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May 16, 2023
  • Communicable diseases are the type of diseases that can be transferred from one person to another through mediums like air, water, body fluids or vectors like mosquitoes and houseflies. These are the type of diseases that are most widespread. Few of the most common communicable diseases are influenza, malaria, tuberculosis, HIV, Hepatitis, etc. According to the World Health Organization (WHO), billions of people around the world are affected by these diseases and approximately four million dies annually.

    The causal organisms for these types of diseases are bacteria and viruses. Most of these microorganisms propagate immensely in poor hygienic environments and are then transported into the human bodies by insects, contaminated food and water, through the air, etc. Many of them like HIV transfer from human to human through contact with bodily fluids like blood and semen. These diseases, at the time of their origin, were very deadly as the microorganisms that were the cause of the diseases were novel and had not been adequately studied. Not just that, the development of technology in the field of medicine had not been developed as it is today, two decades ago, therefore, finding cures for these diseases were very difficult. The cures for these diseases took a long time to develop and these communicable diseases caused all the epidemics in the history of the world. Even today, the emergence and spread of the novel coronavirus which is the cause of a communicable disease has caused a pandemic and wreaked havoc on the world.

    Tuberculosis and HIV/AIDS in South Africa as a politico-economic problem, social problem and medical problem

    Tuberculosis is a bacterial infection of the lungs (mainly) which causes coughing and sometimes bloody sputum, weight loss, night sweats and fever. The bacterium that causes this contagious disease is Mycobacterium tuberculosis. The disease is mainly transmitted via air. Tuberculosis can be of two types. One is latent that maximum of the population suffers from. It doesn’t cause any symptom in the body and is nothing to be worried about. The other one is an active type that manifests in the form of symptoms like severe coughs, bloody sputum, weight loss, etc.

    HIV which is the commonly used term for Human Immunodeficiency Virus is the causal organism for the disease AIDS. HIV causes the immune system of the human body to be weakened and if left untreated and uncontrolled, it will lead to AIDS which is a permanent failure of o body’s immune system leaving the body susceptible to a variety of other diseases.

    The problem arises when HIV/AIDS is combined with other diseases that make even light diseases deadly to a person infected by the virus. Therefore, if an individual carries latent tuberculosis and gets infected by HIV, the combination of these two diseases will prove fatal to the individual. In most cases, latent tuberculosis seldom manifests into an active case. Only about five per cent of the latent cases have chances of developing into active TB in later life. The latent TB is also quite sensitive to antibiotics and proper completion of the treatment course with a combination of drugs can eradicate the disease. However, in cases when the treatment course remains incomplete or the effect of drugs is not desirable, the disease transforms into multi-drug resistant TB (MDR-TB), which is a major source of concern to the present-day medical officers and researchers. This kind of cases can be seen in South Africa which had severe consequences for the citizens of the country. Approximately two per cent of the cases in South Africa are MDR-TB (Dye and Williams, 2019).

    South Africa is one of the poorest countries in the world in terms of its health care facilities and developments. The population of South Africa are burdened by both communicable and non-communicable diseases and the situation is not any better than it was some two to three decades ago. The present healthcare condition of the country indicates that more than seven million people are infected by HIV. South Africa is currently the centre of the biggest HIV epidemic in the world and the Kwazulu-Natal region of the country is the epicentre of the epidemic. The country has been suffering from an HIV epidemic for the past few decades and this has in turn aggravated Tuberculosis. The condition worsened with the introduction of multi-drug resistant strain of tuberculosis bacteria. Today, tuberculosis is the leading factor for the death of people in Africa. It causes the death of every three out of ten people in the country (Abayomi, 2014).

    The people of the country are quite wary of these contagious diseases that plague them and there are several underlying reasons for this. Some of these reasons are the economic condition of the country that leads to poor living conditions of the population, the social disparities, the political instability of the country, etc. In terms of the political situation, the country is not at its best which is reflected in the economic situation of the country. Poor economic condition deprives the citizens of the country of basic needs to a comfortable and healthy life. The country lacks proper infrastructures, transportation and healthcare facilities that make controlling and curing diseases a mammoth task for the healthcare workers. Also, human resource in the public health care sector is dwindling which make the task all the more difficult. This lack of human resources can, in turn, be attributed to the lack of infrastructure and education in the country. These two factors are complementing and fuelling one another just as is the case for HIV and TB. The HIV epidemic gained momentum not only because of the poor politico-economic condition of the country which resulted in poor healthcare or medical facilities but also the social implications and stigma that comes attached with the disease or infection. The misconception that HIV is only transmitted through sexual intercourse and that the infected individual is amoral or a disgraceful person makes HIV/AIDS a social taboo. Religious doctrines and ideologies prevalent in society also play a huge role in it. The society is ignorant of the fact that the virus is transferable through blood as well. But more than that the judgemental eye of the society renders the infected individual shameful to admit and take necessary measures for its cure on time. The stigma attached to the disease may result, or rather, has resulted in people infected by the virus to not seek help when it is crucial.

    Although, the situation in South Africa looked bleak at the beginning of the epidemic the situation has somewhat come under control. However, it cannot be said to be under control to a great extent but new light can be seen. The country invested more than a billion USD in the year 2017 to run programs aimed at combating HIV. It also has the world’s largest antiretroviral treatment (ART) programme. It has also shown progress in its UNAIDS 90-90-90 targets. Although measures and programmes are being adopted to curb the epidemic, there is still a considerable number of cases and works for its betterment is still being done.

    Critical Medical Anthropology and Tuberculosis and HIV/AIDS epidemic in South Africa

    The branch of medical anthropology, Critical Medical Anthropology is considered to be the theoretical perspective which focuses on the health of human populations and its relation to the economic and political structures of the world. It emphasises on the impact of political and economic powers upon the sickness and welfare of humans. It is focused more on the critical histories of the society rather than just on the physiological and biological justification when the medical treatment and the health of each individual are involved. The critical medical anthropologists have been carrying out researches on people around the world who doesn’t have access to medical care due to any political or economic outcomes. These researches are carried out on both macro and micro level with the results that people sometimes make tough decisions to live a lifestyle where they do not have access to proper nutritious foods and medical facilities which gives rise to numerous health problems. Critical medical anthropologists have worked around the world has worked with various labour unions, community organisations and self-health as well as self-care groups (Carboneutica, 2015). Critical medical anthropology also advances on the modern practices related to healing, sickness and health that is entirely based on this ethnographic fieldwork and brings into focus the social roots as of the wellbeing as well as the disease.

    Principles of Critical Medical Anthropology

    According to Merrill Singer who is a critical medical anthropologist, there are seven key principles of critical medical anthropology (CMA) and they are:

    • The first principle of CMA defines health as access to and control over non-basic and the basic material resources that are used to promote and sustain life at peak satisfaction. The approach sees the disease as both social and biological rather than just the latter, and the approach is meant to discover the relationship that might exist between the social and biological roots of the disease.
    • People living biologically in social and economic inequalities have been discovered to experience inequality transcribed in their bodies as well. This principle has been proven by work done by Paul Farmer and Clara Han respectively.
    • The principle of syndemics was introduced in the mid-1990s by CMA which evaluates the work of curing illness as quarantined as well as the dissimilar kind that is free of the societal contexts. In simpler words, it can be described as more than two epidemics and their way of interacting synergistically inside the human bodies which amount to an extreme burden of ailment in the people (Witeska-Młynarczyk, 2015).
    • Principle of sufferer’s experience focuses on the assumption that sick people live through their illness within a society according to the way their daily life has been shaped by the political and economic forces and socially constructed meanings.
    • Another principle of critical Medical anthropology includes medicalization popularised by Irving Zola and Ivan Illich who were both sociologists. Medicalization describes the cycle of scientific medicinal expansion along with the evolution of humans.
    • Another principle of CMA is called medical hegemony which was built by moulding and relating medicalization to the capitalist economy of the world. Medicalization was given new meaning through this principle. It was established as a process through which one class tends to control the intellectual as well as the cognitive life of society through structural means rather than a coercive one (Witeska-Młynarczyk, 2015).
    • The principle of medical pluralism implies that several remedial customs are present in contemporary society. It has been implied that national medical systems are dominant over other medical practices.

    Applying the principles of Critical Medical anthropology with the Tuberculosis and HIV/AIDS epidemic in South Africa

    The main reasons behind tuberculosis and HIV epidemic in South Africa have been related to various political-economic, social and medical problems. This can be related to the poor governing management of the country which has resulted in the underprivileged economy of the people of South Africa. The poor lifestyle of most of the people within the country as a result of inequality and also negligence in the management of patients as well as fragmented health services is what transpired the spread of these two contagious diseases. This is because, with the poor economic condition within the country, people are forced to adopt a poor living standard and living close to these disease-causing bacteria and viruses. This can be directly related to the principle of critical medical anthropology emphasizing on the social and economic inequalities among the people.

    The principle of syndemic can also be related to the condition that persists within South Africa. Various researchers over the year have concluded that latent tuberculosis may be present in several individuals but do not necessarily manifest its symptoms. It has been found that most of the HIV patients of South Africa manifest the symptoms of latent tuberculosis in individuals and has found these two agents of the epidemic to interact synergistically with each other. This results in an extreme burden of ailment in the patients like pointed out through the critical medical anthropology principles of Merrill Singer.

    Though HIV and tuberculosis have become very common in South Africa the sufferer stills lead their life according to the socially constructed meaning of this illness. Sometimes individuals may be suffering from HIV/AIDS due to their high-risk behaviours (Avert, 2018). However, this is often misinterpreted by society and marginalises the ones suffering from these diseases. It has also been found that the myths and misinformation increases the discrimination as well as the stigma surrounding HIV/AIDS which can be related to the principle of sufferer’s experience where the people living with illness has to lead their lifestyle according to the social norms and socially constructed meanings

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