12/21/11

Wednesday, December 21, 2011

HIV/AIDS Prevalence in Nigeria


 


The Human Immunodeficiency Virus (HIV) is the biggest challenge to the contemporary biomedicine and social sphere. It has remained the topical disease condition that has afflicted man in recent times (Okechukwu, 2007). Understanding the prevalence and patterns of HIV infection and risk behaviors are important for every country irrespective of the stage of the epidemic or the level of HIV prevalence (Panchaud et al, 2002, pp11-29). Especially, a country like Nigeria which is classified as one of the most populous HIV/AIDS infected country in the world (Herek at el. 2002). Apart from the typical medical difficulties that the Nigerian HIV/AIDS infected patients suffer, like the devastating health condition of the patients, expensiveness of the treatment and lack of the availability of treatment facilities; social stigmas are also crucial factors in the deteriorating health condition of the HIV/AIDS patients. Because, HIV/AIDS- related stigma are directly linked to the delays in testing and the initiation of treatment (White et al. 2005 pp347-359). In this paper I will try to investigate that in a country like Nigeria, which is one of the world’s most infected region in terms of HIV/AIDS infection;the social norms and sexual behaviors of the people are hindering in collecting the correct records of the infected. Also instead of coping with the elimination of this epidemic the society is seem to be rather taking active part in discriminating the infected patients and then labeling them with social stigmas.

                         Nigeria is one of the developed countries of Africa (UNGASS, 2007). The country lies on Africa’s west coast and occupies 923,768 square kilometers of land bordering Niger, Chad, Cameroon and Benin (UNGASS, 2007). The country is currently under a democratic government for a third consecutive term of 4 years each after about 30years of military rule (UNGASS, 2007). In Nigeria, an estimated 3.6 percent of the population is living with HIV and AIDS (UNGASS, 2010). In 2003, 290,000 children in Nigeria were estimated to be living with HIV/AIDS. (UNAIDS, 2004) Its prevalence is high among young people in Nigeria, especially young women. Among those ages 15-24, the estimated number of young women living with HIV/AIDS was almost twice that of young men (US,NIC, 2002). Although HIV prevalence is much lower in

 Nigeria than in other African countries such as South Africa and Zaia, the size of Nigeria’ population (around 149 million) means that by the end of 2009, there were 3.3 million people living with HIV/AIDS (UNGASS, 2010). The HIV/AIDS cases were first reported in 1986 by the international AIDS conference, shortly after which the Nigerian government established the National AIDS advisory committee which was then followed by the NEACA (Establishment of National Expert Advisory committee) on AIDS. The Nigerian government was slow in responding to the rapidly growing AIDS pandemic until 1991 when the Nigerian government finally established Federal Ministry of Health to abate the spread of HIV/AIDS. The result that it showed was astonishing, as 1.8% of the Nigerian population was infected with HIV/AIDS and it rose from 3.8% to 4.5% from 1993 to 1998 (Sofo et al. 2003). Health condition of the people of Nigeria started to get better when Olusegun Obasanjo became the president in 1999. His regime focused extensively on the health care facilities of the people and prevention strategies against HIV/AIDS. The government ruled out three-years HIV/AIDS Emergency Plan (HAEP) in 2001. In 2005 a new framework was developed covering the period from 2005 to 2009 (Adeyi et al. 2006).

Despite such influential strategies from the government side to control the epidemic, in 2006 it was estimated that only 10% of HIV infected men and women were receiving antiretroviral therapy and only 7% of pregnant women were receiving treatment to reduce the risk of mother-to-child transmission of HIV (UNAIDS, 2008). Therefore, another mega-scale project was launched to rule out the possible prevention and treatment expansion in general public of the Nigeria from 2010 to 2015 through comprehensive National Strategic Framework, which requires an estimate of 5 billion USD to implement (All Africa, 2010). This framework is supposed to reach 80% of sexually active adults and 100% of most-at-risk population through HIV counseling and testing, also to improve the access toquality care and support services to at least 50% of the people living with HIV by 2015 (NACA, 2009). The legal fight for resource control, the fight over the system of control (Sharia), the economical and political struggle to regulate the petroleum sector are considered to be the only crucial state issuesbut the vital issue regarding the control of overgrowth HIV/AIDS infection is sidelined (UNAIDS, 2008) This doubtful scenario of the Nigerian government put the battle against AIDS in jeopardy. This country is at verge of disastrous rate ofhttps://writer.zoho.com/images/spacer.gif infections and death, however, unless quick remedies are made sure.

HIV/AIDS in Nigeria is transmitted through three ways; heterosexual sex, blood transfusion and mother-to-child transfusion (UNGASS, 2010). Some small scale studies also show the transmission of HIV/AIDS through injecting drug users. In Nigeria there is a distinct lack of HIV testing programs. In 2007, just 3% of health facilities had HIV testing and counseling services (WHO, UNICEF, UNAIDS, 2008) and only 11.7 percent of women and men aged 15-49 had received an HIV test (UNGASS 2010). In 2009 there was only one HIV testing and counseling facility for approximately every 53,000 Nigerian adults (UNGASS, 2010).

Apart from management issues regarding the health facility in Nigeria, the collection of statistics and data regarding HIV/AIDS infection is problematic and sometimes unreachable. During the mid 1980s to the mid 1990s, most countries concentrated their resources on documenting the prevalence of the virus (UNAIDS, 2000).  However, although HIV prevalence data provide some indication of the level of HIV in the general population, most existing HIV surveillance systems are yielding insufficient or unreliable data or data that are difficult to interpret and that do not capture the diversity of the epidemic in different population groups or do not adequately measure and explain changes over time (Ibid). First of all, the time of infection is difficult to detect, because the test that is used to determine the prevalence of HIV at some point will show a combination of different infections which may be recent or happened many years earlier (Ibid). Prevalence that is stable or decreasing may reflect past trends, may mean a recent decrease in new infections, may reflect omission of groups with an increasing rate of infection, or reflect changes in the likelihood of being tested or a combination of these factors (Ibid, 1998). In addition, current systems rarely monitor behaviors that provide early warning signs of the possible spread of HIV and do not help to identify subgroups most at risk of infection (Panchaud, 2002). In order to improve the existing methods of recording and tracing the infection WHO/UNAIDS proposed a method by adapting to the context of changing epidemic profiles (Ibid). With the international collaborative work to get an understanding of HIV surveillance led by WHO/UNAIDS resulted in a synthesis document; setting new guidelines for a second generation of HIV surveillance. This includes:
https://writer.zoho.com/images/spacer.gif“(a) Tailoring the surveillance system to the pattern of the epidemic in each country.
 (b) Concentrating data collection in population subgroups most at risk of becoming      newly infected.
  (c) Collecting more data on sexual behaviors.
 (d) Making better use of other sources of information (for example sexually transmitted diseases “(Pachaud, 2002).

The goal of these assessments is to arrive at some interpretation about the usefulness of the literature that is currently in use and to provide insights into ways of improving HIV surveillance in a developing country like Nigeria with relatively few resources, so as to obtain, the best possible measurement of HIV prevalence and indications of future trends (Ibid, p12). There are different approaches to measure the prevalence of HIV/AIDS infection which range from a broad focus on the entire population through sentinel surveillance. That is the screening of donated blood known as sero-prevalence studies at the national level. On the other hand, at the micro level, studies focus on small targeted-group that is at high risk of transmitting HIV. Sentinel surveillance is usually based on unlinked screening of blood and measures HIV prevalence in selected population subgroups (usually women seeking prenatal care, STD clinic attendees, and commercial sex workers) (Ibid, p13). Although this type of study indicates national coverage, but due to its limited capacity associated with a particular sub-group, it is difficult to provide an overall statistics of the whole population. Sero-prevalence studies arean opportunity for testing and counseling. The main shortcoming in such studies is that they are costly and time consuming (Ibid).

WHO/UNAIDS has formulated a rather extensive approach to measure and indicate the behaviors attached to HIV infection-transmission (UNAIDS, 1998). The indicators contain number ofsexual partners, engaging in casual or commercial sex, usage of condom, availability of condom at national level as well as local level and the quality of awareness about HIV/AIDS among general population (Panchaud et al, 2002, p14). And to carry on with such strategies, cross-https://writer.zoho.com/images/spacer.gifsectional behavioral surveys are conducted. That, usually, includes socio-demographic information. Panchaud et al. conducted such surveys which included 35 studies on HIV prevalence and methodology. Of which, 34 studies were conducted to indicate the sexual behavior of Nigerian people. Half of these studies contained samples greater than 300 (Ibid). Although, different strategies were used to indicate the prevalence of HIV in the same population sample, but the data which were collected, indicate that those behaviors which are associated with sexual transmission of HIV /AIDS are, somehow, similar (Ibid, p20). Studies which constituted number of sexual partners indicate that males (aged 15 years and above) are more likely to have two or more partners (17%) than females in that same age group (Rossem et al. 2000). Panchaud indicated that people who are classified as occupational group (those who are employed), are more commonly engaged in multiple sexual partners. This indicates high cases of sexuality in work places (Panchaud et al. 2002, p21).

Much effort has been done by the Nigerian government to get realistic and useful data regarding the prevalence of HIV/AIDS infection which resulted in some substantial outcomes (Ibid, p25). A lot of such data were made possible using the sentinel system which is, somehow, considered a backbone of HIV/AIDS surveillance in Nigeria and also in many developing countries (Ibid). However, a lot of improvement in the collection of such data has been reported, but on the other hand, it posits many challenges particularly in many developing countries like Nigeria.

“Testing of blood is required by most methods used to determine HIV status,
a procedure that may be too expensive and difficult to perform at the necessary
scale in countries where health systems are insufficiently developed and that
lack resources to make testing facilities widely available” (Ibid, p26).

Not only the accessibility of drug in treating HIV is the issue, the reduced incentive to be tested is also one of the crucial factors which hinders in broad scale treatment of this epidemic. One of the major factors in the reduced-incentive to be treated is the ‘stigma’ attached to HIV/AIDS inhttps://writer.zoho.com/images/spacer.gif Nigeria. Also, the lack of confidentiality is considered to be an undeniable factor which often discourages people from adopting treatment procedure and take advantage of medical facilities (Panchaud et al. 2002, p26).

HIV/AIDS has been associated with negative connotation, and it is especially prevalent among those who suffer from devastating illnesses. Particularly, those patients who suffer from HIV/AIDS infection are usually the worst victims of social stigmatization. Erving Goffman defined stigma as a ‘deeply discrediting’ attribute in the context of a set of relationships (Goffman, 1963, p3). Stigma, is therefore, an undesirable potential that an individual posses which decreases the status of the individual in the eyes of the society. Under Goffman’s definition, an individual is thus labeled as deviant by the society (Goffman, 1963, p 5). The same kind of concept was presented by Jones et al, who said that stigma is any attribute that links a person to undesirable characteristics. Discrimination, on other hand, is an aspect of stigma which can also be called as marginalization by the society due to stigmatization.
Stigma is expressed in three ways (Okechukwu, 2007).
     (a)    Instrumental expression: it involves the individual’s concern and perception about the risk of his having the disease. In short it is manifested by the infected individual.
     (b)   Symbolic expression: it is expressed on a broader scale by the political and religious setup of that particular region. It also includes the cultural and social valves that play a vital role in creating an environment that breeds stereotypical trait in individuals.
     (c)   Courtesy expression: it includes the manifestation at the organizational and nongovernmental level which are associated with the HIV/AIDS (Ibid).
Discrimination against the HIV/AIDS patients make them ostracized. The infected people choose to live a life a rejection and avoidance. These prejudices, expressions and manifestations have been reported through different surveys (ibid, p2).

Thorough studies done by Emmanuel Monjok, Andrea Smesny and E. James Essien on the Nigerian population have further classified the affects of S&D (stigma and discrimination) on individual patients who suffer from HIV/AIDS into three levels. At individual level S&D leads tohttps://writer.zoho.com/images/spacer.gif identity crisis,isolation, loneliness, low self esteem and lack of interest in containing HIV/AIDS (Valdiserri, 2000). That can further lead to lack of motivation to carry on with the prescribed prevention procedure and reduced care taking behavior (Parker, 2003). At the community level, the families who take care of the patients are also prone to stigma and discrimination. Therefore, open support from the community is highly reduced. At the institutional level, the patients can lose their jobs by forced termination or resignation, and, therefore, are treated with hostility. Discriminative acts among healthcare workers include, delivery of poor quality treatment and counseling services, early discharge from hospital, segregation of hospital wards, isolation, the marking or labeling of patients beds, files and ward, selective application of “universal” precautions and lack of confidentiality (Ehiri, Anyanwu, Donath, kanu, Jolly, 2005). Discrimination against the HIV/AIDS patients is so intense that at some point in time in their lives many infected individuals become suicidal when they get their diagnosis done for the first time. Because they know that they will face a discriminatory attention of the society. Such thoughts become the source of their mental illnesses like post traumatic disorder, generalized anxiety disorder insomnia and panic attacks (NYSDH, 2006, p. 1-8). Unluckily, the association of HIV/AIDS with sexual relationship, this disease is looked down upon through different lenses. Cancer is too a life threatening disease but the accompanying and social support of the family and sympathy of the society make the patients to at least hold on to their healthy conception of their self. Such a notion of the society makes the cancer patients to engage in health seeking behaviors and at least they are emotionally willing to do so. On the other hand, HIV/AIDS patients try to hide their disease from the society because they are afraid of the response they will get from the peers. They know that they will never get the support of the family or friends. They won’t even seek forgiveness or engage in religious activities. They perceive themselves as the cursed ones.
             It can be argued that it’s the society of Nigeria which associates stigma to the patients who suffer from HIV/AIDS. These social norms are more lethal than the medical malfunctioning itself as in case of HIV/AIDS patients, if the care and surveillance is failed to remove the unwillingness to be treated then they can become the direct cause of the increase in HIV/AIDS rates. As AIDS related stigmas can cause a delay in treatment, poor treatment adherence, and greater number of new infections (Goudge etal, 2009). Goudge et al. through case studies on the Nigerian populationhttps://writer.zoho.com/images/spacer.gif illustrated various response to diagnosis, like anger, violence, blame, shame, withdrawal, grief and depression. Most of the patients areneglected, and sometimes are verbally abused. These conditions expedite signs of betrayal, and disappointment of fractured relationship and fear of a potential fatal disease.
The risk of transmitting HIV/AIDS is also increased due the false conception about sexual practices. Jordan Smith conducted a survey and recorded many case studies regarding the faulty conception which in turn increase the risk of spreading the HIV infection. He presented a case study of a 23 years old boy named Ike, who sold electrical appliances in Aba, a southern region of Nigeria. When he was asked about the usage of condom, his remarks showed carelessness about the inherent risk that they seem to accept. His remarks were, somehow, same as were shared by many other young adults of his age (Smith, 2007, p 228).

“I use condoms with loose girls, you know, the ones who have
Sex anyhow. They could give you something a man has to
protect himself. But if a relationship is serious like being in love,
then I can trust My partner and we would not have to use them.
You have to know your Partner’s character” (Ibid).

 Same kinds of remarks were made by the females of Nigeria. Smith (2007) mentions one case study where a 20 years old girl, named Chinwe, who works as receptionist in her uncle’s Business in Kano.

“You have to respect yourself, or no one else will respect you. It's
dangerous to sleep around here and there. If a girl is going to have
sex, she should know her partner and be able to trust him.
Some guys go about putting the thing here and there.
https://writer.zoho.com/images/spacer.gifFor me to have sex, I have to love the man and know that he
loves me. ... I think it's always good to use condoms, but
with a partner that you love, who you can trust, it's not as necessary.
My boyfriend and I don't always use condoms because
I know I can trust him” (Smith et al, 2007, p. 228).

Many Nigerian men, usually, think of those girls who ask their boyfriends to use condom that they have already been engaged in sexual behaviors before or have many sexual partners which make the girls to keep silent about the usage of condom. Otherwise, their relationship would be jeopardized (Smith, 2004, p. 230). “Oneyebuchi, a 24-year old apprentice learning to repair electrical generators in Kano, reflected some young men’s attitudes”:
                        “if a girl keeps a condom in her room, you will feel somehow,
                        like she is professional.” (Ibid)

In such circumstances the behavior of the women’s reluctance to initiate discussions of condom use is understandable (Ibib).

It is, therefore, evident that the young males and females of Nigeria associate the issue of HIV/AIDS with morality and conceive it on religious grounds. The idea that the relative risk of acquiring HIV/AIDS isassociated with the morality of a sexual relationship is further reinforced by religious interpretations of the AIDS pandemic and religious discourses about premarital sexuality (Green 2001; Takyi 2003; Smith 2004). Most of them are Christian and religiosity is increasing in the youth (Marshall 1993; Marshall-Frantani1998; Smith 2004). Therefore, religious understanding of this pandemic promotes the morality of the issues related to HIV/AIDS; many religious as well social figures depict HIV/AIDS as a consequence of the immorality of the society. People tend to associate this pandemic with God by saying its God’s curse onthe people who have lost the right path ofhttps://writer.zoho.com/images/spacer.gif glory. Several other believe that AIDS is God’s punishment for their sin. The words of Nnenna, a 19 years old girl living in Kano (Nigeria) illustrate such proposition. “AIDS is a terrible thing. But this place is like Sodom and Gomorrah. Nigerians are being punished for their sins. If people did not have sex here and there, if the society were not so corrupt, there would be no AIDS.... Yes, it is God's punishment, but we have brought it on ourselves” (Smith, 2007, p. 229). So it is quite clear that the general perception of AIDS is more than just a pandemic. It is considered to be an evil sign and those who are inflicted have been morally as well as religiously degraded. So the societal valves of the infected patients are reduced and therefore stigmatized. Not only are that, the discussion regarding safe sex and usage of condoms during intercourse sidelined. As religion convince people that their misery is because of their deviation from the true path and when they return to right path by waiting and holding their sexual desires till their marriage, will make them clean in God’s eye and therefore, they will no longer be affected by HIV (Ibid). Chidi, a 21 year old, living in Aba expressed his thoughts in the same way. “I know that condoms are supposed to prevent AIDS. But you cannot count on them. They could be old or have a hole or break. If God wants you to get AIDS, it will not matter how you try to protect yourself. The best thing is to have faith in God“(Ibid). This behavior of abstinence until marriage or finding true love projects their thoughts about the importance of morality. Growing emphasis on notions of love as the basis for acceptable pre-marital sexuality when fused with religious interpretations of AIDS as punishment for sin creates a context where open discussion of condom use can be seen as suggesting that one, one's partner, or one's relationship is immoral and risky. Religious interpretations of sex and of AIDS decrease the perceived need for condoms within "moral partnerships," (Ibid). Such model of conception sidelines the risk of getting infected which cannot be argued within the circle of their conception. Ifeoma, a 23-year-old woman who braided hair in the Sabon Gari market in Kano, offered a common description of couples' negotiations concerning condom use (smith, 2007, p. 229):

“You use a condom because you do not want to get pregnant. How could you tell a guy that you want him to use a condom because you fear he might have AIDS? If I thought a guy had AIDS, I would never agree [to have sex with him] even with ten condoms. Tofiakwa! [God forbid such an abomination!] Even if you want to be careful, you know, and you do not know the guy very well, can you imagine asking him to put on a condom and telling him it is because you fear he has AIDS? Besides the insult, I mean, that would ruin the whole thing” (Ibid).
https://writer.zoho.com/images/spacer.gif 
Not surprisingly, things like condom which is used as a prevention technique of getting infected from HIV/AIDS are infected with the stigma. (taylor, 1990; Hillier et al, 1998). The stigma that surrounds HIV/AIDS infection is due to its association with sexual relationship which in Nigeria is considered the object of intense moral scrutiny (Smith, 2007, p. 230). To talk about the risk that this infection entails and to take decision for the usage of condom is like bringing the consciousness into account when young people engage in having premarital sex which is more likely to be avoided by these young Nigerians (Caldwell et al, 1989). Additionally, with the rise of the idea of love in this context makes it even more complex to create awareness on purely rational grounds as people make decisions which go against medical serenity and these people are more likely not concerned about that at all. Even, premarital sex is not discussed as sinful, religiously, if the couples are found out to be engaged in romantic love and they consider it as a moral partnership. It is because, the conception of morality regarding premarital sex, particularly for a woman, depends on the notion that the relationship is a romantic relationship and therefore don’t need any worldly ideas to hinder in its way (Ibid).

Health Issues of Illegal Aliens in America

   United States of America is home to the largest number of illegal immigrants in the world. The illegal immigrant population of the United States in 2008 was estimated by the Center for Immigration Studies to be about 11 million people, mostly from Mexico, India, China, Philippines and South American counties (Preston 2008). The biggest incentive for the immigrants to migrate to America is the economic incentive. International polls by the Gallup organization have found that more than 165 million adults in 148 foreign countries would, if they could, move to the US, which is the most desired destination for migrants (Clifton 2010). The government of the United State of America has stepped up to reduce the population of foreign aliens in America. From passing the bills in Congress against illegal immigrants to increase border patrolling, the government has doing a lot to stop illegal immigrants from trespassing into America. These policies have quite an adverse effect on the lives of millions of illegal immigrants; especially the health issues have been increased. The isolation of these immigrants from the health coverage and the lack of access to health care services have deteriorated the health of undocumented immigrants. Particularly, the female immigrants have become the biggest target of these policies. In short, structural violence is perpetrated against the illegal migrant because of their illegal status in the world’s biggest democratic country.

            In order to grasp the deeper picture of the immigrants in America, we must look into the history of immigration in America. The immigrants in America have a long history. What America is today is because of the immigrants. Since the discovery of the Americas in 15th century by Christopher Columbus many immigrants of different nationalities have settled in America. American immigration history can be viewed in four epochs: the colonial period, the mid-nineteenth century, the turn of the twentieth, and post-1965. Each period brought distinct national groups, races, and ethnicities to the United States. The first of all were Dutch, English and Spanish settlers who came to seek their fortune in a new country which was thought to have unlimited resources. Many new settlements were founded by these arrivals. The Swedes and French followed them. After the independence of the United States of America in 1776, many immigrants were imported to America as slaves because cheap labor was necessary for the rapid industrialization of the country. The mid-nineteenth century saw mainly an influx from northern Europe; the early twentieth-century mainly from Southern and Eastern Europe; post-1965 mostly from Latin America and Asia. Slowly and steadily they all were incorporated in to the American family. As Hasia Diner, a professor of history at New York University, explains,”Tens of millions of immigrants over four centuries have made the United States what it is today. They came to make new lives and livelihoods in the New World; their hard work benefited themselves and their new home country” (2008).
                                
                             I will use different anthropological theories to frame my analysis of the data. The main theory I will use is ‘Critical Medical Anthropology’. Critical Medical Anthropology is a theoretical approach within medical anthropology that focuses on the political economy of the health and health care (Singer 2004). It examines the influence of government policies and the economic system of a country on the health of the general population. It puts emphasis on culture histories, rather than purely biomedical and social explanations of analyzing health and applies critical theory in the consideration of the political economy of health, and the effect of social inequality on people's health. I this paper I will examine the affect of US policies on the health of illegal immigrants. The worsened health situation of illegal aliens because of their exclusion from health care services, low wages, poor working and living conditions and their lower socio economic conditions can mainly be attributed to the actions and policies of the government. Moreover, the paper will analyze the sufferings and agonies of illegal immigrant women from the feminist perspective. Drawing arguments from feminist theories I will look into some issues of female illegal immigrants.
           
                                  Many bills have been passed in recent years by both the state and federal governments to decrease the population of illegal immigrants and stop them from trespassing into America. The proponents of the bills have welcomed these steps taken by the government while some have criticized these bills by calling them unconstitutional and racist decisions by the policy makers.  In such an act, the then government of the State of California passed a bill, Proposition 187, in 1994, which was called “Save Our State” by its proponents, in which the government eliminated all public services including health, education and other welfare schemes for undocumented immigrants (Balin 2008). The advocates of this bill assert that the money spent on the education, health care system and overall welfare of illegal immigrants put a lot of burden on the state treasury and while in the period of recession it is necessary to take such steps. Though Proposition 187 didn’t last for a long period but it encouraged and motivated other state governments to take such bold steps. Following the steps of Californian state government, the government of Arizona has recently passed a bill which is even more extreme from the one passed by the Californian government. The bill gives power to the police to demand proof of citizenship upon a lawful stop, detention or arrest (Archibold 2010). Though these policies could be an effective way to force the illegal immigrants to leave the country but it also has drastic effects on both the immigrants and the citizens of America.
            
                                        The most affected social group by America’s policies on illegal immigrants is the women immigrants. The exclusion of illegal immigrants from using public health services has greatly affected the health of women aliens. Women need the health care services more than the men do. The number of women immigrants in America has been increasing and it is estimated that about 3.2 million illegal immigrant women reside in America, who are marginalized and living in an extreme poverty and shabby conditions (Casey 2004). These women come to the new land to seek opportunities for their families, to improve their lives and the lives of their current or future children.   They are exposed to vastly different and dangerous scenarios because of their sex. They are highly vulnerable to sexual harassment at workplace. They are exploited because of their illegal status and are forced to work on low wages. Miriam Yeung of the National Coalition for Immigrant Women’s Rights (NCIWR), who is an active advocator of the alien women, says, "Despite their contributions to our economy, these immigrants live at the margins of U.S. society -- subsisting on poverty wages, enduring humiliation and exploitation in the workplace, and living in constant fear that their families will be shattered if they are detected,"(“Immigrant Rights”). Language and cultural barriers have made it more difficult for them to seek health care services. These hapless women could barely speak English which have added more miseries to their already challenging lives. According to a report patients who face such barriers are less likely than others to have a usual source of medical care; they receive preventive services at reduced rates; and they have an increased risk of nonadherence to medication. They are also more likely to leave the hospital against medical advice (Flores 2006). Moreover, most of the illegal immigrant women do not seek any help from the legal authorities or report any crime perpetrated against them because of the fear of deportation. Silvia Henriquez, the executive director of the National Latina Institute for Reproductive Health, tells a story of Juana Villegas, an illegal immigrant, who was dishonored and treated harshly by the police officers,

“Just two years ago Juana Villegas was arrested for a routine traffic
violation in Nashville after leaving a clinic for a pre-natal visit and
detained when she was unable to produce a license. Despite the fact
that driving without a license is a misdemeanor in Tennessee that
generally leads to a citation, Ms. Villegas was taken into custody due
to suspicions about her immigration status. Ms. Villegas was jailed for
six days, during which time she gave birth to a little boy while shackled
to a bed under the watchful eye of the sheriff’s officer. Barred from
speaking to her husband, her baby was taken from her upon birth,
leading to a number of health repercussions for both mother and baby.
Local police stood by their actions, calling Nashville “a friendly and open
city to illegal residents.” In a chilling display of Nashville’s
“friendliness,” local police also confiscated Villegas’ breast pump.(Henriquez 2010)”
            
                        Another problem that illegal immigrant women face in America is giving birth to babies in American hospitals. Due to the medicalization of women health by biomedicine in today’s world, giving birth to babies in hospitals is viewed necessary. Though according to American immigration policies, emergency health services including delivering babies can be availed by the undocumented immigrants, yet the alien women face severe situations during their pregnancy and labor. The only coverage by the state that is available for an undocumented alien pregnant woman is the cost of delivery. The medicines and other health services required by these pregnant women have to be covered by themselves. Due to their poor socio economic status, it is very hard for these women to bear the cost of the expensive health services and medicine. Lack of access to adequate health services after childbirth leaves both child and mother in worsened health conditions.
            
                       The illegal men and women immigrants are not the only one that is being suffered by the US immigration policies. The children born to parents whom citizenship status is illegal also share the ordeal for a long time.  There are about 363,000 children born to illegal aliens each year (Cohen, Jeffery and Passel 2009). There are two kinds of immigrant children in America: those who are born to parents who have illegal status in the country and those who are brought to the country illegally or unaccompanied. Moreover, every year more than 8,000 unaccompanied illegal immigrant children arrive in America. These children come to America to seek protection, freedom and safety from the indignities of abuse, mistreatment, torture and even human trafficking that they have been forced to endure. According to a study by researchers, children whose parents are illegal immigrants or who lack legal status themselves face uniformly negative effects on their social development from early childhood until they become adults. Many illegal immigrant parents work long hours in low-wage jobs, sometimes more than one job. They live mostly from hand to mouth. Given that the medical treatments are quite expensive in America and most of them are uninsured, consequently their children do not get proper health care. On the other hand, America itself could suffer from its own current policies. Anchor babies, a term given to the children born to illegal aliens in America, automatically acquire US citizenship. These children are the future of America.
            
                      A question remains unanswered that whether the American government actions and crackdown against illegal immigrants are justifiable. Are they really a threat to the US economy? The issue of whether illegal immigrants are beneficial for the economy of the United States of America or a burden on the country’s economy is debatable. Many contemporary economists have focused on the negative economic effects illegal immigration have on the labor market. These critics have argued that significant numbers of illegal immigrants harm the economy by displacing low-skilled natives, depressing wages and neutralizing market pressures that would otherwise result in a rising trend in wages (Djacic 1997). American workers and politicians have adopted this line of reasoning in calling for stricter immigration controls to protect US jobs and the wage structure. On the other hand, many economists are in the favor of the presence of illegal immigrants in America. They take help from classical economics which hold that immigration benefits the host country because it subsidizes the labor supply (Nadadur 2009). In other words, the sending country bears the costs of raising a worker to the age when s/he is ready to enter the labor market. . As a result, the sending country pays for the labor productivity of the receiving country. According to this argument, immigrants also positively benefit the economy by increasing demand, spurring investment, and keeping receiving-country industries competitive through enhancing capital productivity (Borjas 1994). Scholars have also argued that illegal immigrants perform jobs that no US worker will be willing to do; as a result, these scholars hold that reducing the illegal immigrant population would be devastating to the US economy (Lerman and Schmidt 1999). Illegal immigrants also positively contribute to the US economy as consumers in the market. It is estimated that 90 per cent of the wages that the undocumented population earns are currently spent inside the US (Hinojosa 2005). As a result, he holds that the total consumptive capacity of illegal immigrants remaining in the US is around $450 billion (Cater et al. 2005). Therefore one can infer that the presence of illegal immigrants in America is beneficial for the country because they have a significant and positive impact on the US economy.
           
                          The exclusion of illegal immigrants from getting the public health services have also made American citizens vulnerable to many contagious diseases. The diseases which had been eradicated from America long ago like tuberculosis, leprosy, polio, dengue fever etc are again appearing on the soil of America. In 1995, there was an outbreak of Tuberculosis in an Alexandria high school, when 36 high-school students caught the disease from a foreign student (Washington Post 1995). In another such case  Typhoid struck Silver Spring, Maryland, when an immigrant from the Third World, who had been working in food service in the United States for almost two years, transmitted the bacteria through food at the McDonald’s where she worked (“Influxof Exotic Diseases” 1992). These cases and many others like these can be attributed to the worsened health conditions and infrastructure provided to the illegal immigrants by the host country. Moreover, many stereotypes have been attached to the illegal immigrants regarding the spread of contagious diseases by them. In fact, immigrants have often played the role of scapegoat in the American history. Tuberculosis is found in the one third of the world’s population mainly in the places where abject poverty and deprivation is found. Tuberculosis is a disease that has been called “the first penalty that capitalistic society had to pay for the ruthless exploitation of labor (Dubos and Dubos 1996:207).” Mary Douglas (1966, 1992) argues that societies erect barriers around the dominant group in order to keep polluting forces outside; in order to cope with the loss of control presented by communicable disease, particular ideas are often ascribed to groups regarding their increased susceptibility. As a result, “people faced with the threat of an illness . . . can deny their vulnerability by finding others to construct as its fitting targets” (Joffe and Haarhoff 2002). So the argument that illegal aliens bring contagious diseases with themselves is not quite true. The deprivation, marginalized status, poor working and living conditions and limited access to health care of the illegal population are the factors that make them an easy target for the contagious diseases. As Dr. Laurence Nickey, director of the El Paso heath district, explains,
                        
                       “Contagious diseases that are generally considered to have been controlled
                        In the United States are readily evident along the border. The incidence of
                        tuberculosis in El Paso County is twice that of the U.S. rate. People have
                        come to the border for economic opportunities, but the necessary sewage
                        treatment facilities, public water systems, environmental enforcement,
                         and medical care have not been made available to them, causing a severe
                        risk to health and well being of people on both sides of the border”(1991)
           
                         Media is sometimes attributed as the fourth pillar of the state by contemporary political analysts. It can be vital in shaping people’s opinion and sometimes the whole political scenario is driven by media. Freedom of press has literally granted absolute power to media and exactly because of this reason it is acting as a channel for higher authorities to articulate and gain legitimacy for their actions. Much of the American public understanding about illegal immigrants is shaped by the media. After 9/11, anti sentiments among Americans have grown drastically towards the illegal immigrants (Ghazali 2008). These anti sentiments could be attributed to the country’s increasing unemployment rate, security issues or overall shrinkage of economy but it is the media that delivers these issues in such a way that manipulates the minds of American citizens. As a democratic country, these views and opinions in return effect the government policies on illegal immigration. A survey research shows that individuals watching FOX news or CNN, a conservative news channels that favor the anti immigration bills, are 9 percent more biased towards the illegal immigrants than the individuals watching CBS, a somewhat liberal news channel than FOX news and CNN (Fryberg et al 2011). If a news channel portray illegal immigrants as a threat to the economy and internal security then Americans are more likely to endorse negative attitudes toward illegal aliens and to support policies that seek to exclude them from American society. By choosing a quote by politicians that links illegal immigration to drug cartels, violence, and crime, the media frames immigration as a threat to the safety and security of the American public. As the key contemporary analyst explains,” The US media has hindered effective policy making on immigration for decades, and their impact has been increasing in recent years” (Suro 2008).  
           
                       In the end, it is not clear that whether the illegal immigrants are a burden or beneficial for America’s economy. But it is quite clear that what the politicians and the media depict about the illegal aliens is not completely true. They have created certain myths which have increased anti sentiments against immigrants among Americans and which the social scientists have rejected. Although illegal immigrants are net cost to the federal budget but their presence in America is very necessary for the country’s economy. They are the driving wheel behind the country’s economy. Moreover, most of them are uninsured and only eligible for the emergency health services; therefore they are not a burden on the health budget. Despite of their illegal status, they pay taxes to the state in form of sales tax. The facts illustrate that undocumented workers contribute more to the revenue stream for US social benefits than they use. In Texas, for example, nearly seven percent of the state’s population was comprised of undocumented immigrants in 2005. The state’s health care costs for undocumented immigrants that same year were a mere $58 million. Yet state revenues collected from undocumented immigrants exceeded what the state spent on social services provided to these immigrants such as health care and education by $424.7 million (“Undocumented Immigrants” 2006). Furthermore, a research by New York City department of health and hygiene conducted in New York has rejected the general perception that these immigrants are the main cause of spreading the contagious diseases (“The Health of Illegal immigrants” 2006). It concluded that in New York City immigrants upon arrival have similar or lower death rates from the 10 leading causes of death in the city compared to US born adults. Thus, when immigrants arrive in the US they are more likely to be healthier than native born individuals, yet as time goes on, their health deteriorates. All these misconceptions and stereotypes about illegal immigrants should be cleared out. The government and media have to play a major role in it. Even if they have done something against the American laws and entered the country illegally, this shouldn’t be an excuse to treat them badly and to take advantage of them because if nothing more, at least they are human beings.
          
                           For decades immigrants have come to the United States of America to seek a better life for them in this new land and to pursue the American dream. They have come to seek a life that they could never have within the borders of their poverty stricken countries. Today illegal immigrants in America find themselves in a very appalling situation. They are exploited, victimized, abused and looked down upon just because of their illegal status in the country. They have been denied the basic human rights. The denial of access to public health services to illegal immigrants shows that despite of being the world’s largest democratic country, a large number of its population are living in an abject poverty and misery. They are the victims of structural violence. The United States government’s policies against illegal immigrants are a major setback in its efforts to eliminate racism in America. To conclude I would say that a nation can’t go any further if it keeps a large number of its population depressed, distressed, marginalized, unhealthy and unhappy.


Written By: Jawad Karim