Beacon

Schools Project

Health Education
Level 8 Planning Guide
2006

Section 3
Units of work suitable for assessment with
AS 90709 Analyse an international health
issue

* HIV and AIDS

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 Achievement Standard

Subject Reference Health 3.2

Title Analyse an international health issue

Level 3 Credits 5 Assessment External

Subfield Health and Physical Education

Domain Health Education

Registration date 12 October 2005 Date version published 12 October 2005

This achievement standard involves explaining factors that contribute to an

international health issue, analysing the implications of the issue for people
who are affected and explaining recommendations for further action.

Achievement Criteria

Achievement Achievement with Merit Achievement with

Excellence

• Explain factors • Explain, in-depth, factors • Explain, comprehensively,

contributing to an contributing to an factors contributing to an
identified international identified international identified international
health issue. health issue. health issue.

• Analyse the implications • Analyse, in-depth, the • Analyse, perceptively, the

of this issue for people implications of this issue implications of this issue
who are affected. for people who are for people who are
affected. affected.

• Explain recommendations • Explain recommendations • Explain, comprehensively,

for future action, in terms
of this issue, that could
achieve a more equitable
outcome for people who
are affected.
for future action, in terms
of this issue, that could
achieve a more equitable
outcome for people who
are affected.
recommendations for
future action, in terms of
this issue, that could
achieve a more equitable
outcome for people who
are affected.

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Explanatory Notes

1 This achievement standard is derived from Health and Physical

Education in the New Zealand Curriculum, Learning Media, Ministry of
Education, 1999, pp. 28–29; Level 8 achievement objectives from
strands A, C and D.

2 Assessment will be consistent with, and reflect the underlying concepts

of, hauora, health promotion, a socio-ecological perspective and the
attitudes and values of:
• a positive and responsible attitude to the well-being of self
• respect for the rights of others
• care and concern for other people in the community
• social justice.

3 For an identified health issue the student must clearly state the health
topic being analysed as well as give examples of significant data to state
why it is a health issue.

4 For the purposes of this achievement standard, an international health

issue is one that impacts on a country other than New Zealand; or offers
comparison of New Zealand to at least one other country; or by its very
nature is international (like globalisation issues) although these will still
need to include discussion about countries other than, or as well as,
New Zealand.

5 Health topics could include:

• industrialisation and health in developing countries
• HIV, AIDS
• the interface between culture and gender
• sexual and reproductive health
• life expectancy and illnesses in a range of nations
• international profile of disease and immunisation
• international drug issues
• health and/or welfare systems in New Zealand and other countries
• colonisation and the health of indigenous people
• globalisation and health in developing and/or developed countries.

6 Factors contributing to an identified health issue refers to the

determinants of health relevant to the identified issue.

7 Explain means to give reasons and/or justify.

8 Analysis of implications will include as appropriate:

• identification of the significance or importance of implications,
• positive and/or negative factors
• short-term and/or long-term impacts,
and must address both personal and societal impacts.

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9 Explain in-depth means to present accurate and detailed supporting
evidence.

10 Analyse perceptively means to demonstrate understanding of the

underlying concepts of the curriculum and respond to them thoughtfully.

11 Comprehensive responses will require students to do one or more of the

following as relevant to the health issue and as required by the
assessment:
• explain relationships and/or interrelationships
• develop reasoned arguments
• explore the complexities of situations (including different
perspectives).

12 Equitable health outcomes must reflect the values of social justice

(fairness, inclusiveness, and non-discrimination). The recommendations
for action must be related to the factors that influence the health issue.

Year 13 students who have chosen to take health as a subject should be

attuned to the need for sensitivity in relation to health issues and should be
fully aware of additional support available to them if needed.

Teachers should inform students of the potential contexts for examining

issues, discuss with the class any potential sensitivities of particular issues
for students and negotiate which issues will be addressed.

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 HIV/AIDS – a national or international
health issue

Introduction

This unit of work has been developed for external assessment using AS 3.2
Analyse an international health issue. It could also be used for AS 3.1 if the
focus remains on New Zealand. The MOH resource (2003) HIV/AIDS Action
Plan: Sexual and Reproductive Health Strategy, downloadable from
www.moh.govt.nz would provide excellent material if using HIV/AIDS as a
learning context for AS 3.1.

The HIV-AIDS epidemic is a shared problem threatening people in every

country in the world. The unit can be developed from a number of
perspectives as long as students are able to
• comprehensively explain the contributing factors to the current
epidemic in different regions/countries being studied
• provide an in depth analysis of the implications of this issue for people
who are affected, and
• establish and justify priorities to describe possible strategies to contain
the spread of HIV across the populations, and achieve more equitable
outcomes for people who are affected.

The unit could have a range of foci, for example it could,

• take a global generalised position in which students analyse the world

wide epidemic and then describe how this could impact on countries
such as New Zealand, for example in terms of immigration.
or
• compare two or more underdeveloped regions in relation to their
epidemic
or
• consider one underdeveloped region/country of the world where HIV
and AIDS pose a major health risk to the population (e.g Sub-Saharan
Africa) and contrast this with a developed country such as New
Zealand, where although HIV and AIDS are a significant health risk, the
incidence and spread has comparatively been contained
or
• consider the issues for youth internationally.

The unit outline described here is generalised and teachers should adapt and
extend it to the particular focus chosen.

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Resources

• Contact the New Zealand Aids Foundation librarian with any specific
requests ph (09) 3033124. They are amazingly helpful.
• Ministry of Health, 2003 HIV/AIDS Action Plan: Sexual and
Reproductive Health Strategy. www.moh.govt.nz
• Hughes T., 2003. The HIV/AIDS epidemic in New Zealand:
Environmental Scan. New Zealand AIDS Foundation, Auckland.
• Davis, P. (Ed). (1996). Intimate details and vital statistics: AIDS,
sexuality and the social order in New Zealand. Auckland: Auckland
University Press.
• Worth H. et al, 2001 Silence and Secrecy: Refugee Experiences of HIV
in New Zealand. Institute for Research on Gender, Auckland University,
NZ.
• UNICEF, 2002. Young People and HIV/AIDS: Opportunity in Crisis.
www.unicef.org
• Tasker G. (Ed)., 2000. Social and Ethical Issues in Sexuality
Education. Section 5 HIV/AIDS. Christchurch College of Education
• NZAF report on: World AIDS conference, 2002. AIDS New Zealand;
Issue 50.
• UNAIDS, WHO. Aids Epidemic: Update December 2003(download from UN
website listed).
• AIDS Explained Mark Thomas, 1999. Department of Molecular
medicine, School of Medicine, Auckland, New Zealand
• Leadership and Partnership: The New Zealand Response to the
HIV/AIDS Epidemic. Briefing to members of the New Zealand
Parliament. Prepared by the New Zealand AIDS Foundation, Update
May 2003.
• Mandatory testing and exclusion of HIV positive immigrants and
refugees. NZAF, April, 1999).

Useful websites

• World Health organisation www.who.int/hiv/pub/en/

• United Nations www.unaids/org/en/resources/publications.asp
• New Zealand AIDS Foundation www.nzaf.org.nz/HIV.asp
• Ministry of Health www.moh.govt.nz and www.healthed.govt.nz
• Australian Foundation of AIDS Organisations
www.afao.org.au/index_afa_177.asp

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 ISSUE: The Spread of HIV/AIDS in Sub-Sahara Africa

Teaching Activities Resources/references

1. Clarifying existing ideas about • Social and Ethical Issues in Sexuality
HIV/AIDS Education Section 5, Activities 1/2

Students to write everything they know

about HIV/AIDS, along with questions
they want answered during unit. Do
continuum activity (SEI) to introduce class
discussion.

Keep student questions for future

reference throughout unit; can use as a
starter activity for relevant periods by
putting questions on board and having
students answer them at end of period.
2. What is HIV/AIDS? – The facts • Ministry of Health, 2003 HIV/AIDS
Action Plan: Sexual and Reproductive
Investigate and discuss signs, symptoms, Health Strategy pgs 3-10
modes of transmission, effects of and
differences between HIV/AIDS. Need to • Social and Ethical Issues in Sexuality
emphasise behaviour rather than medical Education Section 5, pgs 126-127
aspects. Spend at most two periods on
the medical aspect, with special mention • UNAIDS, WHO. Aids Epidemic: Update
of window period (3-6mos) – from time of (See Beacon folder information)
infection to antibodies building up in body
and able to show a positive test to HIV –
hence the need to have repeated tests
and the risk of spreading the disease.
3. Epidemiological research – fact • UNAIDS, WHO. 2004 Report on the
finding global AIDS epidemic: Executive
Use appropriate strategies for identifying Summary
rates of infections worldwide and rates of
death due to HIV/AIDS. Do broader • Avert.org AIDS around the world
overview first – jigsaw with world views,
then narrow focus onto Africa.

4. Examine the determinants • Background information in Beacon folder.

Students to do independent research with • Social and Ethical Issues in Sexuality

a focus on economic, political, cultural, Education Section 5, pg 128-130
environmental and social determinants
that contribute to HIV in Africa. Jigsaw
activity: home groups of five, each
student has to do readings for all
determinants (set for homework), then
break up into expert groups, write a 400-
word paragraph to comprehensively
explain the determinant. Put all together
on board.

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5. Describe the implications of • World Vision: A Global Challenge
HIV/AIDS transmission at Powerpoint presentation reinforces
personal, interpersonal and concepts discussed so far, with powerful
societal levels. messages on personal and interpersonal
implications
Using a variety of strategies such as
brainstorming, class discussions, • Avert.org AIDS around the world
watching relevant videos and
independent research, have students • UNAIDS, WHO. 2004 Report on the
describe in detail the implications of global AIDS epidemic: Executive
HIV/AIDS. A good idea to introduce the Summary
exploration of ethical issues at this point
which can be elaborated on later when
• Beacon folder background information.
looking at recommendations.
• Social and Ethical Issues in Sexuality
Education Section 5, Activities 2 & 4
6. Looking at recommendations for • UNAIDS, WHO. 2004 Report on the
prevention and/or treatment of global AIDS epidemic: Executive
HIV/AIDS in Africa. Summary. Excellent comprehensive
source of information on
Analyse what needs to happen to ensure recommendations.
positive outcomes in relation to the
transmission of HIV and support for those
living with HIV/AIDS in Africa. Students
need to identify and justify priorities for
action using the framework of the Ottawa
Charter and a range of health promotion
strategies. All priorities for action need to
be linked to the determinants described
when looking at the factors contributing to
the spread of HIV/AIDS in Africa. Can be
done as a jigsaw activity similar to
determinants jigsaw, but alter groups so
students not looking at same determinant
as before.
7. Putting it all together • 2004/5 Exam Papers

Students work in pairs to practice writing

coherent paragraphs for each factor
(determinant). Students then look at the
implications for these factors. Finally look
at recommendations for each factor.
Utilise the exam papers from 2004 to
practice writing responses.

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 Prior Learning: Resources:
Health Determinants, Health Promotion, Level 3 Beacon Folder, World Vision “A
Interpersonal Skills Global Challenge”, HIV/AIDS – Ministry of
Health booklet, various websites
Unit: Investigate an International Health Issue: HIV/AIDS

Unit Aim: By the end of the unit students will demonstrate an Key Area of Learning: Sexuality Education
understanding of HIV and AIDS, factors that influence and
contribute to global effects of the AIDS epidemic. Students will also Duration: 25 – 28 periods
investigate and analyse the implications of HIV/AIDS for people at a
personal, interpersonal and societal level. Class Level: Year 13/Level 8

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Level Learning Outcomes Processes/Activities/Strategies Underlying Concepts Assessment
Students will: Opportunities
8A4  Investigate and understand the definition of HIV/AIDS Continuum activity (SEI) Learning Journal
What is HIV/AIDS? Hauora
HIV/AIDS.
(identifying the effects of
8C2  Demonstrate an understanding of various terms ­ signs, symptoms HIV/AIDS on a person’s hauora
relating to HIV/AIDS. ­ differences between HIV/AIDS in a holistic view.)
 Demonstrate a clear and accurate understanding of ­ physiological processes
the signs and symptoms, the process of transmission
­ modes of transmissions
and various effects of HIV/AIDS. Learning Journal
 Identify the demographic groups who become Who gets it?
8C2 infected with HIV globally ­ International statistics (www.who.org)
 Investigate the global regions where HIV/AIDS is
prevalent ­ NZ statistics – orientation and gender
8D2 (pg 12 MOH book)
 Research global regions of HIV/AIDS and investigate
­ NZ epidemiology (Beacon folder) Attitudes
the implications on specific societies in those regions Jigsaw Activity
­ Video: All About Eve (Inside NZ) & Values
(developing respect for the
­ World links (OHT – Report on Global rights and opinions of others in
AIDS) respect to HIV/AIDS and
­ HIV Transmission Card Game developing a sense of empathy
with people with HIV/AIDS.
­ World Jigsaw Activity*

8C2  Investigate and analyse the prevalence of HIV/AIDS Why is Africa so hard hit and how does
throughout the Sub-Sahara region in Africa. Africa compare with the west?
 Compare and contrast the prevalence of HIV/AIDS in ­ Individual African countries’ endemic
8D1 Africa with the rate of infection in Western World infections (www.avert.org website)
­ Video: HIV/AIDS in South Africa Practice Exam
(2004 Level 3
(Assignment 2001) Socio-Ecological
8D2 Exam)
­ World Vision: A Global Challenge Perspective
8D1  Identify and explain how the Determinants of Health ­ Western world health determinants that
contribute to the widespread infection of HIV/AIDS affect HIV/AIDS rates (identifying factors that
globally, with specific focus on Africa influence HIV transmission and
8D3 ­ Determinants of Health in Africa that actively contribute to the health
contribute to widespread infection of other societies by
(Report on Global AIDS) investigating equity
­ discrepancies between African
nations and Western society’s
8A3  Describe the implications of HIV/AIDS transmission How does HIV/AIDS affect society? treatment of HIV/AIDS.)
at personal/interpersonal and societal levels. ­ Personal, interpersonal and societal
8C2  Explore the ethical issues relating to HIV/AIDS in implications
Africa and NZ. ­ World Vision: A Global Challenge
How do Africa and Western world differ in
8D1 Health Promotion
their treatment of HIV/AIDS?
(investigating and exploring
­ Costs and availability of drugs options available for countries
­ Mandatory testing with people with a high rate of
­ Mandatory reporting HIV/AIDS infections.)
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­ Mandatory disclosure
8D1  Critically examine the HIV/AIDS policies and What are countries doing about HIV/AIDS
practices adopted in various countries, particularly now?
Essential Skills Communication Skills 1 2 3 4 5 6 7 8 9 Social & Cooperative Skills 1 2 3 4 5 6 7 8 9 10 11

Self Management Skills 1 2 3 4 5 6 7 8 Problem Solving Skills 1 2 3 4 5 6 7 8

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 Background Information
Adapted from: Sample Assessment for Health Scholarship developed in February
2003.

1. The most relevant categories of determinants for countries of high HIV/AIDS

prevalence are:

 Economic determinants national economic forces play a crucial role in the

spread of HIV. e.g. in Africa, exploitation of resources including human resources
by foreign countries shifts population groups from rural to urban environments.
The prevalence of HIV is higher in urban centres, along trade routes, amongst
commercial sex workers and amongst male migrant workers. Lack of national
financial resources means governments cannot provide adequate health and
education services and results in widespread poverty.

 Cultural determinants e.g. religious beliefs such as HIV is a punishment from

God, moral beliefs about monogamy for women, denial or ignorance about
modes of HIV transmission due to attitudes to sexuality, concepts of masculinity
that cause resistance to condom use.

 Political determinants e.g. war making many people refugees; government

health policies that do not provide support services and medication for HIV
sufferers; interference in national economies by foreign investors.

 Environmental determinants e.g lack of access to adequate housing, clean

water

 Social determinants including lack of personal economic resource, lack of

adequate care for children, social exclusion caused by the stigma of HIV, lack of
adequate nutrition, lack of employment, lack of access to health services

2. Interrelationships between these factors

Increased foreign competition reduces demand for local rural production. Rural
workers are forced to migrate to urban centres to where work is available. This may
influence patterns of sexual relations since male migrant workers move from a single
partner to having multiple casual partners in urban centres. When the migrant
partner returns they facilitate the spread of HIV into the rural communities and to
casual partners along the highways. Women infected with HIV in rural areas become
stigmatised and are social outcasts. In addition downturn in economies caused by
war or political interference or foreign competition may cause women to become
casual sex workers and ability to negotiate safer sex decreases as competition in
this area increases. Women and men may turn to the drug industry to complement
declining wages. Decreased government spending on health and education will also
impact negatively on people’s ability to stay safe.

3. Immigration Issues for New Zealand

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 ‘Under the United Nations High Commission for Refugees(UNHCR)New
Zealand has a commitment to accepting 750 refugees annually, selected under
various criteria including women at risk, medical/disabled and family
reunification. This number does not always include family members who arrive
later under the family sponsored categories, nor asylum seekers who are
granted refugee status in New Zealand each year. Our overall commitment,
when these refugees are included, is actually around 1,250 refugees a year
which is around 2.5% of the annual NZ Immigration Programme’. (From: World
Refugee Day Speech by Hon. L. Dalziel, 2001)

‘The World health organisation discourages the use of restrictive measures as

a response to HIV infection. The WHO Assembly (1987) and the United
Nations (1991) has urged member states to protect the human rights of
people with HIV and AIDS, and in particular to avoid discriminatory action
against them in travel and immigration. The UN (1919:55) states that the
following measures would in present circumstances, constitute interference
with the right to privacy of the individuals concerned, and would not be
justifiable under international human rights law on public health(or any other)
grounds:

 Mandatory testing of any individuals (other than voluntary donors of blood,

semen, or tissues or organs) for HIV infection, no matter how they are
selected

 Compulsory registration of suspected HIV carriers’

(From: Mandatory testing and exclusion of HIV positive immigrants and
refugees. NZAF, April 1999)

a)Health Requirements for Refugees, Asylum Seekers and Migrants

(1999 NZ regulations)
Temporary entry as a tourist, or to work or study:
a) Under two years: no full medical or X-ray required, but Immigration Services
can request it
b) Over Two years: Must supply medical and X-ray certificates. Certificates can be
referred to a doctor, who may recommend and application be declined because
of risk of disease infecting New Zealanders or burden to the health system.
Immigration Service can waive the requirement in some circumstances, but not
for visitor or student visas or permits.

Permanent Residence: Not compulsory to have HIV or AIDS test for migrants. But
migrants are asked if they have ever suffered from AIDS or AIDS related condition.
If migrant answers yes or if tests positive for HIV or AIDS in other tests, they can
be declined. However Immigration. Service can still allow entry for humanitarian
reasons.

Refugees: Given full medical tests including those for HIV, AIDS and TB once
they arrive in New Zealand – the test is voluntary but to date there have been no
refusals to have the tests. They are entitled to the same public health support as
New Zealand citizens.

Asylum Seekers: Tested only if they sign a consent form. While they are making a
case to stay in NZ they can get public health support.

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b) The major health determinants and their impact on well-being for refugees
diagnosed HIV positive when living in New Zealand

Many of the refugees arriving in New Zealand are from countries of high HIV/ AIDS
prevalence. It is important to be aware of the health determinants that most
significantly contribute to their vulnerability to HIV/AIDS infection in their countries of
origin, and also the major health determinants and the impact of these on all aspects
of well-being, for those refugees diagnosed as living with HIV/AIDS when they take
up residency in New Zealand These determinants may inter-relate and compound
the issues in relation to HIV/AIDS.

An HIV positive diagnosis can have devastating effects on refugees in New Zealand
who are already coping with having fled from their own homes, communities and
countries. As forced migrants, refugees not only suffer displacement but are also
compelled to live in new settings and conditions not of their own choosing. HIV is
generally regarded as a source of shame and fear among most refugee groups in
New Zealand. There is a common perception that HIV is a punishment from God.
Thus their spiritual wellbeing in terms of their sense of self is deeply affected.
Similarly, they often lose their hopes and aspirations for a new and better life as their
experience of people living with HIV/AIDS in their country of origin has been very
negative in terms of general health and life expectancy.

If their emotional well-being is adversely affected by feelings of fear, shame and guilt
this may mean they choose not to tell anyone in their community that they are HIV
positive. They may suffer from depression.

Fear and shame can have a serious impact on their relationships and may result in
partnership break-ups. This is an issue particularly for women, anxious about
rejection if they tell their partner and the difficulty of negotiating condom use to keep
their partner safe if they don’t tell. Their social support networks are thus non-
existent or very limited within their own community and language barriers make it
difficult for them to access social support within the wider community. They have left
most of their family behind in Africa and many are in New Zealand on their own.
Isolation (social exclusion) compounds their fear and depression.

Coupled with lack of employment (most frequently due to language barriers,

qualifications from their previous country not being accepted here, and sometimes
racism) and consequent limited financial resources, secrecy may also be a barrier to
accessing medical assistance. Their physical well-being is harmed and may be
further compounded through economic hardship, through lack of adequate housing
and poor nutrition and limited access to health services.

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c) An example of an ethical dilemma and conflicting perspectives in relation to
containing the spread of HIV/AIDS in New Zealand.

‘Mandatory testing for HIV of refugees, asylum seekers, immigrants and

even tourists has been suggested as the best way to control the spread of
HIV/AIDS by some sections of New Zealand society’.

Arguments for mandatory testing could include:

 The rights of New Zealanders should come before the rights of immigrants and
refugees.

 HIV is a killer disease and the government has an obligation to prevent any
unnecessary entry of infectious diseases into New Zealand.

 Refugees already are a high cost on the public systems of health, education and
social welfare. People living with HIV/AIDS will increase the burden to the
taxpayer even further.

 HIV is set to become an enormous drain on the country’s economic resources as

drug resistant strains are developing and new HIV treatments are so costly.
Access to treatment cannot be denied once a person is living in New Zealand so
from a purely economic view it would be advantageous to identify HIV positive
people coming into the country

 Statistics clearly show that the increase in the rate of HIV infection in recent
years is a result of arrival of people from countries of high HIV prevalence (may
use graph data here)

 New Zealand is a country that compared to other countries, has effectively

contained the spread of HIV (data provided). Our track record is at risk if we
allow people with HIV into our country.

 We have had cases such as that of Mwai, where one HIV positive individual
infected several New Zealand women with devastating effects.

Arguments against mandatory testing should include arguments involving

economic, social, human rights and public health and safety issues such as:

 Mandatory testing is against international human rights legislation (Cite evidence

from material provided)

 There would be many negative outcomes for refugees as to send them back to
their country of origin could result in their death. They would be unlikely to
receive the level of care from their country of origin compared to New Zealand

 People living with HIV can still be useful productive members of society, actively
contributing to the economy.

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 It would be inconsistent to single out HIV infected individuals as opposed to
people with other conditions who may place a similar cost on the health system
e.g. people with cancer.

 The indirect (opportunity costs) associated with mandatory testing programmes

would divert resources away from educational programmes, which have proven
effectiveness, and from protection of the blood supply

 Considering the number of immigrants, refugees and asylum seekers (not to

mention tourists) who enter NZ each year, the direct costs of large-scale
mandatory testing would be enormous. The cost of a test is between $10 -$15,
without costs of pre and post counselling taken into consideration.

 Restrictive policies would fail to reduce the overall reservoir of infection in a

population where HIV is already present. Would people returning from overseas
visits to areas of high HIV prevalence also be included in the testing regime?

 There are logistic issues such as where testing would take place; whether the
elderly and young would also be tested; how specimens and data would be
managed.

 There would be a question over the validity of screening results since an

individual may give a ‘false negative’ if the test was administered within the up to
six month ‘window period’.

 Screening and excluding infected individuals from New Zealand may create a
false sense of security amongst residents. This would run contrary to public
health aims as residents may be less consistent in their practices of ‘safer sex’.

The belief that prospective immigrants infected with HIV are a danger to public
health and safety would set a precedent that all people living with HIV should be
similarly viewed. HIV/AIDS is a very specific disease .It is not casually transmitted
and is different from other diseases such as TB which can be transmitted through
the air. It is certain behaviours that put people at high risk of infection ie just because
a person is living with HIV/AIDS does not make them a risk to public health. In
addition, the rate of infection is lower for HIV than for many other infectious diseases
(for example, the hepatitis B virus) that also can cause death. The exclusion of HIV
infected immigrants reinforces the message to the public that HIV is casually
contagious, or that avoiding certain people will give protection, thus increasing
discrimination and isolation for people living with HIV/AIDS. Prevention measures
designed to prevent the epidemic from spreading must counteract incorrect
information about ‘risk groups’ and ‘risky behaviours’ that are present in particular
communities. All people must adopt safer sex practices to prevent transmission of
HIV, not just those currently infected.
Education requires financial resources and policies that divert funding to large scale
testing programmes may limit this and other health promotion strategies.

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d) Making a difference

A range of priorities to contain the spread of HIV/AIDS in New Zealand could

include:

 education about the specific nature of HIV and it’s transmission and the need to
dispel myths about this for all sectors of the community
 the New Zealand data on groups most at risk, (men who have sex with men,
refugees and immigrants from areas of high HIV prevalence)
 the impact of positive HIV/AIDS diagnoses for refugees
 human rights issues
 economic considerations including the provision of appropriate health services

Justifications for priorities according to how benefits could accrue could include:

(i) benefits for refugees:

Comprehensive programmes to assist with language and NZ customs, education
about HIV/AIDS and it’s transmission, housing assistance, development of support
networks and provision of employment opportunities will all contribute to improved
personal health; improved relationships; improved employment/education
opportunities and experiences; better integration into the NZ community; improved
ability to help self and others manage the transition to a new environment and
culture; more acceptance, empathy and assistance for those in their community
living with HIV/AIDS.

(ii) benefits for the whole of society:

Education for all sectors of society could contribute to adoption of ‘safer-sex’
behaviours by all those sexually active and hence a containment of the spread of
HIV; a reduction in discrimination and stigmatisation of groups perceived to be more
likely to be HIV infected; acceptance (even valuing) of diversity of cultures, sexuality
and lifestyles; empathy and assistance for people living with HI/AIDS; inclusive
behaviours and practices towards refugees. This could contribute to reduction in
health costs through improved personal health across all dimensions of hauora ( i.e,
not just the containment of the spread of HIV ) resulting in lower demands on public
health services.

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 OHP 1: HIV/AIDS Determinants
In Sub-Sahara Africa

ECONOMIC
• Lack of national financial resources means govts
cannot provide adequate health and education
services and increases widespread poverty

• Foreign countries exploit resources (ie oil, land,

gold, diamonds, humans) which shifts populations
from rural to urban environments, where HIV
rates are higher (male migrant workers,
commercial sex workers, trade routes etc.)

• Anti-retroviral drugs (ARV) are expensive, costs

determined by foreign pharmaceutical companies
who do not produce cheaper/generic products
for widespread use amongst African nations
(patent protection)

ENVIRONMENTAL
• Lack of access to adequate housing, clean water
• High density population living in poverty, which
facilitates spread of diseases such as HIV

• Lack of high quality infrastructure with

adequate medical facilities or schools

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CULTURAL
• Moral beliefs about monogamy for women but
polygamy for males

• Religious beliefs such as HIV is a punishment

from God or caused by bad supernatural spirits

• Denial or ignorance about modes of HIV

transmission due to attitudes to sexuality

• Cultural beliefs about condom use (seen as

threat to masculinity or example of disrespect
or mistrust)

• Early marriages for females to prevent HIV

(often reverse effect happens) and female
circumcision makes women more susceptible to
HIV infection

POLITICAL
• Prevalence of war making many people refugees

• Government health policies that do not provide

support services and medication for HIV
sufferers

• Denial or ignorance about HIV/AIDS situation

by government leaders

• Interference in national economies by foreign

investors

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SOCIAL
• Lack of personal economic resources

• Social exclusion for HIV sufferers because of

stigma

• Lack of adequate care for children

• Lack of adequate nutrition (malnourishment

makes people more susceptible to HIV infection)

• Unemployment leads to increases in sex industry,

drug trade

• Lack of access to health services

INTERRELATIONSHIPS BETWEEN FACTORS

Construct a paragraph to show the interrelationship
between the factors given, ie how the economic,
political, environmental, cultural, and social
determinants can work together to increase the rate
of HIV transmission in Sub-Sahara Africa.

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OHP 2: The Effects of HIV/AIDs
In Sub-Sahara Africa

PERSONAL
• Sickness and physical effects of HIV infection

• Inability to work, go to school or look after

children

• Loss of income and increased strain on limited

resources to purchase medicines, hence poverty
increases due to financial stress

• Increased risk of catching other opportunistic

infections or diseases

• Social isolation due to stigma of being infected,

can often lose companionship if “found out” to be
HIV-positive

• Female children take on adult roles with helping

with other children or looking after sick
relatives; often shortens childhood and
interferes with schooling

• Death

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INTERPERSONAL
• Family members have to care for sick relatives

• Loss of income for families which have to spend

money on medicine or funeral costs; widows and
orphans can lose land, homes and possessions
because property and inheritance rights are
denied

• Productive family members may have to drop out

of school or leave work to care for others at
home

• Grandparents forced to look after grandchildren

when parents die

• Extended families may be forced to take in

orphans from dead family members; again adding
financial stress to limited resources which
increases poverty

• Malnourishment increases in families as

resources are spent on medical care and funeral
costs instead of food; overwhelmed guardians
may choose to feed own children first, leaving
orphans hungry and malnourished

• Normal immunizations of children may be

abandoned because of having to look after sick
relatives; increased risk of diseases such as
malaria or TB in families
SOCIETAL
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• Reduced labour supply and productivity due to
illness and deaths because of HIV/AIDS

• Reduced exports and increased imports reduces

economic growth and increases risk of
governments relying on international economic
aid to get out of debt

• Reduced skills in labour market due to deaths, ie

school teachers and nurses, forcing closure of
schools and lack of medical care

• Increased numbers of orphans needing care

• Females become more at risk and bear the brunt

of the epidemic which increases gender
inequalities; they are most likely to lose jobs,
income and schooling, face stigma and
discrimination and usually care for the sick

• Lower life expectancies for populations

• Poverty and hunger increases by reducing

agricultural productivity and families’ incomes
for food
• Strain on health services as medical sectors are
forced to deal with burden of AIDS patients and
loss of staff due to AIDS deaths

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 OHP 3: Recommendations for
HIV/AIDS
In Sub-Sahara Africa
ECONOMIC
• Increase in global AIDS funding to Sub-Sahara
Africa and ensure funds are actually delivered;
according to World Vision, out of the $10 billion
promised annually for the African AIDS crisis in
2001, to date only $3billion has actually been
paid up. In contrast, after Sept 11, $40billion
was allocated to the war on terrorism.

• Reduction in price for ARV drugs; costs are down

from US$10,000 per patient to US$300, needs
to come down to US$50. This can be done by
foreign drug companies releasing their patents
and enabling technology transfer to African
companies to make ARV drugs locally and cheaply

• Governments direct funding into education

prevention programs and treatment programs;
increase access to condoms, ARV drugs, HIV
counselling and testing, school-based AIDS
education and peer counselling services for those
not in school

• Trade agreements need to be established to

enable Sub-Sahara countries to trade their way

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 out of reliance on international economic
assistance

• Increase funding to health services by

increasing incentives and working conditions for
health workers to reduce impact of labour
shortages due to AIDS-related deaths and/or
skills migration to higher income countries

• Cancelling the debts of Sub-Sahara African

countries to the World Bank in order to enable
governments to put resources into education,
health care and AIDS treatments instead of
paying off loan interests and debt-service
payments

• Strengthening the coping capacity of AIDS-

affected households by providing direct financial
assistance, home visits from health services,
food and nutritional support and waiving of
school fees

ENVIRONMENTAL
• Developing infrastructures at local and regional
levels with adequate housing, water facilities,
schools and hospitals

• Develop rural communities with stronger

infrastructures in townships, agricultural
assistance to develop farmlands (IFAD), try to
develop social and economic change for rural

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 people with microcredit and income generation
schemes

SOCIAL
• Social support structures put in place to assist
families with HIV-positive members

• Assistance programs for families/individuals to

access adequate nutrition, health care and
sanitation

• Anti-discrimination legislation put in place to

assist individuals with HIV obtaining
employment, education and health care

• Financial assistance available to help families

with childcare, especially for those who have to
adopt orphans because of AIDS deaths in
families

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CULTURAL
• Implementation of factual education programs to
dispel myths of HIV transmission and causes
that target specific cultural beliefs and values;
combat stigma of ‘bad spirits’ or a ‘vengeful God’

• Addressing the gender and cultural inequalities

for women by promoting women’s rights and
decision-making strategies, empowerment of
women, development of negotiation skills and to
teach men respect and support of women

• HIV/AIDS education that emphasises the

importance of condoms as an effective barrier
for HIV transmission

• HIV/AIDS education that emphasize social

norms and skills for healthy human relationships,
effective communication and responsible
decision making

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POLITICAL
• Create policies to help reduce the vulnerability
of people by including access to education,
prevention services and enabling the
empowerment of women

• Eliminate AIDS-related stigma and

discrimination through effective legal
frameworks and protecting individual rights
(50% of sub-Sahara Africa yet to adopt
legislation to prevent HIV discrimination)

• Developing national AIDS plans that incorporate

ARV treatments for HIV-positive individuals

• Expand voluntary counselling and testing to

promote widespread knowledge of HIV status,
treatment and prevention

• Political commitment from governments by

showing strong national leadership and ownership
of HIV prevalence (ie in Lesotho, PM and 80
senior civil servants publicly tested for HIV to
break stigma)

• Create mechanisms for civil society and business

to contribute to AIDS response through public-
private partnerships

• Establish accountability mechanisms to track

resources and ensure effective use of them

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