SOCI3250:

Service Learning Paper

Will Trice

11-20-15

Sociology of Health and Illness

Dr. Annice Yarber-Allen

 What is HIV/AIDS? The simplest way to put it: HIV/AIDS is a serial murderer. Its not a

human being like most serial murderers. Its not even cancer, which one can come back from

after it goes into remission (unless were talking pancreatic cancer, which no one has come back

from as of yet). Its HIV/AIDS, a disease of the chronic and terminal type that no one ever comes

back from. Acquired Immunodeficiency Syndrome, or AIDS, is caused by the Human

Immunodeficiency Virus, or HIV. It disables our immune systems, enabling infections that are

normally controllable and thus taken for granted, to overcome our systems, and then kill us. Not

to mention there is a gross amount of stigma attached to this disease. Its HIV/AIDS, and it kills

all people all over the world.

What to do to combat this infectious serial murderer? Medical AIDS outreach programs,

for one thing. Medical AIDS Outreach of Alabama, or MAO, is one such program. I will not go

into its entire history; its website will say it better than I can, and this is not what this paper is

about anyhow. I will, however, touch on MAO and HIV/AIDS as they relate to the course

material. I may also recap the chapters we have gone over in order to further put them into

context. MAO is where we the class did our community service. We were to volunteer for one

of three community activities: The MAO Food Pantry, the Garden of Hope, or MAO education

programs. And we had to have seven hours worth of service. Just in case one is unfamiliar, the

class in question is Sociology of Health and Illness. Dr. Annice Yarber-Allen, our teacher, is the

vice chair on the Board of Directors at MAO (2). Occasionally, we have received visits from

other MAO officials, including Timothy Spraggins, the secretary on the Board of Directors at

MAO (2). This is a passion of Dr. Yarbers; she cares deeply and has made us care, if we havent

already. But how does one combat the HIV/AIDS pandemic without first researching it? And not

only the pandemic itself, but how it affects us, not only as human beings but as a society?

Exactly; No one ever wins a war, or has a chance at winning, without first getting to know the
enemy. Thats a fact of life. There is no easy answer for how to fight HIV/AIDS, nor are we here

to look for one, because there are no easy answers in sociology. If there are, they should be

questioned; this is where critical thinking comes in. Critical thinking is where one takes a page

out of Marc Cohns songbook and asks oneself, Do I really feel the way I feel? (6) I will

answer this question at the end. By the way, the local MAO clinic is a five-minute drive from

where I live.

MAO had to be well-versed in sociology itself before they could set out to do what they

set out to do, and so had we the class. Chapter one is, as it says, a brief introduction to the

Sociology of Health and Illness. To recap, medical sociology, according to Ruderman, is the

study of health care as it is institutionalized in a society, and of health, or illness, and its

relationship to social factors (1, p. 1). Decades and centuries ago, we were dying from acute and

infectious diseases such as the Common Cold. Thanks to the hiring of sociologists at medical

schools and funding provided for medical sociology in the 1950s and 60s, death from the acute is

mostly a thing of the past, and now we mostly die from diseases and illnesses of the chronic and

degenerative variety, such as HIV/AIDS (many more contributions followed) (1, p. 3-4). We

would not have come this far without the inclusion of sociology, which attempts to understand

individual behaviors by placing them in social context (1, p. 6). What is society but a group of

individuals? (We would run into the word individual a lot. I mean, a lot.) Three well-known

theoretical perspectives are: Functionalism, Conflict Theory, and Interactionism (1, p.7-8).

Whichever approach an individual favors depends on how that individual understands health and

health care. Regarding functionalism, I am well aware that good health and effective medical

care are necessary for society to function harmoniously, and that ill health and poor medical care

will contribute to upending society in the future. The function of MAO is to educate on

prevention, promote good health, provide quality service, et cetera, and pull it off with
compassion. At the same time, without the Conflict Theory, how could we point out social

inequalities, who benefits more from what and so forth so that they can potentially be resolved?

These inequalities persist even as HIV/AIDS knows no bounds. Regardless if one is an

interactionist, who believes that good health depends on how one looks at it, everyone can agree

that HIV/AIDS was always an illness and in fact does have an objective reality. I believe that

everybody in this class has made their own contribution to the service learning project, and as a

result, we had a group with its own role to play in the war on HIV/AIDS.

Like I said, no one ever wins a war without first getting to know the enemy. MAO studies

the social epidemiology and social etiology of HIV/AIDS, and also the social stress that it causes

in order to promote health behavior and educate the clients on prevention. Social epidemiology

studies the social determinants and the social distribution of health (1, p. 5). Epidemiology in

general is the study of health and disease in populations; we study these to understand disease

dynamics so we can control disease and thus promote health (1, p. 35). Our jobs as

epidemiologists are to investigate patterns and links of diseases and illnesses, and to track a web

of causation. With all due respect to my home region, while the Southern United States may be

famous for hospitality and culture, it has the worst track record health-wise when compared to

the other regions. And my home state has got the worst of it. Here are four factors I can name

that contribute to HIV/AIDS morbidity among southerners. (Warning: I may reiterate from an

exam I did previously.)

The first factor is the general health status; 9 of the 10 states with the worst health ratings

are reported to be from the South, which has a high STD level that could partially explain why

HIV/AIDS is so concentrated here (3, p. 4).

The second factor is poverty; you know the old saying: Health follows wealth. Wealthy

people have more access to health care than people in poverty (or anyone else for that matter),
and when people in poverty do get access, its more of the inadequate and cut-rate variety.

Poverty itself stems from lack of quality (or any) education and lack of adequate (or any) health

care access. It usually becomes a vicious circle; Illness follows poverty, and this means more

poverty, which in turn means more illness, and the beat goes on, until one day, death finally

comes. This explains why HIV/AIDS is more concentrated in low-income areas, of which there

are many in the South. Poverty makes it more difficult for the Southern States to respond to

health care as they should (3, p. 4).

The third factor is race/ethnicity and gender issues; HIV affects African-Americans at a

disproportional rate, and most reside in the South, where HIV/AIDS is mostly concentrated.

African-Americans with HIV/AIDS do not just contract it through poverty; they are also affected

high incarceration rates, unstable housing, HIV-related social stigma, fear and mistrust of social

institutions, and perceived racial discrimination in health care. The proportion of the HIV

infected among women is highest in the South, with 71% among women in this region being

African-American women. Hispanics/Latinos in the South are also hit hard; half of new

HIV/AIDS diagnoses among Hispanics/Latinos also reside in the Southern States (3, p. 4-5).

The fourth and final factor is our state geography and culture; everyone knows the gross

amount of social stigma attached to living with HIV/AIDS, and its worse if one lives in a region

that is both culturally conservative and consists of mostly rural areas, such as the South. There

are laws and policies that indirectly spread HIV around and make the problem worse. There is

either abstinence-based sex education or no sex education at all (I should know; the pamphlet I

received in class stressed abstinence as a first response, but at least talked about condom use and

staying faithful to ones partner, which isnt so bad); this leaves teenagers ill-prepared for HIV

and STD transmission. There are also laws criminalizing behavior that might be AIDS-related;

they marginalize populations at high risk of receiving HIV and discourage the already infected

from seeking treatment. Rural areas are where the social stigma is most prevalent; they have an
inefficient supply of health care and lack the financial resources with which to get more, thus we

would have to travel to the citya long ways awayto get the proper care (3, p. 5) Fortunately,

MAO has clinics in some rural counties (2) (a step in the right direction), and is going above and

beyond the call of duty to educate us on these things. And MAO is getting further help from the

Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO)

for information and strategies on how to control HIV/AIDS.

There are also sociodemographic variables on life expectancy related to HIV/AIDS

patients in the South. The first is socioeconomic status; as I said before, the wealthy can get

more quality health care than anyone else and thus have a longer life expectancy (see above for

what I say about poverty) (1, p. 43). The second is race/ethnicity; in America, Caucasians have a

longer life expectancy than most racial and ethnic groups, especially African-Americans, who

have the lowest life expectancy for reasons stated above (1, p. 44-45). The third is social class

and race; some life expectancy and mortality differentials have a genetic basis, such as sickle cell

anemia. But it is socioenvironmental factors that play bigger roles in life expectancy and all, and

most of them are related to poverty among minorities (again, see above for information on

poverty-related issues) (1, p. 45-46). And the fourth and final is gender; females tend to live

longer than males (80 years for females vs. 75 years for males), but even so, females have a very

high infection rate in the South (1, p. 46). This is only part of the detective work necessary to do

what needs to be done. Another part is social etiology.

To recap, social etiology is the study of the identification of the causes of disease

patterns (1, p. 5). To investigate this, a medical sociologist has to differentiate between

proximate risk factors (health-related individual factors such as diet and exercise) and

fundamental causes (underlying social conditions such as socioeconomic status and social
inequality). There are six possible causal pathways through which ones position in the social

structure could determine health status or disease likelihood: the physical environment, the social

environment (and psychological response), differential susceptibility, individual lifestyles,

differential access/response to health care services, and reverse causality (1, p. 65). Lets talk

about HIV/AIDS and its etiology. Acquired Immunodeficiency Syndrome, or AIDS is an

infectious disease caused by the Human Immunodeficiency Virus, or HIV. HIV disables our

immune systems (1, p. 79-81). Once our immune systems are down for the count (specifically,

when our CD4 cell counts are below 200) (2), AIDS soon follows; normally controllable

infections such as pneumonia or high fevers, will overtake us, and then kill us (1, p. 81). And we

would be relieved to feel no pain anymore too, especially the chronic pain that AIDS would give

us. Unlike cancer, we will never go into remission from this one. And this happens all over the

world. Normally it is transmitted through exchange of body fluids, to be specific, blood and

semen (2). (Disclaimer: NOT sweat and tears.) There are three most common HIV/AIDS

transmission routes in the US: 53% comes from male-to-male sexual contact. 32% comes from

heterosexual contact, and this is the fastest growing transmission rate. And 17% comes from

injection drug use (2). Mind you, said sexual contact is of the unprotected variety. HIV/AIDS is

horrible enough in the world in general, but less developed countries are feeling the worst of it;

today, 95% of persons infected with HIV live in a developing country. Of all continents wracked

with HIV/AIDS, Africa is getting the worst of it.

Years ago, when people first started encountering HIV/AIDS, it was derided as a gay

cancer. But it did not take too long before heterosexuals, intravenous drug users, and eventually,

virtually everyone else started getting it too. Before long, more and more research was done on

this disease, debunking more and more myths. For example, a woman can give a man HIV, just

at a much lower risk than it happening the other way around. It happens through prolonged
unprotected heterosexual contact; the more cuts on a mans penis and/or the more untreated STIs

either partner has, the higher the risk. For another example, we CANNOT get HIV through

bloodsucking mosquitoes. Granted, it is true that we can get it through (prolonged) blood

contact, but mosquitoes cannot inject the blood of the animal they have last bitten. Even if they

could, they would be hardly likely to stay on a person for long. Furthermore, HIV does not last in

an insect for long (2). Oftentimes we have to remember that not everyone sees things the way

educated people do. Again, social etiology is only part of what needs to be observed and

reported. The last part is social stress.

MAO studies and treats social stress. To recap, social stress is the study of the imbalance

or unease created when demands on a person exceed the resources to deal with them (1, p. 5).

We do not simply get rid of stress; it is managed, controlled, balanced. Our bodies way of so

balancing is homeostasisa state in which the bodys physiologic processes are in balance and

are properly coordinated, says Walter Cannon (1, p. 97). There are three categories of

psychological stress: Harm (damaging event that has already occurred), Threat (perceived

potential harm that has not yet occurred [most common]) and Challenge (event we appraise as an

opportunity rather than an occasion [Its in the attitude]). HIV/AIDS can be either a threat or a

harm, never a challenge. Regarding the fight-or-flight reaction, if an individual already has

HIV/AIDS, fighting to stay alive is recommended. Otherwise, flee or fight to keep from getting

it. HIV/AIDS is among the toughest things to deal with. Not only does it damage our bodies, but

the notion of receiving a death sentence makes us do things we would not normally do. Years

ago, when HIV/AIDS arrived on the scene, no one knew how to cope with it. Think of the worst

possible reactions to it such as panic, thats what happened. Panic counts as a bona-fide

emotional disturbance. HIV/AIDS is a game changer for ones societal roles. Whatever a new

role is for a HIV/AIDS patient varies from social environment to social environment. Sometimes
an individual might as well be seen as a leper even though not. Sometimes the patient may be

ostracized. According to the looking-glass self, if others treat the patient like only a victim, the

patient will end up only a victim. And sometimes the patient gets social support, a reminder of

still being human and unalone. Social support contributes to personal well-being and health even

in the absence of stress. MAO excels in social support through means of counseling, case

management, mental health services, and the like, as HIV/AIDS-related stress tends to run the

gamut in producing stress-related ills.

Okay, so now weve done the research, so now we know what were up against. Now its

high time to start helping the clients engage in health-protective behaviors. Dont remember what

those are? Okay, here goes. Health behavior is the study of behaviors intended to promote

positive health. From a biomedical perspective, health is simply the absence of disease or

physiological malfunction. In other words, they only consider the first dimension of health:

physical functioning. But from the sociological perspective, all six dimensions of health are

considered: Physical functioning, mental health, social well-being, role functioning, general

health perceptions, and symptoms. In other words, without medical sociology, we wouldnt have

psychotherapy, counseling, motivational speakers, social workers, life coaches, human resource

managers, an expansive number of specialties for physicians, public health organizations,

environmental health organizations, et cetera, et cetera. In fact, we would not have much of

anything without sociology in general. Especially no MAO! There are four dimensions of health

behavior: prevention (minimizing risks of disease, injury, and disability), detection (detecting

disease/injury/disability before symptoms appear), promotion (encouraging and persuading

individuals to engage in HPBs; avoid/disengage in health-harming behaviors), and protection

(societal level; monitoring environments). I must say, MAO has its fingers (and toes) in every

pie, health behavior-wise. But everyone must remember three things: (1), what may be
considered healthy by one person may not be considered healthy by another. (2), the perception

of health is relative to ones culture. And (3), not everyone sees things the way educated people

do. There are four macro-level factors with a direct impact on individuals: (1), the availability of

protective/harmful consumer products (such as fast food and condoms). (2), physical

structures/characteristics of products (seat belts). (3), social structures and policies (day care,

fines). And (4), media and cultural behaviors (advertisements for fast food and alcohol). We

have watched a couple of documentaries on health behavior: Fast Food, Fat Profits and

Drugged: High on Alcohol. On the macro level, the companies that manufacture fast food

and alcohol know we like both, so they take advantage of it. They put out the prices and the

advertisements, making us sit down and take notice of the juiciness of it all. They do not care

that we are giving ourselves potential heart disease, or that children are getting obese from their

product. The (perhaps false) labels such as nutrition are only a legal formality. And the money is

just too good for the policymakers to act fast to lower the taxes on health food and raise the taxes

on junk food and high-sugar drinks; capitalism at its finest. Oh, these ads. These cursed, cursed

ads. On the micro level, we as individuals respond to them and the low, low prices by going out

and buying more. Some people are sometimes so frail they would rather eat whats cool than

eat whats healthy. Good thing we wont find either in the MAO Food Pantry. The closest thing

we have to junk food in the Pantry is Cheez-Its. I wouldnt say fast food or alcohol would give

me HIV/AIDS, but they certainly wouldnt help me if I had it; in fact, they would be detrimental

to my health.

So weve studied health behavior, now its off to illness behavior, which is the study of

the ways we perceive, interpret, and act in response to disease, illness, and disability (1, p. 5)

Behold, Suchmans Five Stages of Illness: (1), Symptom experience (something is wrong, may

self-treat). (2), Sick role assumption (surrender responsibilities, try to get better [Note: MUST try
to get better in order to assume the sick role]). (3), Medical care contact (expertise is necessary,

seek illness legitimization). (4), Dependent-patient role (medical therapy time). (5), Recovery

and rehabilitation (leave sick role, return to real life) (1, p. 146). HIV/AIDS is not something that

can be cured or treated once transmitted, only delayed. I had the flu on Halloween weekend, but

only had to go through stages one, two, and five; it took me a small sip of NyQuil at night and

many bottles of water to flush it out the next day, but I was in the coughing stage for the next

week. Something we could do on the Micro level: wash our hands. It takes a mature adult to

admit sickness. Even more so if sick from HIV/AIDS. But we can make the decision to go to

MAO for AIDS counseling and quality palliative care.

We now live in an age of variety, health care-wise. We have been slowly turning to

Complementary and Alternative Medicine, or CAM, consists of healers and healing outside of

conventional medicine (1, p.5) Among the five core elements of CAM is Holism, which I believe

MAO practices, in a way. Holism consists of treating the patient holistically, which means in all

areas. Not just physically, but mentally, spiritually, and socially (1, p. 246-47). And I believe that

if certain herbs could help with HIV/AIDS as good as any pill or antibiotic, MAO would have

them in supply. Now that the root has been researched and been proven not to be heathen,

superstition, snake oil, ineffective, or artificial, we eat this for medicine (1, p. 246).

Here are my closing thoughts: Community Service implies that an individual is doing

community work out of obligation. Well, there may have been a grade in it for us the class, but I

did not feel like I was obliged to. It did me good to do some good, actually. We have a long ways

to go to fight against HIV/AIDS. HIV/AIDS has brought us nothing but tragedy, but Id say we

are making some progress. So now, Ive thought about it, and when I ask myself, Do I really

feel the way I feel? Id say yes, I believe I do.

 Bibliography: Works Cited

Weiss, Gregory L., and Lynne E. Lonnquist. The Sociology of Health, Healing, and Illness. 8th

ed. Upper Saddle River: Pearson, 2015. Print.

Medical AIDS Outreach of Alabama, Inc. n.p. n.d. Web. 2 Nov. 2015.

Reif, Susan, et al. HIV/AIDS Epidemic in the South Reaches Crisis Proportions in the Last

Decade. Southern HIV/AIDS Strategy Initiative. Duke Center for Health Policy and

Inequalities Research (CHPIR), Duke University, Durham, NC. December 2011. Updated

October 23, 2012. Web. 20 November 2015.

Fast Food, Fat Profits: Obesity in America.

Drugged: High on Alcohol.

Marc Cohn. Walking in Memphis. Marc Cohn. Atlantic, 1991. CD.