Abstracts

83 so many people not receiving medication, the disease continues to spread, with 2,400,000 new infections each year (UNAIDS, 2019). An epidemic of this magnitude is fueled by more than a lack of access to health care; sociocultural factors like racial and sexual prejudices play a significant role. South Africa has a long history of prejudice that has systematically prevented colored and black South Africans from accessing health care. Black South Africans had a 16.6% HIV prevalence rate in 2017; this rate is significantly higher than that in colored South Africans, with a 5.3% prevalence rate, and white South Africans, with a 1.1% prevalence rate (Simbayi et al., 2019). South Africa also has a strongly patriarchal society that limits women’s autonomy, as evidenced by a 25.8% HIV prevalence rate among women aged 15 to 49, significantly higher than the national average (UNAIDS, 2019). When considering the sociocultural norms and the history of South Africa, the most effective way to end the epidemic is to empower marginalized groups through preventative treatments that will protect individuals before exposure to HIV and simultaneously work to close the sociocultural inequities. What Is HIV/AIDS? The HIV attacks and slowly destroys T cells, the cells in the immune system that fight disease (Division of…, 2019). As the HIV infection progresses, these cells become infected and die, and the afflicted person slowly becomes more susceptible to other, opportunistic infectious diseases. Symptoms usually do not show up until 5 to 10 years after the infection event. If left untreated, HIV progresses to AIDS in 10 to 15 years (World Health Organization, 2017). Progression to AIDS indicates that a person has fewer than 200 T cells per cubic millimeter of blood and the infected person no longer has a functioning immune system (Division of…, 2019). This immune deficiency leaves the person vulnerable to opportunistic infections, including tuberculosis and pneumonia, which are common comorbidities. HIV can be transmitted through body fluids, including semen, vaginal secretions, and blood, and most often is sexually transmitted (World Health Organization, 2017). HIV is a retrovirus; it can never be entirely eliminated once the infection takes hold because it incorporates its own genetic information into the host’s genome. There currently is no cure for the virus; it is treated using antiretroviral therapies (ARTs) that block steps in the pathway of integrating the virus’s genome with the host’s genome (Warnke et al., 2007). An infected person must continue to take ARTs for the remainder of their life. Treatments have improved since they were first created so that infected persons can reduce their viral load (the number of viral particles in a blood sample) to undetectable levels with firm adherence to their treatment plan (Division of…, 2019). Administration of ARTs prior to exposure to the virus can prevent the infection from taking hold and save individuals from the burden of a lifelong disease and protect their bodies from a lifetime of medications. Due to the extended incubation period until symptoms become noticeable and the fact that HIV/AIDS is just one of a long list of dangers that could destabilize daily life, the disease is not a pressing issue for many South Africans. People need to worry about feeding their families, working, and many other responsibilities that are more salient to daily life than HIV/AIDS. Thus, it is often ignored and forgotten (Trinitapoli & Weinreb, 2012). Sociocultural barriers have created a host of other problems that the impoverished population must face before even considering testing and treatment for HIV. Historical Context The prejudice and racism that underlie the inequalities and barriers to health care that many South Africans face have deep historical roots. Discrimination began in 1652 with the colonization of South Africa and the consequent enslavement of the natives. The enslavement of South Africans disenfranchised them in ways that weakened their connections to the land and to their families and completely decimated their sense of self (SAHO, 2017). The end of slavery did not restore their familial connections nor did it alleviate the prejudices colored and black people endured.