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A Case Study of the HIV/AIDS Epidemic in the United States. Mapen

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A Case Study of the HIV/AIDS Epidemic in the United States. Mapen ABSTRACT The Relationship between Rhetoric and Public Health: A Case Study of the HIV/AIDS Epidemic in the United States. Mapenzi Joy Smith Director: Dr. Beth Lanning, Ph.D., MCHES People living with HIV who perceive high levels of HIV-related stigma are more likely to abstain from testing and treatment for HIV and experience negative feelings towards themselves due to their positive HIV status. The perception of stigma directly impacts their health and wellbeing. This aim of this thesis is to investigate the relationship between rhetoric and health outcomes for those living with HIV/AIDS to understand better the role that health communication may play in forming and perpetuating stigma for this population. To evaluate this relationship, articles from The New York Times, The New York Native, The Washington Post and excerpts from Randy Shilt’s book And the Band Played On detailing the HIV/AIDS epidemic in the United States between 1981 and 1990 were assessed as a comprehensive narrative to analyze the portrayal of those infected with or at high risk HIV/AIDS. Maurice Charland’s theory of Constitutive Rhetoric was used as a rhetorical approach to determine the implications of audience identification on public perception of the virus and public perception of themselves concerning the virus. This analysis uncovered that negatively constituted identities might result in stigmatization, marginalization, and discrimination towards a specific population, which in turn, may lead to poor health outcomes. This research provides new insight on the power of scientific narratives and seeks to caution the media on how the construction of scientific narratives, specifically narratives that can constitute identity, may directly impact an individual’s health outcomes. APPROVED BY DIRECTOR OF HONORS THESIS: ________________________________________________ Dr. Beth Lanning, Ph.D., MCHES, Department of Public Health APPROVED BY THE HONORS PROGRAM _______________________________________________________ Dr. Andrew Wisely, Interim Director DATE: ______________________ THE RELATIONSHIP BETWEEN RHETORIC AND PUBLIC HEALTH: A CASE STUDY OF THE HIV/AIDS EPIDEMIC IN THE UNITED STATES A Thesis Submitted to the Faculty of Baylor University In Partial Fulfillment of the Requirements for the Honors Program By Mapenzi Joy Smith Waco, Texas May 2021 TABLE OF CONTENTS List of Figures .............................................................................................................. iii List of Tables .............................................................................................................. iii Acknowledgements ...................................................................................................... iv Chapter One: Pathology and Origins ............................................................................1 Chapter Two: On Science Communication, Rhetoric, and Stigma .............................16 Chapter Three: Methodology ......................................................................................24 Chapter Four: Results ..................................................................................................34 Chapter Five: The Constituted Identities and Health Implications ..............................44 Bibliography ................................................................................................................54 ii LIST OF FIGURES FIGURE ONE: Conceptual Framework of HIV/AIDS Related Stigma .......................4 LIST OF TABLES TABLE ONE: Selected Articles from The New York Times ..................................... 29 TABLE TWO: Additional Articles used in Text Selection ........................................30 TABLE THREE: Selected Articles from Morbidity and Mortality Weekly Reports ..31 iii ACKNOWLEDGMENTS I am deeply indebted to Dr. Lanning. Thank you for your unwavering support and dedication to this project. It has been an honor to have been your student these last four years. I have become a better writer, a better thinker, and a better public health practitioner because of you. You have taught me what it means to serve with your entire being through your commitment to me and each of your students. Thank you. I would like to express my deepest appreciation to my committee members: Dr. Kelly Ylitalo and Dr. Ashley Barrett. Thank you both for your insight into this work, for your commitment to me, and to its success. I am forever grateful for the time, patience, and work you have put into creating this document. To my parents, you have taught me compassion, love, joy, empathy for my neighbor, and the Source of all that is good. To my dad, thank you for giving me your heart for those living with HIV, for being ever patient and ever-loving, and always turning my eyes to focus on Jesus. To my mom, thank you for supporting me in every aspect of college. Thank you for providing a path for me to pursue my dreams. You have taught me to be strong and courageous and to always trust in what God has for us. To Kathryn, you have taught me so much wisdom and brought me so much joy. I dedicate this work to you. To my dearest friends, thank you for reminding me to take a break and for being home for me here in Waco. I would not have been able to complete this project without you all. To Trey, you have been a rock through this process. Thank you so much for listening to and always supporting me. You have been steadfast, compassionate, and ever-loving. iv CHAPTER ONE Pathology and Origins of HIV/AIDS The aim of this thesis is to explore the relationship between HIV/AIDS, science communication, and public health outcomes. In order to achieve this goal, an understanding on what HIV/AIDS is, what its origins are, and the way it affects the body is important. The understanding of the disease itself, specifically how it is transmitted and the largest demographics affected, provides a framework for understanding how the disease was interpreted in a social context. What is HIV/AIDS? Acquired Immunodeficiency Syndrome (AIDS) is caused by two lentiviruses, human immunodeficiency viruses type 1 and 2 (HIV-1 and HIV-2) (Sharp, 2011) Lentivirus is a genus of retrovirus, a type of virus that inserts a copy of its ribonucleic acid (RNA) into the deoxyribonucleic acid (DNA) of the host cell (GeneTherapy, 2020). The insertion of the invading RNA changes the genetic material of the cell. Once inside the host cell, the virus integrates itself into the host's DNA and begins transcribing and translating the viral genes while incorporating the viral DNA into host's genome (NIH, 2018). Following replication, the virus leaves the host cell and proliferates throughout the body, infecting other cells. HIV/AIDS targets and infects vital cells in the human immune system, including helper T cells, macrophages, and dendritic cells (NIH, 2018). Helper T cells or CD4+ cells are white blood cells whose primary function is to recruit other immune cells to destroy the invading organism (NIH, 2018). When these helper T cells 1 die, as in those with untreated HIV or severely immunocompromised, the body cannot detect and destroy the infections. This reduced immune capacity leaves the body vulnerable to a range of infections, many called opportunistic infections (CDC, 2020a). Signs and Symptoms of HIV Without treatment, HIV infection advances in stages. The first stage is acute HIV infection. Most individuals within this stage are unaware that they have been infected with HIV, but may start having symptoms two to six weeks after infection (NHS, 2018). During the acute stage the body's immune system begins to fight against the virus. Early signs include headaches, fatigue, aching muscles, sore throat, swollen lymph nodes, red rash on the torso, and fever (NHS, 2018). Testing for HIV is critical in this stage so the infection can be identified in the early stages and antiretroviral therapy can be started to keep the immune system healthy (CSH, 2020). Stage two is called the asymptomatic period or chronic HIV infection. In this stage that the HIV continues replicating itself throughout the body infecting and killing CD4 cells and destroying the immune system (WHO, 2017). One may remain in this stage for decades, usually about 10-15 years before moving into stage three. It is important to note that if untreated, transmission can occur even if the individual is asymptomatic. Understanding the first two stages of the disease gives insight into how and why this disease spread and became an epidemic in the 1980s in the United States. Stage three, AIDS, is late-stage HIV infection. In this stage, the CD4 counts have decreased to below 200 cells/mm3 (cubic millimeters of blood) (CSH, 2020). For comparison, normal CD4 count ranges from 500-1,400 cells/mm3 in adults and teenagers 2 (CSH, 2020). When the count drops below 200, the individual becomes highly susceptible to many opportunistic viral, bacterial, and fungal infections as well as various cancers. Fungal infections that are characteristic of AIDS include candidiasis, cryptococcosis, and histoplasmosis. Candidiasis is caused by an infection with the fungus Candida. This is deemed an opportunistic infection when it causes severe infections in the mouth or vagina, in the esophagus, trachea, bronchi, or deep lung tissue (CDC, 2020). Cryptococcosis is a fungal infection caused by the fungus Cryptococcus neoformans. These fungi typically enter the body through the lungs and cause an infection of the lungs (pneumonia) or affect the central nervous system (CDC, 2020). Histoplasmosis
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