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And The Band Played On

And, The Band Played On

  1. Based on what you observed in the film or read in the book; clearly articulate and delineate at least three of the sociopolitical factors that influenced public health policy development for HIV/AIDS prevention and control in the United States. Then discuss separately each of the three sociopolitical factors.

The three key socio-political factors that informed policy development for HIV were homosexuality stigma, competing political priorities, and competing economic interests.

Homosexuality stigma and stereotypes were one of the greatest socio-political influences. Homosexuality or its public expression was unacceptable and was also imbued in the political climate of the time. In the film, Dr. Jim Curran, who led the Sexually Transmitted Diseases branch of the Centers for Disease Control and Prevention (CDC), withheld his findings regarding the patterns of spread of HIV from the public for fear of reduced funding (Pillsbury & Spottiswoode, 1993). This indicates that homosexuality stigma and its political ramifications were a major influence in the expansion of HIV research and prevention efforts.

Competing political priorities also had a major influence on HIV policy development. The prevailing global political climate in the US in the 1980s made the department of defense a significant political priority in terms of the federal budget. One of the scenes indicated that President Ronald Reagan would consider cutting the public health budget to increase funding for the Department of Defense (Pillsbury & Spottiswoode, 1993). This is ironic, considering that the virus had hit epidemic proportions at the time.

The best example of the role of competing economic interests in HIV policy development was in establishing policies for testing blood and blood products following the discovery of HIV in hemophiliacs. Individuals in the blood products industry were hesitant to allow mast testing of blood products even though the CDC had devised a test that would be 88% efficient in this regard (Pillsbury & Spottiswoode, 1993). According to the opposers of this policy, a few HIV-infected hemophiliacs was a huge price to pay for the millions of dollars that would be lost following the roll-out of this policy.

  1. How were early victims and contacts identified and located?

Contact tracing was designed to target individuals who had experienced “mysterious deaths” using a retrospective approach. Individuals who succumbed to infections that were known to be non-fatal were investigated, and their contacts trailed. This was also done for individuals who were previously free of any medical illness but became sick due to suspected opportunistic infections such as pneumocystis. In the majority of the early contact tracing effort, the endpoint was considered a homosexual individual.

  1. Select an epidemiological model. Apply events in the video to components of the epidemiological model.

A suitable epidemiological model for HIV based on the events in the film is the SIR model with vital dynamics. In the model, individuals who become infected remain with the infection for more than 10 to 20 years. ‘S’ represents individuals susceptible to the infection, ‘I’ represents those infected, and ‘R’ represents individuals who became infected and died. Additionally, individuals who are born provide a new pool of susceptible people. In the events in the film, HIV is assumed to pass from one person to another via sexual transmission and blood contact, such as the hemophiliacs in the film. Individuals infected with the virus leave this status only when they die since the infection is incurable and comprises mainly gay individuals in the film. Similarly, uninfected individuals are at risk of infection because infected individuals are asymptomatic. The R category in the film includes individuals who have died from the viral infection or are too debilitated to transmit it sexually.

  1. What was your overall reaction after viewing this film/reading this book with respect to the impact on the health care system in the United States?

The most important highlight of this film was the role of the U.S. healthcare system in the wider healthcare inequalities. Although social and economic disparities are inherent in society, the political and health systems are significantly culpable in the ramifications of these inequalities on access to health care. In the film, although the sexually transmitted nature of the virus was eventually discovered, the initial association of the infection with a sexual minority status allowed a large proportion of the homosexual population group to become infected when they could have benefited from more early efforts to elucidate the epidemiological dynamics of HIV. Clearly, there is a shortage of measures in place to ensure that every U.S. citizen has the opportunity to attain the highest level of health. More importantly, measures are required to limit the political influence on the health sector.

  1. Compare the historical perspectives of the emergence of HIV with the current HIV Situation in the US.

Compared to the historical perspective surrounding the emergence of HIV, the virus is given greater attention from a healthcare policy perspective. When the viral infection emerged, the efforts to contain it received little or negligible federal support. In the film, Dr. Don lacked the funding to procure equipment such as microscopes to engage in research to understand the virus. The infection was labeled Gay-Related Immune Deficiency (GRID) by many health providers. Additionally, public health experienced a budget cut, with the bulk of the budget channeled to the department of defense. In contrast, public health efforts to contain the virus are currently robust. A significant amount of funding is committed to supporting population-level mass testing for individuals to know their status, enroll infected individuals in treatment programs, trace contacts, and enhance treatment adherence.

  1. Define ‘vulnerable population’ and identify the vulnerable population in this film.

A vulnerable population refers to a category of individuals who are socially, economically, or politically disadvantaged, which puts them at a greater risk of poor health. The vulnerable population in this film is homosexual men. Since the majority of individuals who initially contracted the virus were homosexual men, the infection was initially treated with stigma as a consequence of the perceived promiscuity of these individuals. This attitude resulted in sluggish efforts to intervene in order to characterize the infection, causing the infection to spread significantly in this population group. Additionally, while an effective initial containment measure would have been to shut down bathhouses, this decision was avoided in order to protect the financial interests of individuals who benefited from the business. Vulnerable populations still exist today, including ethno-racial minority groups such as African Americans, who report high morbidity and mortality rates from non-communicable diseases due to limited access to healthcare driven by systemic racism.

Reference

Pillsbury, S., Sanford, M. (Producers), & Spottiswoode, R. (Director). (1993). And the band played on [Motion picture]. USA: HBO Pictures, Spelling Entertainment.

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Question 


And, The Band Played On

Directions

View the video or read the book, And, The Band Played On. Respond to the following essay questions. Use the rubric to be certain that you are include all pertinent information.

And The Band Played On

And The Band Played On

  1. Based on what you observed in the film or read in the book; clearly articulate and delineate at least three of the sociopolitical factors that influenced public health policy development for HIV/AIDS prevention and control in the United States. Then discuss separately each of the three sociopolitical factors.
  2. How were early victims and contacts identified and located?
  3. Select an epidemiological model. Apply events in the video to components of the epidemiological model.
  4. What was your overall reaction after viewing this film/reading this book with respect to the impact on the health care system in the United States?
  5. Compare the historical perspectives of the emergence of HIV with the current HIV Situation in the US.
  6. Define ‘vulnerable population’ and identify the vulnerable population in this film.

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