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Since the 1960s, HIV/AIDS epidemic has played a big role to change the profile of cancer in Uganda especially the enormous increase of AIDS-related Kaposi sarcoma (KS) (Parkin et. al. , 1999; Wabinga et. al. , 2000). Unlike in Europe and United States where cases of AIDS-related KS have significantly declined due to HIV treatment with highly active antiretroviral therapy (HAART) (American Cancer Society, 2016; Hermans et. al. , 1996), the disease is still a huge burden in Uganda. Recent research shows that Uganda has one of the world’s highest concentration of infection-related cancers inclusive of AIDS-related Kaposi sarcoma (Fred Hutchinson Cancer Research Center, 2015). Kampala Cancer Registry Report 2007-2009, also shows that AIDS-related KS is among the most three diagnosed malignancies in both sexes and the disease affects mostly children under the age of twelve and middle-aged adults. (Kampala Cancer Registry report 2007-2009, 2012). More research shows that in 2008, AIDS-related KS was the leading cause of death in men in East Africa and most commonly diagnosed malignancy (American Cancer Society: Cancer in Africa, 2011). In general, cancer is a latent public health burden killing more people than HIV, Tuberculosis and Malaria combined particularly in Uganda and Africa at large (Fred Hutchinson Cancer Research Center, 2015; Jemal et al. , 2014). Worldwide, cancer is the leading cause of morbidity and mortality accounting for 8. 2 million deaths and around 14 million new cases in 2012 (WHO factsheet, 2015).
In Uganda, KS is mainly caused by HIV in both children and adults (Ziegler et. Al. , 1997). Other factors such as poor coverage with HAART, gender issues, affluence, inadequate health facilities, education levels and poverty facilitate the development of the disease (Boer, 2012; Ziegler et. al. , 1997). This paper analyzes the role of socio-cultural and socio-economic factors that contribute to the upward trend of AIDS-related KS. The paper will also discuss human rights issues, sustainable development, and gender inequality in relation to socio-cultural and socio-economic factors that contribute to AIDS-related KS prevalence. AIDS-related KS is a type of cancer caused by human herpes virus-8 (HHV-8), also called Kaposi sarcoma-associated herpes virus (KSHV) according to American Cancer Society (2016). A person can contract this virus during intercourse, through saliva, or from mother to baby during childbirth.
However, not everyone who is infected with HHV-8 develops Kaposi sarcoma but only some people with a weakened immune system (American Cancer Society, 2016). The disease starts in the lymphatic system or blood vessels causing tumors on the skin or mucosal surfaces inside the mouth, nose or throat and in internal organs (Fred Hutchinson Cancer Research Center, 2015). AIDS-related KS is an AIDS-defining illness because it develops in people who are infected with HIV/AIDS and whose immune system is weak (American Cancer Institute, 2016). Worth noting is that HIV/AIDS is still a significant burden in Uganda accounting for 1. 5 million people living with HIV in 2015, 83,000 new HIV infections, and 28,000 AIDS-related deaths (UNAIDS Gap Report 2016).
Aim: The aim of this paper is to analyze the role that socio-cultural and socio-economic factors play in increasing AIDS-related KS in Uganda. The analysis will also include three themes, that is, human rights, sustainable development and gender inequalities. I will first analyze the socio-cultural and socio-economic factors, followed by human rights, then sustainable, gender inequality and lastly conclusion.
What role has socio-cultural and socio-economic factors played to the upward trend of AIDS-related KS in Uganda?
Research indicates that the upward trend of AIDS-related Kaposi sarcoma is to some degree related to the socio-cultural and socio-economic factors as discussed below;Socio-Cultural Factors Gender –Female social related issuesBecause AIDS-related KS was traditionally a disease afflicting men in Uganda before HIV pandemic (Fred Hutchinson Cancer Research Center, 2015; Parkin et. al. (1999), its increase among women reflects the existence of socio-cultural issues related to this gender. Ziegler et. al. (1997), attributes the problem to increased married couples where the husband has many other sex partners which contribute to the spread of causative agent of Kaposi sarcoma.
According to AVERT (2015), most new HIV infections in Uganda occur among adolescent girls and young women who have been exposed to gender-based violence such as sexual abuse and lack of access to health services, social protection and information about how to cope up with the inequalities and injustices. More so, Jacobsen (2014: 228), noted that women have a higher social risk of getting HIV than men because they marry at a young age and lack the power to demand condom use. These female social related issues contribute to the upward trend of AIDS-related KS. Also, the prevalence of HIV infection among pregnant women and the high risk of childhood HIV infections explain the increased incidences of AIDS-related KS among children (Mbulaiteye et. al. , 2006). This finding correlates with Wabinga et al. (2000) that the incidence of Kaposi sarcoma corresponds closely with the age-specific reporting rates for AIDS in the country. Worth noting is that the two most severely-hit age groups by AIDS-related KS in Uganda are middle-aged adults (20-39 years) and children under the age of 12 (Fred Hutchinson Cancer Research Center, 2015; Parkin et. al. , 1999).
Prejudices and social discrimination are the primary causes of some HIV/AIDS infected groups in Uganda such as sex workers and homosexuals to avoid health care services (AVERT, 2015) which predispose them to the causative agent of KS. HIV/AIDS patients are subjected to both internal and external stigmas such as social bans, verbal harassments, sexual rejection, family rejection and lack of social support which hinders them from accessing treatment (AVART, 2015; Lubega et. al. , 2010). Stigma hinders patients from seeking medical care services which significantly contributes to the late-stage presentation of the disease (American Cancer Society: Cancer in Africa, 2011) hence contributing to the development of AIDS-related KS.
An interesting finding indicates more cases of AIDS-related KS among the highly educated population (Ziegler et. al. , 1997). This is associated with the elites’ engagement in social networks based on school or professional ties that can result in increased HIV transmission hence contributing to the number of AIDS-related KS. Socio-Economic FactorsAffluence While some research attributes the upward trend of AIDS-related KS to occupations associated with affluence in young adults (Ziegler et. al. , 1997), other research attributes it to poverty (Boer, 2012; Wabinga, 2002). Affluent young adults are reported to have several spouses or frequent partner change with less protection which expose them to a causative agent of AIDS-related KS and also a higher rate of STDs (Ziegler et. al. , 1997). Interestingly, to Ziegler et. al. (1997), relative poverty protects against developing AIDS-related KS, nevertheless, in a country like Uganda stricken by poverty, having several spouses without protection among the poor young adults especially women is also common (AVERT, 2015).
On the other hand, AIDS-related KS according to Boer (2012) among the poor population is associated with poor nutrition and lack of or delays in HIV treatment which leads to suppressed immune system. Due to poverty, Wabinga (2002) reports that a significant number of people cannot afford medical services such as biopsy examinations which lead to the development of AIDS-related KS. Given the impediment caused by limited resources, the availability of cancer medical care in Uganda depends on the patient’s financial input (Gondos et. al. , 2005).
Although the available research about AIDS-related KS mentions little about the role of transport in the development of the disease in Uganda (Ziegler et. al. 1997), high transport costs and long distances to health cares centers especially for people in rural areas (Wabinga, 2002), affects HIV patients’ compliance to medical appointments. With failed adherence to recommended treatment regimens due to transport problems, HIV patients have high chances of developing AIDS-related KS. Poor and inadequate health facilitiesEven though the number of cancer patients has increased in Uganda, the country has inadequate resources, outdated cancer equipment characterized by frequent breakdown, and insufficient drug combinations to effectively manage cancer (Gondos et. al. , 2005; Ministry of Finance, Planning, and Development, 2015). With over 40 million people, there is one hospital catering for all cancer medical-care services with understaffed medical personnel and influx of patients (Ministry of Finance, Planning, and Development, 2015). Some research link poor cancer survivals in Uganda to poorly developed health services such as limited cancer diagnostic and treatment facilities (Sankaranarayanan et. al. , 2010: 170). Even though the country has outdated medical facilities, the availability of diagnostic modalities for instance endoscopy since the 1990s have improved case finding of some cancers such as AIDS-related KS (Wabinga et. al. , 2000). Poor coverage of Highly Active Antiretroviral Therapy (HAART)Despite a high prevalence of human herpesvirus 8 (HHV8) infection in Uganda, considerably higher than in the USA and Europe (Wabinga et. al. , 2000), the availability and accessibility of HAART to reduce the risk of KS among HIV/AIDS patients is still low (Boer, 2012). With about one-third of patients diagnosed with cancer infected with HIV/AIDS (Fred Hutchinson Cancer Research Center, 2015), treating HIV patients with HAART can reduce the development of AIDS-related KS (Jemal et al. , 2011).
Also, poor distribution of HAART has been reported as one of the major issues causing people in Uganda to resort to local herbs and traditional medicines (Lubega et. al. , 2010) which enhance causative agents to AIDS-related KS. Human Rights Human Rights General Comment 14 (2000) as noted in Backman (2012: 47) states that regardless of a country’s development level, the right to health should meet certain essential elements, that is, health-care facilities, goods and services, and social determinants should be available, accessible, acceptable, and of good quality (AAAQ). In Uganda, cancer and HIV health-care facilities, goods, and services, for example, are not available in sufficient quantity (Gondos et. al. , 2005; Sankaranarayanan et. al. , 2010; Ministry of Finance, Planning, and Development, 2015). Secondly, Health-care facilities are not accessible to all due to stigma, gender inequalities, transport problems, and poverty ((AVART, 2015; Lubega et. al. , 2010; Wabinga R. H. , 2002). Thirdly, the quality of health-care facilities and services is still low (Sankaranarayanan et. al. , 2010). Combined, these factors contribute to the upward trend of KS.
Health is crucial for sustainable development both as an essential contributor to human rights and as an important aspect to achieve sustainable development (Sustainable Development Solutions Network Technical Report, 2015). Promoting good health at all ages contributes to national development through reduced expenditure on illness care, productive employment and social cohesion (Sustainable Development Solutions Network Technical Report, 2015: 6).
Basing on this explanation, the upward trend of AIDS-related KS in Uganda stagnates sustainable development since it is costly to treat (causing poverty), and affects productive ages (children and mid-aged adults). Gender InequalitiesIn Uganda, women experience a variety of gender inequalities such as low social status which reduces their power to act independently (fsdinternational. org). Also, they lack economic self-sufficiency which forces them to trade sex for economic survival hence increases their risk to HIV/AIDS infections, a causative agent to AIDS-related KS (fsdinternational. org). More so, wealth inequality and lack of women representation in tertiary education remain a challenge in Uganda (Gender Equality & Women Empowerment in Uganda, 2014). These gender inequalities explain the increase of AIDS-related KS in women and children since they play a significant role to expose women and children to causative agents of AIDS-related KS. significant role to expose women and children to causative agents of AIDS-related KS.
In a nutshell, socio-cultural factors such as gender inequality, stigma, education levels (AVART, 2015; Lubega et. al. , 2010) and socio-economic factors such as poverty, inadequate health facilities, transport problems and low HAART coverage (Boer, 2012; Wabinga, 2002; Ministry of Finance, Planning and Development, 2015) contribute to the upward trend of AIDS-related KS. Nevertheless, the promotion of HAART (Jemal et al. (2011) together with positive improvements in socio-cultural and socio-economic factors, human rights and sustainable development can greatly reduce KS in Uganda.
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