A Critical Analysis of Urban Poverty in those with HIV or AIDS

While those living in urban poverty may be miserable, many of those are also in urban poverty but also suffering from AIDS or HIV, which is the direct cause of AIDS, compounding their problem tremendously. The key issue in regards to urban poverty for those with HIV or AIDS is that urban poverty tends to lead to HIV or AIDS, although not necessarily the other way around, yet since these two diseases are sexually transmitted very easily, the growth of these with HIV or AIDS has the potential to be tremendous in any given area. This paper will aim to examine some of the underlying problems in regards to HIV and AIDS and why urban poverty is an environment these two diseases thrive in, as well as measures that may be taken to alleviate the spread of these two diseases.

The first step is to identify exactly what the term "urban poverty" refers to, in order to gain a clearer idea of just how to objectify it. The general consensus is that urban poverty represents a deficiency of human necessities (Wratten 1995). These human necessities include not just the basics such as food, water, and shelter, but also a lack of more abstract concepts, such as education, employment, or income. In that respect, there are two primary schools of thought in regards to urban poverty definitions. The first is strictly economic, and involves identifying urban poverty via conventional economic definitions such as income, consumption, or a number of other social indicators to classify those in urban poverty against a common index of material welfare (Wratten 1995, p.12). The second school of thought is simply referred to as "alternative," which allows for local variation in the meaning of poverty, and expand the definition to encompass perceptions of non-material deprivation and social differentiation" (Wratten 1995, p.12). In short, this second definition allows for more localized definitions of urban poverty, since urban poverty, in itself, can be a rather abstract concept, while HIV and AIDS are not. These two definitions are the most commonly utilized tools in determining whether an individual is suffering in urban poverty or not, and will be used for definition purposes in this paper as well.

One of the most prominent examples of urban poverty being exacerbated by HIV or AIDS is in some parts of South Africa, where both urban poverty and HIV or AIDS run rampant. In fact, one of the greatest causes of the spread of these diseases in South Africa is the rise of sex with many partners. One author refers to this concept as "the materiality of everyday sex" (Hunter 2010, p.4). Essentially, this means that there are a number of social, economic, and political issues at work in South Africa and, because of these issues, physical intimacy, including sex, has been increasing, leading to higher and higher rates of HIV and AIDS. One of the most immediate causes of increased intimacy and, thus, HIV and AIDS prevalence is the rising unemployment problem in South Africa. This goes hand-in-hand with the growth of urban poverty in South Africa, suggesting that these two problems are, indeed, intrinsically related to one another. The unemployment problem in South Africa is grave. In just 2005, 72 percent of women and 58 percent of men between the ages of 15 and 24 were unemployed (Hunter 2010, p.5). This has also caused a reduction in marriage rates in South Africa, and has become almost exclusively, as the author calls it, a "middle-class institution" (Hunter 2010, p.5). Furthermore, the urban poverty in South Africa is a self-fulfilling prophecy of sorts, because it perpetuates the growth of HIV and AIDS, which, in turn, contribute to the growth of HIV and AIDS, where approximately 68 percent of all 33.4 million global infections of HIV and AIDS exist (Hunter 2004, p.6). The most probable way these HIV and AIDS specifically interplay in South Africa is simple. The most likely explanation for this, as is common with nations suffering from economic crises, is that the economic hardships put a strain on the providers of the household, causing stress, strain, arguments, and, eventually, breakup or divorce. This then leads to promiscuity in both parties, and a continued spread of HIV and AIDS. This is exacerbated by the increase in prostitution that also develops when nations suffer from deteriorating economic conditions, which naturally increases the rate HIV and AIDS for citizens, especially those in the lower economic classes, and in poverty. One example of this can be found in South Africa's KwaZulu-Natal region, which suffers from a large number of HIV and AIDS cases (Peltzer et al 2006). Historically, this province has been the victim of a large amount of industrialization, which, in the 1970s and 1980s, created a cultural and physical rift between whites and blacks in the province, with many blacks being left out of jobs in the province (Hunter 2004). The incidence of HIV only increased when the KwaZulu homeland merged with the Natal province in 1994 to form the province today, which contains 9.4 million of the country's 44.9 million people (Hunter 2004, p.19). This led two struggling areas, which were similar already but at least distinct in terms of geography, to be merged, leading to further intermingling of the largely infected population there, further cementing the province as one of the largest breeding grounds for HIV and AIDS in South Africa (Peltzer et al 2006). This example serves as a telling demonstration of how HIV and AIDS' intermingling with urban poverty can exacerbate the symptoms of both problems, leading to even greater losses.

Another nation facing a growing poverty crisis is none other than the United States. While the United States remains a relatively healthy nation in terms of economics, there is a growing polarization between the rich and the poor, leading to a greater number of those in urban poverty and, as in South Africa, a steadily decreasing number of citizens in the middle class. Here, there are fewer cases of HIV and AIDS than in South Africa, even in those who live in urban poverty, but those who suffer from HIV and AIDS and live in urban poverty are nevertheless suffering in an entirely different way. Most notably, urban poverty in the United States is growing at an alarming rate, and although the specific rate is difficult to pin down, experts have referred to is as an "epidemic," which helps to put the scale of this problem into perspective (Singer 1994, p.933). Unlike in South Africa, the aspects of urban poverty within the United States are tied more with both economic and, sometimes, racial issues than other countries. For example, according to one study "The vast majority of urban-dwelling African-Americans, as well as Latinos, are members of the low paid, poorly educated working class that have higher morbidity and mortality rates than high-earning, better educated people" (Singer 1994, p.933). Essentially, this means that there is still a polarizing gap between those in urban poverty, or those in danger of entering it, and those who have more income, except the factors leading to this polarization are much more diverse in the United States, as factors such as political, socio-economic, or environmental, are much more varied than other countries such as South Africa (Singer 1994). As a result, urban poverty in the United States does not necessarily mean that, for example, an individual is living out of their van, or under a bridge, barely scraping by. Oftentimes, it can mean that they are simply living well under specific income margins, or simply live in what would be considered "a bad neighborhood." However, taking HIV and AIDS into the equation complicates matters, as those living with these diseases in poverty, in both the United States as well as the rest of the world, must either seek medical help with their disease, or simply "live with it," and both of these undesirable choices have detrimental effects to society at large.

First of all, the financial implications of having HIV or AIDS are tremendous, and, coupled with an individual already living in urban poverty, this can put a tremendous toll on his or her financial resources, unless some form of insurance or assistance can otherwise be acquired. Those living in urban poverty with HIV or AIDS also have certain tendencies, which help to paint a picture of the lifestyle of which a large number of those are living every day. For example, in terms of age, one study shows that those living in urban poverty who also have HIV or AIDS are most likely young adults: for females, in their twenties, and for men, either in their late twenties or early-thirties (Van Donk 2002 p.4). Other common demographics include women in general, although the reasons for this differ from country to country, as gender equality is an issue that had varying levels of reception, depending on the country, so women are oftentimes forced into urban poverty, in many cases (Van Donk 2002). Of course, those in urban poverty with HIV or AIDS are also much more likely to be very poor than those merely living in urban poverty without HIV or AIDS, as those who are poor have the fewest resources or knowledge to prevent infection from HIV or AIDS (Van Donk 2002). Illegal immigrants, for any country, are also much more likely to live in urban poverty with HIV or AIDS because they are oftentimes unable to access the same public services afforded to native residents of a country (Van Donk 2002). It should be noted that this concept is not unique to countries like the United States, but virtually all nations with a significant amount of illegal immigration. Finally, prostitutes are also much more likely to live in urban poverty with HIV or AIDS simply by virtue of their profession, which often involves sexual activity with other low-income clients, and, through this sexual activity, HIV or AIDS is allowed to spread to many different people simply through one infected individual (Van Donk 2002). These factors mean that some specific demographic groups, such as poor black women, are at an even greater risk of HIV or AIDS infection than someone who possess merely one of the above factors (Van Donk 2002, p.5). Of course, the exact factors that lead to urban poverty or HIV or AIDS infection differ greatly from country to country, but the above factors are the most prominent aspects of those living with HIV or AIDS in urban poverty.

However, the specific factors within urban poverty that actually lead to HIV or AIDS prevalence levels are not necessarily consistent, as there have been a number of studies that have been performed, each finding slightly different findings. For example, one study found that food insufficiency associated with inconsistent condom use with a non-primary partner, and general lack of control in sexual relationships led to higher prevalence of HIV, and that higher educated women, but not men, were less likely to report high-risk behaviors, which are proven to lead to higher chances of HIV (Gillespie 2007, p.S7). This calls into question the prevailing notion that those in urban poverty suffering from HIV or AIDS only come from one relatively small pool of disadvantages covered earlier. Another study found that belonging to a household in the middle wealth category (essentially, what is commonly referred to as the middle class) increased the risk of HIV seroconversion, with additional education (i.e. college education) only reducing the hazard of HIV seroconversion by 7 percent (Gillespie 2007, p.S7). However, residing within an urban residence, the same study found, increased the hazard of HIV seroconversion by 65 percent (Gillespie 2007, p.S7). These studies essentially question the part that wealth has in those living within urban poverty contracting or spreading HIV or AIDS, with other factors, such as education level, sexual promiscuity, and geographical living area, playing much greater roles. What these studies do help to solidify, however, is that there is a definitive, concrete link between certain factors and HIV or AIDS transmission. Thus, those living in urban poverty with HIV or AIDS are much more likely to be sexually promiscuous, live within a heavily populated, urban area, and possess a below-average education, although many of the studies posted earlier call the validity of the education aspect into question, as many of them found an inverse relationship between education level and HIV or AIDS prevalence.

Another general constant for those living in urban poverty with HIV or AIDS is that receiving medical care tends to be extremely difficult. While the reasons explained above for the difficulty of acquiring care still ring true, the issue is also a bit more complicated than that, as there are a number of factors at play here, many of which are constant even across different nations. One of these factors is that caring for those with HIV or AIDS puts an increased strain on the urban area, town, or city within which an individual resides, and this care comes with its own share of negative effects for all parties involved. "…looking after people living with HIV and AIDS does deepen poverty in town as well as in the village. It can stop people going to work or force them to take leave. Households may even employ someone to care for the sick person, or, if people are involved in the informal economy, it can result in reduced business" (Gillespie 2006, p.194). This means that even having one individual in urban poverty with HIV or AIDS puts a strain on the resources of the community at large, slightly decreasing the quality of life of everyone around him or her. On a larger scale, the effects of this can be profound, forming a sort of snowball effect, as can be seen prominently in many of the areas of South Africa. This is also due in large part to the extreme contagiousness of HIV or AIDS, as it is, at present, a permanent affliction, and even an individual who is receiving aid can still transfer the disease to others if they are not careful. This is why so many countries place vital importance on diagnosing and attempting to decrease the chance of exposure of HIV or AIDS in an individual, because the disease can very easily get out of hand, and, in countries without socialized medicine, the care must come from their own pocket, from the community at large, or not at all. Even for countries with socialized medicine, the prevalence of those living in urban poverty having HIV or AIDS puts considerable strain on their resources, meaning that either taxpayers must pay more, or that care will be spread thin as a result.

Another crucial aspect of urban poverty within the confines of HIV or AIDS is the social stigma associated with it. The simple fact of the matter is that those living within urban poverty are already largely outcast from their own community, but when those same people also have HIV or AIDS, those problems are compounded tenfold. Not only are they seen as unfit for society, they are seen as unclean as well, to be avoided at all costs, and this makes establishing a hold of their life difficult for many. This stigma oftentimes causes people, within any country, to refuse to acknowledge the presence of one in urban poverty suffering from HIV or AIDS. Furthermore, many see these people as leeches to society, especially those who are receiving socialized care for their situation, which creates psychological toil for the sufferer in addition to their other host of problems. Oftentimes, this stigma can actually spread to the friends and family of the affected, further widening the scope of psychological damage caused by the mere stigma of one living in urban poverty with HIV or AIDS. While this compounded stigma is detrimental to their chances of success, this problem is also one that can be fixed with the right application of information, counseling, coping skills acquisition, and contact. Perhaps the most effective step to reduce stigma, according to one study, is to utilize some sort of additional intervention strategy for the sufferer, such as counseling or coping skills acquisition, which the study found was effective in changing the attitudes and behaviors toward the sufferer, although the actual strategy for performing this counseling or coping skills acquisition tend to be varied (Brown et al 2003, p.15). In the vast number of studies performed, the most effective ways to reduce overall stigma seemed to involve a number of different factors, such as role play, presenting factual information in an attempt to remove ignorance, open conversation to reduce negative feelings, and simple social contact with the person in urban poverty (Brown et al 2003, p. 24). While these measures will not work in every situation, they do serve as guidelines for how to alleviate one of the greatest hurdles that those living in urban poverty suffering from HIV or AIDS must struggle through every day.

Perhaps the most depressing and sickening consequence of those living in urban poverty having HIV or AIDS is the possibility of their children being born into a bad situation, or, even worse, increasing the odds that they themselves will get HIV or AIDs at some point in their life. Unfortunately, this is a sad reality for many parts of the world, since sexual promiscuity, it has been established, is a telling factor in determining one's chances of both living in urban poverty and suffering from HIV or AIDS. One study, conducted in Tanzania, focuses on the effects that HIV and AIDS have on those suffering in urban poverty. One common factor in this scenario, the study found, is that many children in this situation find themselves unable to subsist within their own home, since urban poverty, compounded with HIV or AIDS, severely inhibits their ability to provide even the basic necessities for their child or children (Evans 2002). In fact, the interview found that 75 percent of young people cited their family's inability to provide their basic needs as a major contributing factor in forcing them to leave their homes (Evans 2002, p.53). As a result, the study found, many of these children end up as orphans, who "…experience loss, sorrow and suffering long before the eventual death of their parents, due to the psychological trauma of a long-term fatal illness that afflicts their parents, combined with the increasing domestic burden of nursing their dying parents, caring for their siblings or elderly grandparents, and increased work in the fields" (Evans 2002, p.54). This means that many of these children in Tanzania, as well as all other countries in the world, have a large part of their lives utterly ruined by urban poverty, coupled with HIV or AIDS, because it eliminates the connection they have with their parents and native home. In fact, the very act of running away from the home of one both in urban poverty and suffering from HIV or AIDS represents a core survival strategy that children simply should not have to go through at their age, yet must, if they are to survive. Essentially, this means that those people suffering from HIV or AIDS in urban poverty are subjecting not just themselves to the negative effects of both, but also their children as well, and, some would argue, that fact alone is even worse than all of the other damage caused by HIV, AIDS, or urban poverty combined.

Living in urban poverty is horrible. Living with HIV or AIDS is horrible. Combined, they form a perfect storm, of sorts, that creates a nightmare scenario for the affected as well as their friends, family, and anyone else who must support them. Perhaps worst of all, the disease spreads extremely easy, and not just for HIV or AIDS, either. In many cases, urban poverty is a self-fulfilling prophecy, of sorts, creating a snowball effect that can cause entire cities to be thrown into poverty, such as many in South Africa. Having to worry about HIV or AIDS on top of that simply compounds the problem exponentially, and creates living situations that are both miserable yet inescapable. However, all is not lost for those suffering in urban poverty with HIV or AIDS. While there is no hard cure for the disease, there are ways to suppress it, and many of the symptoms that come with these two negative factors can be decreased in severity as well. For example, those suffering in urban poverty have resources at their disposal to improve their situation by relying on their community, such as soup kitchens or other providers of necessities. This way, those individuals are able to escape from urban poverty and focus on living their lives. While HIV or AIDS and urban poverty can break the mind and body of an individual, they are not exactly a death sentence. Recovering does require a great deal of time and money, in most cases, as well as the support of the community in order to alleviate the social stigma involved, but overcoming these obstacles only makes one stronger, in the end.

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