Gender Disparities in UK HIV Care

Introduction

As per the research of Hayes, Prior and Campling (2017), women currently consist of one third of the number of HIV affected patients within the United Kingdom. Apart from this, women also comprise of one quarter of the entire numbers of the new HIV diagnosed patients within the UK. Furthermore, Leung (2020) have outlined that a third of the HIV affected women at the UK, currently, are aged 50 years and above with extensively demanding and complicated healthcare necessities. However, empirical evidence pertaining to healthcare research could indicate the fact that development of healthcare assistance services for the personnel has not been designed and tailored to meet the necessities of such female patients pertaining to their specific health support requirements. To this effect, the corresponding research study based essay would be striving towards the addressing of existing knowledge gaps regarding the gender inequality measures which persist within the UK healthcare structures pertaining to the female HIV patients. The essay would be attempting to provide an overview of the epidemiological conditions of HIV with respect to female patients so at to evaluate the HIV testing progresses along with the quality of care which could be received by the women within UK. Furthermore, the research process would also highlight the Intersectionality Theory to specify the necessity to apply a process of health and clinical service enquiry in terms of formulation of the sociological research approach pertaining to the research topic under consideration. The concept of Intersectionality would also be significant from the perspective of exploratory investigation of multiplicity of conditions of disparity which are embodied in the existing and observable structural and functional components of UK healthcare concerning performance of HIV treatment.

Analysis

According to Burch (2016), the growth in the interest in multiple embodiments regarding the gender inequality status within the UK pertaining to the female HIV patients, could be acknowledged from the perspective of the chronological continuation of the Feminist critique of the second wave of Feminism which had originated in the West. Judd et al (2017) have argued that the crux of such feminist criticism had been on the disregard or downplaying of the gender disparities which exist within the UK healthcare framework, both at the operational and policy parameter constitutional levels, involving especially the HIV affected female patients. This strand of argument has also emphasised on the necessity to treat multiple differences in healthcare services implementation, at the collective and interpersonal levels, as the sum total of distinctive individual discriminations perpetrated by the incumbent healthcare functionalities. As per the research of Samuriwo et al (2020), in terms of the diagnostics based trends which could be identified at the UK health industry in the previous years, some pertinent facts have been identified. According to Campbell and Gibbs (2016), the new cases of confirmed HIV diagnosis which have been performed in the UK during 2017, in terms of identification of the female HIV positive patients, have been 1106 only. The majority of such female patients have been either of 15 years of age or above. This could be identified as approximately only a quarter (26%) of the entire number of diagnosis (4334 cases) performed in the UK pertaining to the HIV affected patients. Jenkins (2018) has projected such statistical observations to be a case in point regarding the shortcomings of the UK HIV care mechanisms in terms of furnishing gender needs specific support since the numbers of diagnosis performed in the year 2017 had been a considerable decline (13%) in comparison to the numbers of cases which had been diagnosed during 2016 (1265 cases) (Horter et al. 2020).

Pascoe, Peacock and Stemple (2018) have juxtaposed such data with the number of HIV diagnoses which have been performed involving heterosexual men. The increment of 23% in cases involving 770 (2016) to 1000 (2017) cases, has been reflective of the evidence regarding the existing gender disparity and inequality in health service provisioning. In this context, Galárraga and Sosa-Rubí (2019) have opined that voices of women have been conspicuously missing from the medical as well as social discourses involving patients who have been infected by and have been forced to live with HIV and such observations have also brought forth the realisation that women have been and are continued to be underrepresented in the HIV research and treatment development procedures. To this effect, Machado (2020) have drawn attention to the publication of the report by the Sophia Forum and the Terrence & Higgins Trust in a combined manner, named as the Women and HIV:Invisible No Longer which had first come into circulation during the year 2018. This specific source of information had claimed that equal attention to the needs, conditions and voices of women affected by HIV, has been overdue in terms of formulation of effective and credible policies by the NHS, the development of the infrastructures through which such required services could be administered and finally, in terms of the research which could be undertaken to explore further the issues which are coming forth with time pertaining to the gender based dimension of HIV affected populace at the United Kingdom. The study, according to Rayment et al (2017), had utilised the conceptual extension of the Blinder-Oaxaca (BO) decomposition approach for the purpose of quantify the data which have been derived from Demographic and Health Surveys (DHS) performed by the National Health Council and, additionally, from the AIDS Indicator Surveys performed by the WHO at the national level of the UK. The quantification has been performed with the purpose of outlining the differences in the prevalence patterns of HIV between men and women and to further attribute such differences to the socio-economic and demographic factors which could be observed in consecutive studies. One significant element of this research has been the concentration of the research emphasis on the awareness measures of young women pertaining to various effects of AIDS. Anderson et al (2017) have further analysed the performed study so as to highlight that the gender inequalities have been categorised into two specific components. These have been the percentage of findings which could be attributed to the differential levels of potentiality of risk factors amongst men and women (identifiable as the composition effect) and the percentage of findings which could be attributed to the risk factors related to the differential and diverging effects regarding prevalence of HIV/AIDS in cases of men and women who have been diagnosed by the health services in response to the estimates (this could be further identified as the response effect)

Womack et al (2017) have observed that although the conducted survey, highlighted by the previously mentioned report, has not been exhaustive and, to this effect, the strategy documents could not be expected to reflect the resolutions necessary to address the gender inequalities in terms of allocation of proper resources towards development of services which could be adequate and effective to address the necessities of women specifically, however, as far as the constituents of ill health could be concerned, three specific patterns could be understood to emerge from the conducted research. According to Greenhalgh et al (2016), the first one is the factor that the element of gender could outline the relation between the concern for accessing of adequate healthcare by women and the process through which issues pertaining to the gender of the HIV positive patients could be streamlined. The orientation is towards enabling all of the women to have equitable access to gender sensitive care. According to Crosby and DiClemente (2018), this pattern brings into focus the next aspect which could be understood to be the necessity to address gender inequalities and to further strengthen the response of the healthcare policy implementation mechanisms towards focusing such policy development procedures on such necessities which are particularly associated with the female patients. Finally, the third pattern involves the normalisation of existing survival and health inequalities on the basis of gender identification of patients. From an academic perspective, according to Chinouya et al (2017) , the element of Gender could be acknowledged to be one of the most significant influences which could determine the direction of development of healthcare related knowledge and associated behavioural aspects which could further signify the measure to which equitable, gender sensitive and efficacious administration of necessary care could be imparted to the patients under consideration. Desai et al (2019) have pointed to the relative scarcity of the global data sets which could be compared and contrasted in this context as well as towards the limitations of the available data sets in terms of focusing on particular conditions which could involve distant objectives such as Millennium Development Goals (MDGs). There are also only a handful of cross-sectional sets of data which could be utilised so as to compare the existing patterns of healthcare seeking and intervention coverage of both men and women. Furthermore, the existing cross-sectional surveys are also not representative of any consensus of all of the determined research outcomes, rather, considerable contradiction exists in between such researches. One particular aspect in this context has been outlined by Piercy et al (2019) to be that of the gender norms in existence pertaining to the overall social/cultural norms which could put constraints upon the autonomy of such women concerning their choices of seeking healthcare for their HIV afflictions as per their own accord and as per their determined timeframe. From the perspective of Peña-Fernández, Peña and Escalera (2018), this has been the reason which has precipitated the relative decline in the rates of diagnosis of HIV affected women since such observations have brought into considerations that women could opt less to seek treatment for considerably long term based ailments such as AIDS. Furthermore, Aebi-Popp, Mulcahy and Gilleece (2020) have stated that some of settings of healthcare provisioning at UK have culminated in the outcome of imposition of gender-inequitable access to the necessary care mechanisms. One such element could be determined to be the out-of-pocket expenditure regarding HIV care and associated health complications which have consecutively heightened the propensity of having to incur a comparatively unsustainable healthcare expenditure and associated costs which have deterred female led households further from attempting to access such care services.

Brown et al (2018) have observed that the quality of HIV treatment and associated clinical care outcomes pertaining to the female patients have been below than the required qualitative threshold. This could be supported from the perspective that the objectives specified by UNAIDS in terms of gender sensitised care have not been met amongst women. The objective had been to suppress the HIV strain within at least 80% of the female patients so that they could not pass the virus on any further. In this context, Clifton et al (2016) have observed that that viral suppression within the women, who could be placed within the relatively young age group of 15 to 24 years, has been much lower in comparison to that of the older women. According to Geretti et al (2017), the latest data derived from the United States Agency for International Development (USAID) and the World Health Organisation (WHO) have specified that continuation of HIV transmission within the UK health structure has not been arrested by the differential policy implementation and the inadequacy of gender related particular care necessity addressing has contributed to the considerable late diagnosis of more than 50% of the diagnosed women with HIV. Rutstein et al (2017) have also emphasised on the fact that the Positive Voices survey performed during 2018 had driven home the necessity of further improvement of the existing health functionalities and the implementation mechanisms of the formulated health policies so as to address the complications associated with social stigma, financial hardships, loneliness and barriers of disclosure of the HIV status of such female patients. The dearth of the support measures for HIV affected women at the UK in terms of the previously mentioned issues has also underscored the requirement of development of better and greater tailored healthcare responses to the diversified and complicated health issues of female HIV patients. According to Downie, Mactier and Bland (2016), these issues mostly pertain to the reproductive functionalities of HIV affected women and could be detailed, from the bio-pathological perspectives, as services which could assist the female patients regarding the menopause and fertility phase associated complications. However, considerable issues also exist involving the mental health conditions and social necessities of such women. To this effect, the previously mentioned observation of women comprising of 1/3 of the personnel who have been diagnosed with HIV infection has been clarified by Baylis et al (2017) as 31% of all of the registered cases of diagnosis (28669 cases of female HIV patients out of the totality of 93385 diagnosed cases). Similarly, out of the entire numbers of 4334 new HIV diagnoses performed during 2017, 1106 have been the cases which involve women of relatively younger age groups. Furthermore, this statistical research has established the fact that incidence of HIV infection within women at the UK in the previous 5 years has been almost halved in comparison to the decade which preceded those 5 years.

Lee et al (2020) have determined that 57% of the women, who have been diagnosed with confirmed HIV strain, had contracted the disease within UK. Out of the entire number of women who had been born abroad and have been diagnosed with the HIV, 42% are projected to have acquired the disease after they had arrived at UK. While, as per the research of Blackstock et al (2017) , the number of female patients who have been subjected to late diagnosis, has declined from 740 during the year 2013 to 560 in 2017, the percentage based proportion which have been diagnosed late with the disease have remained relatively high (50%) till 2017. The data derived from the national level health surveys, according to Adams and Balderson (2016), have indicated that women who have been diagnosed late, have been most probably living around 3 to 5 years with the disease in the undiagnosed conditions. From the demographic perspective, Moseholm and Weis (2020) have outlined that the educational levels amongst HIV positive women at UK is generally high with two fifths of such patients being either graduates or post-graduates. In terms of employment status, 58% of women who have been diagnosed with HIV have been either employed partially or had been employed permanently. However, such personal conditions did not translate to the improvement of their status in terms of HIV affected patients and the subsequent observations also highlighted the dearth of social and medical support mechanisms within the UK healthcare sector concerning addressing the gender specific requirements of the AIDS affected women. To this effect, 69% of the diagnosed women have conveyed their inability to meet their needs pertaining to their daily amenities such as electricity, medications, rent and provisions due to monetary complications. This statistical measure has been compared by Sannathimmappa and Nambiar (2019) with the 62% of the HIV affected men who have also experienced such complications. On average, the ratings associated with the HIV support services have not been rated much high by women (4.3 out of 10) (Wilton and Doyal, 2018). Two particular shortcomings have been outlined by Booth (2017), pertaining to the efficacy of UK healthcare systems to support women diagnosed with HIV and these have been the inability to impart sufficient social agency to such women to manage their social conditions through acquisition of financial stability and the absence of involvement of such female HIV patients in the decision formulation process regarding their treatments. This second shortcoming has been highlighted by Weait (2020) to be the contravention of patient centric care principles. This observation has been instrumental in terms of explaining the relative greater propensity of HIV diagnosed women at UK to be affected by Depression (28%) as well as Anxiety (20%) in comparison to HIV diagnosed men with 17% propensity of getting affected by Depression and 13% probability of becoming troubled with Anxiety. This disparity in pathological and psychological conditions could as well be observed to extend into other ailments such as Obesity where 41% of the HIV diagnosed women could become affected by this disease inn compared to 24% of HIV diagnosed men(Carter et al. 2017).

Intersectionality of gender inequality in health service provisioning at UK

From the performed research, it has been evident that increasing interrelations could be identified through different axes of social determinants and influents such as gender and economic status. This process is not an additive but an intersecting one and, pertaining to the intersection between gender and healthcare inequalities, the study has also brought forth the realisation that the resultant impacts on health status of HIV diagnosed women, including that of gaining proper access to healthcare, have been extensive. According to Anderson et al (2017), the concept of Intersectionality, in terms of the research context under consideration, could suggest that intersecting stratification procedures could extensively alter the outcomes and influences of any particular dimension of inequality, such as that engendered by gender based considerations, within any operational framework, such as the UK health sector. The healthcare inequalities involving HIV affected women have been primarily inveigled by disparities in gender sensitive approaches which have been required by the healthcare sector within UK to implement. This could be better explained from the perspective of Stopard, Hauck and Hallett (2019) as gender could influence the manner in which risk factors have been translated into the health outcomes for the HIV diagnosed women at UK. However, the intersections in between the element of gender and the health outcomes have been complex. This complication could be understood to be the extensive variability of responses towards unaffordable or inaccessible HIV care services.

Conclusion

At the conclusive phase, it could be ascertained that the preceding study has been instrumental in terms of establishment of the rationale that the healthcare institutions within the UK are required to focus on the health support mechanism improvements for women affected by HIV infection since gender inequalities could impart intense and often unmanageable effect on the social and biological conditions of women/girls who could contract such terminal illnesses such as AIDS. It is a universal fact that women/girls are less privileged and have lesser numbers of opportunities in comparison to men and the socio-economic structure of the UK is not much different to such observations. Therefore, it is of urgent necessity to redress the existing imbalances in healthcare service impartation which do not correlate to the gender specific necessities of female patients diagnosed with HIV. This process could as well be considered to be a complementary component of the promotion of gender equality throughout the social architecture of the UK. The improvement of service delivery and attribution of greater significance to the female patients in the process of development of treatment and support policies by the healthcare institutions would be the focal point of any such mechanism of redressing the gender specific issues within the UK healthcare industry. The ultimate objective, in this context, would be the establishment and promotion of absolute gender equity within such healthcare services.

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