals (Braveman & Gottlieb, 2014).
The social determinants to be discussed are the stigma and discrimination along with social
justice; a vulnerable group is injecting drug users of Australia and USA. The essay will
demonstrate the condition of Human ImmunodeficiencyVirus/Acquired Immune Dsficiency
Syndrome in Australia and USA and compare the impacts of stigma and discrimination together
with social justice on injecting drug users in the context of HIV/AIDS in the two nations.
The use of heroin has increased among women and men in the United States of America
across all income levels and in most age groups which have risen by 63 percent amidst 2000 and
2013. The contributing factor to the increase is the prescription of opioid misuse specifically in
non-urban regions where formerly injecting drugs had not been a substantial problem which
concurs with the rise in hepatitis C infections and the new outbreak of HIV/AIDS. For example,
in 2015 Scott County in Indiana with a population of only 23,744 encountered 181 new HIV
infections (Des Jarlais, 2017). The present statistics between 2008 and 2014 indicate that the
annual number of new HIV/AIDS diagnosis among individuals who inject drugs decreased by 48
percent in the USA.
However, the decline has slowed down, and there are concerns that it may reverse or
stagnant because of the increased levels of injecting. 6 percent of new HIV/AIDS diagnosis in

SOCIAL DETERMINANTS OF HEALTH 3
2015 was characterized by injecting drug use and another 3 percent to male-to-male sexual
contact along with injecting drug use (Spiller et al., 2015). Moreover, of the HIV/AIDS diagnosis
attributed individuals who inject drugs, 41 percent were among women and 59 percent among
men in 2015. When analyzed on ethnicity, 19 percent were among Latino people, 38 percent
African American, and 40 percent among white people.
In Australia, 2 percent of newly diagnosed HIV/AIDS infection cases were attributed to
injecting drug use between 2008 and 2012 which indicates the success of prevention strategy of
HIV/AIDS among individuals who inject drugs (Degenhardt et al., 2017). This success was
supported by the early introduction and maintenance of syringe and needle programs along with
the contribution of peer-based education and drug-user institutions in the avertion of HIV/AIDS.
In 2015, 3 percent of transmissions were attributed to injecting drug use (Degenhardt et al.,
2017). In the period between 2011 and 2015, a higher proportion of notifications of newly
diagnosed HIV/AIDS infection were attributed to injecting drug use with 16 percent among the
Aboriginal and 3 percent among the Torres Strait Islander population (Ward et al., 2014).
Stigma and Discrimination
The impacts of HIV-related stigma and discrimination continue to be a significant barrier
to dealing successfully with the outbreak of HIV in Australia and around the globe (Johannson et
al., 2017). This effect is not only felt by people living with HIV but also has direct repercussions
on the public health retaliation of Australia to the epidemic by undermining avertion, care, and
medication efforts. HIV related stigma and discrimination is a root of substantial harm in the
lives of people resulting in the decline in health and quality of life via shame, anxiety, and

SOCIAL DETERMINANTS OF HEALTH 4
depression along with social isolation (Major, Dovidio, Link & Calabrese, 2017). Also, in
physical health social isolation is correlated with poorer adherence to HIV medication.
In Australia, stigma, and discrimination has been discovered to result in several adverse
health results given the strong association amidst poor health and stress (Wilson, Brener, Mao &
Treloar, 2014). It has been demonstrated to elevate negative health behaviors like smoking and
also it is a significant effect on the willingness of individuals to access general attention.
However, in a study conducted in the USA to assess the relationship between the access to public
care among low-income persons and the discerned stigma from a health care provider showed
that stigma was substantially related to low access to general attention (Chaudoir & Fisher,
2017). This outcome suggested that the perceptions of patients that health care providers attend
to them in a stigmatized and discriminatory way could significantly impact their use of necessary
medical services.
Moreover, fear has been associated with injecting drug users with HIV which impacts the uptake
of HIV medications along with the adherence to HIV medication (Dawson et al., 2018). When
individuals are stigmatized it becomes very hard to present to healthcare facilities for attention
and this fear bars them from engaging with healthcare providers regarding risk behaviors and
even preventing them from adhering to medication (Philbin, Hirsch, Wilson, Ly & Parker, 2018).
These factors, in turn, pose a risk to the public health objectives of reducing the transmission of
HIV/AIDS. For instance, in the USA, higher levels of stigma were related to not taking up HIV
treatment together with lower HIV treatment adherence (Temoshok, 2016).
This unwillingness to involve in medication seems to stem from fears around the
undesirable revalation of one’s HIV status along with subsequent stigma and discrimination

SOCIAL DETERMINANTS OF HEALTH 5
(GaddyNoy & Forstein, 2017). Notably, those injecting drug users with HIV felt that if they were
seen collecting or taking their treatment their HIV status would be disclosed and therefore the
shame of taking the medication in a social setting would contribute to poor treatment adherence
(Ahmed et al., 2018).
Stigma and discrimination are so prevalent in the USA than in Australia. As an
illustration, individuals who live with HIV in the USA do experience denial and termination of
employment, loss of insurance coverage along with social isolation (Freeman et al., 2017). On
the other hand, Australia does provide critical legal protections against discrimination by HIV
status (Delany‐Moretlwe et al., 2015).
Social Justice
My second social determinant of health was social justice. However, social justice is
defined as the equal access to opportunities, wealth and privileges in a society (Bell & Adams,
2016). Considering the vulnerable group as the injecting drug users in the USA, this social
determinant of health has several impacts within the context of HIV/AIDS. To start with, in the
United States of America, the social justice has helped reduce HIV infection by setting aside
save injection sites where there are fewer chances of blood transfusion among the individuals
which might result to HIV infection (Fordham & Haase, 2018). There is also equal consideration
to employment, and therefore individuals are in a position of using drugs with a sterile injection
which they can afford instead of sharing due to poverty (Cloud et al., 2018).
On the other hand, the social justice to the injecting drug users in Australia in the context of HIV
has also had a high impact on the individuals. As an illustration, there has been low HIV
infection among the injecting drug users in Australia. Supply restriction of drugs which is a kind

SOCIAL DETERMINANTS OF HEALTH 6
of regulation of markets is one of the strategies that has helped in Australia. There is a peer-
based organization in Australia which advocates for access to sterile injecting equipment and
funding for peer education (Newland, Newman & Treloar, 2016).
There are also programs that provide readily accessible sterile injecting equipment,
syringe, and needles. In that case, social justice has helped Australia to control HIV infections
among the injecting drug users (Newland, Newman & Treloar, 2016). This is the reason why
Australia has maintained as one of the world’s lowest HIV infection rates among those who
inject drugs (Madden, & Wodak, 2014). Social justice has an extraordinary impact to injecting
drug users in Australia as compared to the USA in the context of HIV/AIDS. This is because
Australia's response to HIV is well regarded internationally and its model has been endorsed by
WHO and hence used in other nations (World Health Organization, 2015).
The international HIV funding from donor governments is contributed via multilateral
along with bilateral channels. PEPFAR is among the bilateral funding sources committed by the
government of USA to handle the world wide HIV/AIDS outbreak (Dieleman et al., 2015). On
the other hand, Australia provide most of their HIV/AIDS funding via multilateral channels
which may include UNITAD, Global Fund together with other United Nations agencies (Kates,
Wexler, Lief & Joint United Nations Programme on HIV/AIDS, 2017).
Recommendations
I would recommend the injecting drug users both in Australia and USA to use
preexposure prophylaxis for the avertion of HIV infection. Accordingly, programs, such as
giving out injecting equipment such as syringes for free should be encouraged in both nations
since some does not afford to buy such materials and if they end up sharing, then it can result to

SOCIAL DETERMINANTS OF HEALTH 7
HIV infection (Green et al., 2017). Accordingly, save injecting sites should be increased where
every drug user can access easily.
Conclusion
In summary, stigma and discrimination along with social justice are crucial social
determinants of health to injecting drug users in the context of HIV. Stigma and discrimination
usually discourage individuals from taking medication which makes their situations to worsen.
Accordingly, social justice typically helps prevent the spread by the provision of resources such
as equipment, fundings along with programs which happens to be educative. Therefore, the HIV
prevention and harm reduction programs for injecting drug users should also highlight drug use
stigma.

SOCIAL DETERMINANTS OF HEALTH 8
References
Ahmed, S., Autrey, J., Katz, I. T., Fox, M. P., Rosen, S., Onoya, D., ... & Bor, J. (2018). Why do
people living with HIV not initiate treatment? A systematic review of qualitative
evidence from low-and middle-income countries. Social Science & Medicine.
Bell, L. A., & Adams, M. (2016). Theoretical foundations for social justice education.
In Teaching for diversity and social justice (pp. 21-44). Routledge.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the
causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Chaudoir, S. R., & Fisher, J. D. (2017). Stigma and the “Social Epidemic” of HIV:
Understanding Bidirectional Mechanisms of Risk and Resilience. The Oxford Handbook
of Stigma, Discrimination, and Health, 457.
Cloud, D. H., Castillo, T., Brinkley-Rubinstein, L., Dubey, M., & Childs, R. (2018). Syringe
Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm
Reduction Coalition. Current HIV/AIDS Reports, 1-7.
Dawson, L., Strathdee, S. A., London, A. J., Lancaster, K. E., Klitzman, R., Hoffman, I., ... &
Sugarman, J. (2018). Addressing ethical challenges in HIV prevention research with
people who inject drugs. Journal of medical ethics, 44(3), 149-158.
Degenhardt, L., Peacock, A., Colledge, S., Leung, J., Grebely, J., Vickerman, P., ... & Lynskey,
M. (2017). Global prevalence of injecting drug use and sociodemographic characteristics
and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage
systematic review. The Lancet Global Health, 5(12), e1192-e1207.

SOCIAL DETERMINANTS OF HEALTH 9
Delany‐Moretlwe, S., Cowan, F. M., Busza, J., Bolton‐Moore, C., Kelley, K., & Fairlie, L.
(2015). Providing comprehensive health services for young key populations: needs,
barriers and gaps. Journal of the International AIDS Society, 18, 19833.
Des Jarlais, D. C. (2017). Harm reduction in the USA: the research perspective and an archive to
David Purchase. Harm reduction journal, 14(1), 51.
Dieleman, J. L., Graves, C., Johnson, E., Templin, T., Birger, M., Hamavid, H., ... & Murray, C.
J. (2015). Sources and focus of health development assistance, 1990–
2014. Jama, 313(23), 2359-2368.
Fordham, A., & Haase, H. (2018). The 2016 UNGASS on Drugs: A Catalyst for the Drug Policy
Reform Movement. In Collapse of the Global Order on Drugs: From UNGASS 2016 to
Review 2019 (pp. 21-47). Emerald Publishing Limited.
Freeman, R., Gwadz, M. V., Silverman, E., Kutnick, A., Leonard, N. R., Ritchie, A. S., ... &
Martinez, B. Y. (2017). Critical race theory as a tool for understanding poor engagement
along the HIV care continuum among African American/Black and Hispanic persons
living with HIV in the United States: a qualitative exploration. International journal for
equity in health, 16(1), 54.
GaddyNoy, F. A. S., & Forstein, M. (2017). HIV AND AIDS IN THE
AMERICAS. Comprehensive Textbook of AIDS Psychiatry: A Paradigm for Integrated
Care.
Green, T. C., Case, P., Fiske, H., Baird, J., Cabral, S., Burstein, D., ... & Bratberg, J. (2017).
Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and

SOCIAL DETERMINANTS OF HEALTH 10
pharmacists on pharmacy-based naloxone in 2 states. Journal of the American
Pharmacists Association, 57(2), S19-S27.
Johannson, A., Vorobjov, S., Heimer, R., Dovidio, J. F., & Uusküla, A. (2017). The role of
internalized stigma in the disclosure of injecting drug use among people who inject drugs
and self-report as HIV-positive in Kohtla-Järve, Estonia. AIDS and Behavior, 21(4),
1034-1043.
Kates, J., Wexler, A., Lief, E., & Joint United Nations Programme on HIV/AIDS. (2017). Donor
government funding for HIV in low-and middle-income countries in 2016. The Henry J
Kaiser Family Foundation, Menlo Park.
Madden, A., & Wodak, A. (2014). Australia's response to HIV among people who inject
drugs. AIDS Education and Prevention, 26(3), 234-244.
Major, B., Dovidio, J. F., Link, B. G., & Calabrese, S. K. (2017). 1 Stigma and Its Implications
for Health: Introduction and Overview. The Oxford Handbook of Stigma, Discrimination,
and Health, 3.
Newland, J., Newman, C., & Treloar, C. (2016). “We get by with a little help from our friends”:
Small-scale informal and large-scale formal peer distribution networks of sterile injecting
equipment in Australia. International Journal of Drug Policy, 34, 65-71.
Philbin, M. M., Hirsch, J. S., Wilson, P. A., Ly, A. T., & Parker, R. G. (2018). Structural barriers
to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity,
stigma, and healthcare access. PloS one, 13(4), e0195000.

SOCIAL DETERMINANTS OF HEALTH 11
Spiller, M. W., Broz, D., Wejnert, C., Nerlander, L., & Paz-Bailey, G. (2015). HIV infection and
HIV-associated behaviors among persons who inject drugs--20 cities, United States,
2012. MMWR. Morbidity and mortality weekly report, 64(10), 270-275.
Temoshok, L. (2016). Adherence to Antiretroviral Therapy among Patients Attending an Inner-
City HIV Primary Care Clinic: Non-obvious Factors are Most Important. J Hum Virol
Retrovirol, 4(1), 00121.
Ward, J., Costello-Czok, M., Willis, J., Saunders, M., & Shannon, C. (2014). So far, so good:
Maintenance of prevention is required to stem HIV incidence in Aboriginal and Torres
Strait Islander communities in Australia. AIDS education and prevention, 26(3), 267-279.
Wilson, H., Brener, L., Mao, L., & Treloar, C. (2014). Perceived discrimination and injecting
risk among people who inject drugs attending Needle and Syringe Programmes in
Sydney, Australia. Drug and Alcohol Dependence, 144, 274-278.
World Health Organization. (2015). The Selection and Use of Essential Medicines: Report of the
WHO Expert Committee, 2015 (including the 19th WHO Model List of Essential
Medicines and the 5th WHO Model List of Essential Medicines for Children) (No. 994).
World Health Organization.