Critical-Reflective Analysis: Similarities seen Between HIV and Mental Illnesses

HIV/ AIDS is a disease that disproportionately affects those whom are living in poverty and deepens the divide between social strata. Although there is no cure for HIV/AIDS, we as health professionals do our best to prevent it from spreading and taking more lives. The best way to do that is educate and create awareness, within ourselves and those around us. Knowledge is empowering, and I believe through my nursing practice, I will be able to share the knowledge and change society’s view on marginalized groups. The topic of HIV interested me because it is a disease that is often stigmatized. I wanted to take the opportunity to connect individuals living with HIV to individuals living with mental illness because they are both stigmatized in society and a target of victim blaming.

Stigma, Assumptions and Victim-Blaming

HIV is widely known to be transmitted through unprotected sex and too often the presumption is made that HIV infected individuals are themselves responsible for having “chosen” unhealthy lifestyles. However, these “choices” are invariably influenced by social and economic circumstances that leave them with few other options (Cohen, 2010). Society tends to place the blame on victims, often claiming that it is a personal choice, which is to be untrue. Victim-blaming plays an influential role to how individuals are stigmatized, and it is important to challenge social assumptions that occur in society and find out why they occur. Taking a step back from personal biases, and interpreting the situation through a critical lens, I find myself asking: why are young girls selling their bodies? Why are they engaging in polygamy? I recognize that life chances differ greatly depending on where people are born and raised, and those who are born and raised in a third world country will face more infectious diseases than those who are not (Marmot, 2009). I agree with Nolen’s argument that the key factor of the poor health in individuals and communities in Africa is poverty (2017). Poverty is linked the lack of the social determinants of health, which can make them susceptible to disease and illness. Through Nolen’s stories, it made me realize the hardship the individuals must face on a day to day basis to survive. It made me realize the importance of the social determinants of health, and how the lack of all, or one of the determinants can be lifechanging for the individual and the communityIt does not surprise me that it is a common practice for young girls to have sex with older men for cash or food (Nolen, 2007).

Due to the lack of resources and desperation to survive, young girls are forced sell their bodies for sex and stay with philandering husbands (Nolen, 2007). I believe gender is a key determinant of health influencing women and adolescent girls, as the uneven sexual dynamics would consequently make them more vulnerable to contracting HIV. Additionally, due to women’s biology, social and cultural gender roles, they often face more disadvantages in a life already influenced by poverty. Being an African young female puts the individual up for intersectional discrimination (Connell, 2012). The addition of being uneducated, having little to no income, and living in a patriarchal society, disadvantage the individual exponentially more compared to each individual component it comprises. Identities often do not exist independently of each other, so being aware of this coexistence and intersectionality, will allow me to appreciate the disparities in health. This facilitates my thoughts on how biological illnesses can manifest differently in groups solely based on their socioeconomic status.

For example, depression manifests differently within patients in poverty, as their level of income prevents them from receiving out-of-pocket treatments. Through reflection, I can recognize the complexity between intersectionality and overall health and wellness. While reading Nolan’s book, it provoked me to reflect on the barriers to health affecting individuals on a local level, specifically those with mental health. To find out the root causes of these barriers, I find myself asking critical questions throughout the course my nursing practice: what is the individual’s mental illness contributed to? How does stigma affect those with mental illnesses? What are the barriers to care for the individuals? Through actively listening to patients’ experiences with mental illnesses, I have come learn that a common barrier to seeking help from an institution is due to the stigma that mental illnesses are associated with. Through experiencing discrimination, many are afraid to access health care because they view hospitals to be an institution of society. I believe by acknowledging each individual’s barriers to care, I can take steps to help the patient receive the care they need and improve their overall health outcome. There is a cyclical relationship between stigma and disease, and through reading Nolen’s book and reflecting on my clinical practice, I realized that am in a position in health care where I can stop the stigma and put an end to the vicious cycle.

The Culture of Silence

“HIV is not an event, or a series of them; it's a mirror held up to the cultures and societies we build” (Nolen, 2007, p. 4). This is a powerful statement that I interpret to mean that the state of affairs in Africa is man-made. Its rapid spread and proclivity to target those that are most vulnerable are facilitated though society’s indifference towards inequality. There is a culture of silence, shame and fear surrounding HIV, in which society has built discrimination around. I believe that silence is often related to the fear of negative consequences which can lead to social ostracism and further discrimination. A culture of silence is demonstrated through Nolen’s story when he inquires about a sick patient in the hospital and asked if they had HIV. In response, a nurse pulled him out of the ward asserting with, “you can’t just say that word” (Nolen, 2007, p. 3). I believe that stigma is a multifaceted social structure that when ignored, will cause social isolation and contribute to overall poor health. The culture of silence seen in Africa regarding HIV has allows me to reflect on the similar culture regarding mental illnesses. Stigma and discrimination lead to feelings of shame in those who are struggling, which creates a serious barrier to diagnosis and treatment. Though I recognize many social movements and public figures trying to start a conversation regarding mental health, it is still the elephant in the room in most societies and workplaces. Many employees are reluctant to raise the subject of mental illnesses to the managers for a fear of discrimination.

Future Movements Through Reflection

I believe to facilitate to change in complex issues, it is important to take an upstream approach that modifies the social determinants of health to achieve health promotion and prevent the spread of communicable diseases. Specifically, regarding the growing the HIV epidemic in Africa, I believe tackling this issue would involve the cooperation efforts of not only the frontline health providers, but many other stakeholders. The upstream approach to HIV prevention would need consider many underlying obstacles which include social, political, economical and cultural factors. The noticeable culture of silence demonstrated in Nolan’s book strengthens my belief that the most important thing I can do as a health care provider, whether regarding HIV or mental illnesses, is to start a conversation and bring awareness to individuals and the community on the presence of the issues. I believe that education and health promotion is an essential mean of empowering individuals and the choices they make that could also positively influence their identity of self. I believe to facilitate change, educating leaders about the injustices of society is important. As they voice through the silence, truth on the issues can come to the surface, which will facilitate conversations. I also want stress the importance of educating the public about the dire situation in Africa, as it would be the first step to address a complex problem that many not be aware of.

I believe that though the general public has a basic understanding of the HIV epidemic in Africa, my experience reading Nolan’s book is that the situation is far more complicated. From reading Nolan’s book, even I was shocked when I realized the depth that these problems ran, and how many forces contribute to the status quo. It made me realize that the HIV epidemic encapsulated many obstacles including: social determinates of health, gender inequality and intersectionality. Reflecting on the obstacles also made me related to the inequalities individuals face regards to mental illnesses. I believe Nolen’s book was a very informative piece that brought attention to the HIV epidemic in Africa. Though he failed to grab the attention of mainstream media to raise awareness to the situation (Nolen, 2017), I applaud Nolan’s attempt and can appreciate his passion on the issue through by publishing this book. Through this book, he was able to carefully articulate to the audience the severity of the HIV epidemic and the desperate need for change. I believe Nolen wanted to demonstrate the side of human suffering from the epidemic, but also the resilience of each individual. It’s truly unfortunate, in my opinion, that these individuals are born in poverty, where it is a cycle that many do have the chance to escape. This cycle of poverty travels down from generation to generation, which is why I believe it is crucial to break.

Final Thoughts

The HIV epidemic in Africa is taking thousands and thousands of lives, but I personally do not see obvious mainstream media coverage on such issue. The lack of attention of the complex issue peek my interest and inspired me to read the stories from Nolan’s book. From reading his stories, I was able to connect through my own personal practice, that though HIV and mental illnesses are drastically different, I believe there are more similarities, than differences regarding how society perceives the marginalized groups. Similarly, overlapping discrimination can be seen in the social determinants of health and intersectionality. Though Nolan’s book, I question that the culture of silence surrounding HIV may be the underlying reason why it is prevalent in the African societies. Similarly, I understand the reason why so many individuals in North America feel they suffer with mental illness alone. I believe that education creates knowledge, and knowledges create change. Though reading Nolan’s book, it has inspired me to break the silence and start conversations regarding mental health to ensure that no one is afraid to talk about the taboo subject.