The Unemployment Cycle
Tacked to the bulletin board above Zoë McLaren’s desk is a quote from former South African President Nelson Mandela: “Overcoming poverty is not a gesture of charity, it is an act of justice.” McLaren, an assistant professor of health management and policy, says she’s often reminded of those words as she researches the economic and social impact of HIV/AIDS.
The disease is profoundly linked to poverty, she says. In South Africa, both HIV and unemployment rates are among the highest in the world—over 17 percent for HIV prevalence, and about 25 percent for unemployment. In what she calls a “vicious cycle,” McLaren has found that individuals with HIV tend to be unemployed, while unemployed people are more likely to be HIV-positive. “Extreme poverty may lead to risky sexual behavior, but it also works in the opposite direction. When you’re HIV-positive, you’re sicker and less able to invest in work.”
McLaren has also found that when HIV-positive individuals in South Africa have access to AIDS treatment, they’re more likely to be employed. Not only are they healthier and more able to work, it’s easier for them to get jobs. Although it’s illegal in South Africa to ask whether a job applicant is HIV-positive, McLaren says employers often base hiring decisions on telltale signs associated with HIV, such as a history of sick days.
The South African government began providing HIV/AIDS treatment programs to communities in 2004, and McLaren’s research shows the programs are effective in terms of reducing unemployment as well as long-standing inequalities between blacks and whites. Early-treatment programs for AIDS also help lower the incidence of tuberculosis, a newly resurgent disease closely associated with HIV/AIDS. McLaren says there’s “a lot of room for improvement” in South African health policy to address the two conditions together, and her recent research is aimed at helping to inform and improve that policy.
Think of the battle against HIV as a soccer game, and it might look like this: A half-dozen players representing the human body stand inside a circle while another half-dozen players, representing HIV itself, stand outside the circle and pommel them with balls. Meanwhile, two more groups of players—representing the human immune system and antiretroviral drugs—help the body fight off its opponents.
The game is called “HIV Attacks,” and it’s part of a global program called Grassroot Soccer, which uses soccer to educate, inspire, and mobilize communities to stop the spread of HIV. Before coming to SPH, second-year epidemiology student Lisa Zook spent the better part of a year working with the program in Port Elizabeth, South Africa. Through games like “HIV Attacks,” the program teaches teens how HIV works and what they can do to protect themselves. Zook helped train coaches, taught kids, and met daily with school groups.
After finishing her MPH this year she’ll pursue global research in HIV and reproductive health. She sees her work as very much part of a human rights and social justice framework and says, “I think it’s really the way the whole field is going.” More on Grassroot Soccer.