Across the world, countries have been attempting to implement the most effective measures for controlling dangerous and widespread epidemics. These epidemics are a threat to the livelihood and growth of any country because they have the capacity to destroy entire populations and devastate economies and cultures alike. One of the most well known epidemics of our time is acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV). This epidemic has showed no discrimination in who it attacks, with 33. 3 million people worldwide living with HIV/AIDS and 1. million annual deaths due to AIDS (HIV and AIDS Statistics From Around the World). Although a large majority of the cases of HIV/AIDS are found in sub Saharan Africa, this epidemic is also prevalent to a lesser degree in Denmark, Germany, Poland, and the United States. These countries share many similarities, yet vary in a number of ways as well. How do the similarities and differences between these four countries impact and shape each country’s individual programs and measures used to control epidemics, more specifically the HIV/AIDS epidemic?
By examining Denmark, Germany, Poland and the United States independently of one another it will become apparent how each country may differ or relate to each other in regards to their methods of dealing with epidemic control. To begin the analysis of health care systems and their methods of epidemic control, Denmark will be the first country investigated. Denmark’s universal health care system has retained the same basic structure since the early 1970’s (Denmark – Health). Therefore, the processes in which epidemic control are implemented will be observed from the 1970’s onward.
According to statistics from 1999, the number of people living with HIV/AIDS was estimated at 4,300, and deaths from AIDS that year were estimated at less than 100. HIV prevalence was recorded at 0. 17 per 100 adults. In 2007, there were 4,800 people living with HIV/AIDS in Denmark, of which 1,100 were women, and adult HIV prevalence was 0. 2 per 100 adults (Denmark). When these two sets of statistics are compared, it is readily apparent that the incidence of HIV/AIDS has increased from 1999 to 2007.
While the rate of increase has not been a substantial or major one, it is still present, and could certainly continue to increase if steps are not taken to prevent the spread of the epidemic. The Ministry of Foreign Affairs of Denmark has stated that one of its major focuses is on HIV/AIDS and reproductive health. This administration considers combating HIV/AIDS as an independent goal among the eight 2015 Millennium Development Goals. Poverty, gender inequality, and social marginalization have all been identified as major contributing factors to the spread of HIV/AIDS.
As a result, Denmark has been progressively placing an increased effort and allocating resources towards these issues, as well as updating and altering its policies and methods for dealing with HIV/AIDS. In 2005 Denmark introduced a new strategy for combating HIV/AIDS, in which it stated that support for the epidemic should be focused on improving the national capacity in the HIV/AIDS field and strengthening the overall health system. In order to reap success from these strategies Denmark needed a plan for the implementation of those strategies.
This plan includes contributing to international organizations, promoting the integrations of HIV/AIDS and reproductive health into the country’s own development plans, gaining support through the health sector, targeting support through HIV/AIDS programs, and providing support to relevant non-governmental organizations (HIV/AIDS and Reproductive Health). Denmark seems to have a very up-to-date set of programs for combating HIV/AIDS, which seem to be working reasonably well.
Although the statistics have shown an increase in the prevalence of HIV/AIDS in Denmark, there are many logical reasons for this increase, such as a growth in the general population of Denmark as well as a possible decrease in the age at which Danes become sexually active, which would increase their chances of contracting HIV/AIDS. With that being said, it is difficult to determine if Denmark’s programs are lacking in accomplishment or if modern trends are merely skewing the statistical values.
However, it is possible to state that the prevalence of HIV/AIDS in Denmark is low compared with certain countries in Africa and Eastern Europe and that the health sector’s programs concerning this epidemic have showed positive results in maintaining a low incidence rate of the virus. After having investigated the methods of dealing with HIV/AIDS control in Denmark, it is now important to explore the programs implemented by Germany in the fight against this epidemic. Like Denmark, Germany utilizes a universal health care system, one of the oldest in the world, and also has a rich history in regards to medicine and anatomy.
According to the Centre for Anatomy, anatomical studies began in 1713, so Germany was well ahead of the curve when it came to understanding medicine and the human body. This strong history in the field of medicine could potentially have an influence over Germany’s approach to combatting and preventing HIV/AIDS, thus causing it to stand apart from other countries. Current statistics show that in 2007 Germany had 53,000 people living with HIV/AIDS and of those people, 15,000 were women. Death due to AIDS was estimated at just over 500 and adult HIV prevalence was 0. per 100 adults (Current Trends in the HIV/AIDS Epidemic in Germany). When comparing this set of statistics with those of Denmark it is interesting to note the differences. The total number of people who have HIV/AIDS is much higher in Germany than Denmark, yet the HIV prevalence is lower in Germany than Denmark. This discrepancy between the total number of people infected with HIV/AIDS and the HIV prevalence percentage can be explained by the huge difference in population size between the two countries – Germany has a population of 82 million and Denmark has 5. 5 million (Country Populations).
According to recent calculations, the estimated total number of new HIV infections in Germany has been largely constant in recent years, although around 1998-1999 the number of new infections showed an increase. Experts believe this was due to increased willingness to test following improvements in treatment, which was one of the strategies Germany implemented in improving its country’s position in regards to HIV/AIDS (Germany). By developing and bettering both the testing and treatment areas for HIV/AIDS more people were inclined to seek help by getting tested and then following up with effective treatment.
Another potential explanation for Germany’s ability to maintain a low prevalence rate of HIV/AIDS could be the fact that the government chooses to introduce sexual education for children beginning at the age of 9. The Family Planning Center in Berlin, Germany gave a substantial amount of insight into the methods used for educating German children. One such method that dealt with the explanation of HIV/AIDS entailed using a friendly and engaging stuffed toy with the name HIV/AIDS on it and a red ribbon symbolizing the virus.
In this manner children are able to become familiar with the epidemic at a young age, even before puberty and sexual activity begins, and will ultimately understand the risks associated with the virus when the time comes for them to consider becoming sexually active. This approach to the sexual education of children may be common in Europe, but it differs immensely from the programs found in the United States, which could have lasting influences on how each country chooses to deal with the HIV/AIDS epidemic.
The next country analyzed will be Poland. In comparison to its neighboring countries in Eastern Europe (Belarus, Ukraine, and Russia – which are each currently facing wide-scale HIV catastrophes), Poland has been relatively lucky in regards to the HIV/AIDS epidemic. With a population of approximately 38 million, in 2009, there were 27,000 people reported to be living with HIV/AIDS in Poland, of which, 8,200 were women. The adult prevalence was 0. 1% and the number of AIDS-related deaths was under 200. Avert: Averting HIV and AIDS) Despite these relatively small numbers, according to a study which examined the trends of the HIV/AIDS epidemic from 1999-2004, both the annual number of newly detected HIV infections and AIDS incidence has been steadily increasing (Rosinska). In present times, nearly 36% of all incident AIDS cases are detected concurrently with the HIV diagnosis. This can most likely be attributed to the fact that Poland currently has one of the lowest rates of HIV testing throughout Europe.
The scarcity of testing may be linked to the general taboo nature of the disease and the dominant role that the Catholic Church plays in Polish society. The Catholic opposition to birth control and sexuality in general, has led to a lack of sexual education (conversely to Germany and Denmark), which may have aided in the further spread of HIV within Poland. The Polish healthcare system is comparable to both the Danish and German healthcare systems, as it is based on an all-inclusive insurance system which offers state subsidized healthcare to all covered citizens.
While this healthcare system does have a relatively strong reputation for providing high quality healthcare by European standards, there are many challenges to the system based on a lack of monetary funds. As witnessed in both the Gynecological and Obstetrics Hospital of the Medical University (translated) and the Medical University Hospital of Karola Jonschera (translated) in Poznan, Poland, there was a shortage of beds and doctors available for treatment at times, as well as a limited availability of more advanced technological diagnostic tools.
In regards to the HIV/AIDS epidemic, there is a scarcity in the availability of antiretroviral therapy. Poland currently has only 30 doctors prescribing HAART and there is an estimated 200 people on a waiting list for this therapy (Wasson-Simon, and Denoue). This suggests that for various reasons, Poland is not currently meeting the needs of its HIV-infected citizens. While HIV/AIDS is currently not the most significant issue in Poland, there exists a clear need to increase general access to and use of HIV testing amongst the overall population, to improve data collection, and to enhance the treatment of those already infected with HIV.
The last country to be examined is the United States, which differs from the former three countries in that it is a North American country instead of a European country, and more importantly, it does not provide universal healthcare for all of its citizens. The healthcare system of the United States consists of several different independent entities, much of which are owned and maintained by the private sector. In contrast to Denmark, Germany and Poland, citizenship does not guarantee health coverage and it is currently estimated by the United States Census Bureau that over 36 million American citizens are uninsured.
With such an incredibly high number of uninsured persons and an increase in the number uninsured in recent years, political efforts have been, and are currently being put towards a healthcare reform. The healthcare reform is looking to address the economic burden of healthcare, alter the government’s involvement, and increase coverage for its citizens. One of the strongest lobbying perspectives against a healthcare reform in the United States is that universal healthcare lowers the quality of provided care.
With this, it is important to look at the control of epidemics and how the care provided and the numbers infected both differ and compare between nations with universal healthcare, like Denmark, Germany and Poland, and the privatized healthcare system of the United States. The first cases of HIV/AIDS in the United States were documented in 1981 and from that point there was a rapid increase of both the number of reported HIV/AIDS cases and the number of reported HIV/AIDS deaths. As prevalence increased, more attention was focused on controlling the epidemic.
In 1996, there was a very recognizable and significant decrease in the number of AIDS deaths due to the use of combination antiretroviral therapy. The decrease continued throughout the late 1990’s, began to level off around 2000, and has since become relatively constant. Between 2000 and 2010, it is estimated that the number of people in the United States diagnosed with AIDS per year was about 40,000 people. The total number of deaths attributed to HIV/AIDS in the United States since the recognition of the epidemic is estimated to be well over 500,000 people.
The number of people currently living with HIV/AIDS is estimated to be around 1. 2 million people. The danger in this estimation is that over 1/5 of the infected population is unaware of the infection; leading to a potential risk for increased transmission rates. When looking at the healthcare system disparities, and the HIV/AIDS epidemic, it can be seen that certain populations overlap. There are striking similarities when comparing the demographics of people who do not have proper health coverage and the demographics of people that are most likely to be infected with HIV/AIDS. The most important factor between the two is poverty.
Those living in poverty or with lower incomes are more likely to be uninsured. In the United States, poorer areas are more affected by HIV/AIDS than wealthier areas. In addition, there is a clear presence of higher rates of HIV/AIDS amongst the African American population in comparison to other ethnic groups. It is estimated that 48% of those diagnosed with HIV/AIDS are African American. Similarly, it is estimated that of those uninsured in the United States, almost half are African American. The racial and economic health disparities that exist are currently being addressed by both governmental and non-governmental agencies.
These agencies are working together to increase the funding for healthcare organizations that focus on HIV/AIDS assistance and care. The majority of the funded money is put towards improving the healthcare infrastructure of low-income communities. Between 50% and 60% of the funding is put towards direct care and treatment of the HIV/AIDS, and the rest is allocated between research, prevention, education and surveillance of the epidemic. It is expressed that the best possibility of controlling and vastly lessening the impact of the epidemic in the United States is to increase awareness and prevention strategies.
Recent evidence has shown that the increase in prevention efforts has decreased the nation’s rate of HIV transmission. It is evident that when attention has been focused on the issue of HIV/AIDS in the United States, great strides have been made in the fight to eliminate the epidemic. After completing the long and short study tours and researching various aspects of the healthcare systems of these four countries, we have broadened our knowledge, skills, and attitudes regarding the subject.
After an in-depth analysis, we have concluded that poverty is a major contributing factor preventing the eradication of the HIV/AIDS epidemic throughout the world. When compared to third world countries, such as sub-Saharan Africa, and certain Eastern European countries, one would not consider these developed countries to be in poverty, however, when the issue at hand is looked into further, it is clear that poverty still exists in these nations and that the majority of people affected by this epidemic are at or below the poverty line.
Learning about this sparked a frustration amongst the group because it became extremely evident that lack of education and racial disparities often stem from poverty. This experience has shown us that since the HIV/AIDS epidemic exists in both universal and privatized healthcare systems, it is not actually the fault of the infrastructure of the healthcare system in place. Rather, it can be attributed to the lack of attention given to the root of the causes of both HIV/AIDS and the continual spread of the epidemic.
With Poland as a small exception, these nations do not necessarily lack the resources to remove the prevalence of HIV/AIDS from their individual countries. This concept led us to the idea of instituting the use of mandatory HIV/AIDS testing. This could both increase awareness, enable people to seek treatment options sooner, and to decrease the further spread of the disease. While this could be considered a violation of individuals civil rights, we as a group, feel that the benefits of this testing would potentially outweigh these violations.
Denmark, Germany, Poland, and the United States exist as nations with many similarities and differences. While each country approaches healthcare differently, they have all been making efforts to improve their policies towards combatting HIV/AIDS. Although advances have been made, there is still immense room for improvement. Our experiences and research have led us to conclude that if the proper steps are taken, the possibility of the eradication of HIV/AIDS in developed countries can be seen in our lifetime.