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PART A AIDS is a disorder in which the immune system loses its effectiveness, leaving the body defenseless against bacterial, viral, fungal, parasitic, cancerous and other diseases. The danger from AIDS comes from the infections that begin when the immune system no longer functions effectively. The intervention for dealing with AIDS which I have chosen to describe is the Retrovir brand Zidovudine (AZT or ZDV). Retrovir belongs to a class of anti-HIV drugs called Nucleoside Reverse Transcription Inhibitors (NRTIs). Zidovudine is not a cure for HIV/AIDS; it acts to inhibit the reproduction of HIV in the body. The HIV virus can still be transmitted to others during therapy with this medication. This intervention is consistent with the disease view of dealing with health because Zidovudine deals with the symptoms of HIV once it has been diagnosed. The disease view is contrasted with the individual determinants view of health whereupon health is seen as resulting from many factors, and by altering one of these factors (see Part B), a person s risk of contracting the HIV virus is decreased. Once prescribed to Zidovudine the basic requirement of the patient is that they take one 300mg tablet twice a day. This is a small but reasonably insignificant behavioral change; although presumably once diagnosed with HIV most patients will cease high-risk behaviour such as unsafe sex in order to prevent transmission of the virus to others. Under the disease view of health, treatment for HIV/AIDS begins once the patient has contracted the virus. The number of people taking Zidovudine is restricted to those that have been diagnosed with HIV. PART B The policy of making free condoms accessible to high school students as a preventative treatment against HIV/AIDS addresses the problem from the individual determinants view. It focuses on identifying the underlying risk factors for HIV/AIDS and beginning at ground level to prevent spread of the virus. The HIV virus is spread in a variety of ways, but the major modes are via sexual intercourse and intravenous drug use. The major risk factors for HIV are unsafe injecting habits, multiple sexual partners and unsafe sexual practices, particularly intercourse without the use of condoms or other barrier methods of protection. Therefore prevention of HIV/AIDS requires a change in the lifestyle or general behaviour of the individual, and this is the fundamental difference between the individual determinants view and the disease views of health. Under the disease view the patient is required to take a daily dosage of the anti-HIV drug Zidovudine which inhibits the spread of HIV in the body. Aside from taking this intervention and the associated side effects, the intervention should not greatly change the patient s lifestyle or general behaviour. Under the individual determinants view, the patient themself takes responsibility for the prevention of contracting HIV, whereas under the disease view a medical professional is responsible for prescribing the intervention. Using condoms is the cheapest, most effective and most readily acceptable behavioural change that most individuals are willing to undergo to prevent HIV infection, as it requires the least effort and change in general habits. It is generally easier to persuade someone to use condoms than to become less promiscuous - it is easier to persuade people to have safe sex than to stop having sex altogether. Using condoms falls under the more expansive view of health because condoms are a method of combating HIV/AIDS that is available to everybody, not just those who have or are at high risk for HIV/AIDS. A preventative policy must be directed not solely towards those at risk for HIV, but towards moving the entire distribution of behaviour among the population as a whole. While Zidovudine is a drug dealing specifically with the HIV virus, condoms are used as protection not only against HIV/AIDS but also as contraception and protection against most other STDs. The individual determinants view is subject to a number of social and economic factors, some of which I will expand on in Part C. Possible problems with this policy occur because the responsibility for this intervention falls on the students. In Part A the intervention is a tablet that is easy to take and it is expected that the patient will take it in order to inhibit the spread of HIV infection, however under the individual determinants view the intervention becomes more complex. Once students have taken the condoms it is not known if they will use them properly or even use them at all. Therefore in order for this policy to be effective it must be accompanied with sufficient education on the use of condoms. PART C There are a number of factors that could result in differences between schools as a function of socio-economic status. The factors I will elaborate on in this essay are cost, religion, drug and alcohol use, culture and gender expectations. Firstly, the cost of condoms. It is reasonable to presume that uptake rates may be higher for schools in low socio-economic areas because the students come from lower income families and have less disposable income. Therefore they will be more likely to take free condoms rather than buy them or pay to go on the contraceptive pill as students in higher socio-economic groups may do. Another factor that may result in differences between schools as a function of socio-economic status is religion. Families living in higher socio-economic areas will have more children at private schools, which are often religion based. In New Zealand, the most common religion for a private high school is Christianity. Christian schools place a high emphasis on the importance of sex education, although this education may be biased or may not cover some relevant points. For example, in some Catholic schools the subject of condoms may be only briefly skimmed over or possibly completely omitted, as they are a method of contraception. On the other hand, students at many private schools are given a comprehensive sex education, as the school realizes that some students are likely to be having sex and it is better that they are well informed about the risks of sex and methods of contraception than practicing unsafe sex. Therefore, there are a number of effects that religion could have on the uptake rates of free condoms at a New Zealand high school. Firstly, students coming from orthodox religious families will be aware of the values (regarding sex and contraception) instilled in them both by their families and by their schools. These values may influence their decisions when it comes to having sex and using condoms. For instance, at a private Catholic school the uptake rate of condoms may be lower either because of the feelings of guilt that using condoms causes for the students, or simply because students have chosen to abstain from sex. These decisions may also go the other way - the uptake rate may be higher among students from strict religious backgrounds due to the tendency of teenagers to rebel against the values of their schools and parents (in this case, by having sex out of marriage) in an effort to discover their own identity. Often the stricter the environment the student has been brought up in, the more rebellious they are. Drug and alcohol use is another factor, seen to be more prevalent in areas of lower socio-economic status. Evidence suggests that adolescents who drink heavily or use marijuana are much less likely to use condoms than adolescents who are not heavy drinkers or marijuana users. The high rates of drug and alcohol use amongst lower socio-economic groups is due to many factors, including increased stress levels, feelings of hopelessness and of being stuck in a situation that is impossible to get out of, social norms, and in many cases simply because there is not a lot else to do. These are all reasons why people living

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