POLICIES INVOLVING STRUCTURAL INTERVENTIONS TO REDUCE RISKS ASSOCIATED WITH HIV/AIDS IN COMMUNITIES OF COLOR IN CHICAGO, ILLINOIS William Ebomoyi, Ph.D. Professor & Chair Department of Health Studies Chicago State University 9501 S. King Drive Chicago, Illinois USA (773)

INTRODUCTION The emergence of virulent infectious diseases creates the need to enact policies and regulations to forestall the spread of these deadly pathogens. Many of these regulations are termed structural interventions.

Existing information about the nature of structural interventions which were legally prepared to restrict and attenuate the risks associated with the abuse of alcohol and the physical and psychological danger associated with the availability and use of the alcohol is poorly understood. INTRODUCTION

STRUCTURAL INTERVENTION Structural intervention identifies the source of public-health problems regarding those social, economic and political environments that shape and constrain individual, community, and the health outcomes of societies.

STUDY DESIGN To review structural interventions in a broad spectrum of health areas among the interviewees. Describe policies involving structural interventions in African-American communities in Chicago List risk factors associated with HIV/AIDS transmission

STUDY DESIGN Specify structural interventions to reduce sexual risks associated with HIV transmission List structural and environmental interventions to reduce alcohol abuse Specify the strategies for alcohol counter advertising and recommend the need for increase alcohol taxes earmarked for prevention, education and treatment programs of alcoholics.

METHODS: PHASE ONE Phase 1 dealt with the qualitative assessment of structural interventions in public health which are pertinent to risk reduction about HIV transmission among respondents in African-American and Hispanic community.

PHASE ONE The components of structural interventions identified were policies and laws about statutory rape, early onset of coitus, encouraging minors not to engage in intercourse while under the influence of alcohol, and incest taboos. Respondents were asked to enunciate their understanding of structural interventions which are pertinent to controlling sexually transmitted infections.

PHASE ONE Interviewees were asked to state why routine health education has not significantly reduced the incidence of HIV/STI in either African- American or Hispanic communities. They were asked to critically specify those structural interventions could be most unique and effective in reducing HIV/STI in African- American and Hispanic communities.

METHODS: PHASE TWO The quantitative component of this study focused on survey of African-American and Hispanics interviewees.

PHASE TWO The questions are as follows: What are the risk factors associated with having coitus while under the influence of alcohol?

PHASE TWO The respondents were also asked to state a list of the existing zoning of alcohol outlets in the contiguous areas of their respective neighborhoods. What are the types of alcohol available? (Is it hard liquor such as vodka, or regular beer?) What are the health implications of restriction on public drinking?

PHASE TWO Respondents were asked to provide answers to ten specific questions involving policies to restrict use of alcohol in public places.

RESULTS Qualitative Results The public, particularly young adults are in denial The public, particularly young adults, do not think that they are at risk of getting infected with HIV/STI The public is either slow or just not willing to change their sexual behaviors

RESULTS con’t Most people do not live by examples Health education is not enough because people do not get the relevant education and they are afraid of the result of HIV tests or they lack self respect.

RESULTS: AFRICAN AMERICAN The five unique, appropriate and effective structural interventions against HIV/STI in African-American communities were as follows: 1) Enforce abstinence among school-age children, mandatory condom use by previously incarcerated African-American males; all sex workers must use condom during all sexual acts. 2) Mandatory partner notification of HIV status, and possible jail sentence for deceit and lack of compliance

AFRICAN AMERICAN RESULTS con’t 3) Mandatory needle exchange program 4) Mandatory reporting of drug use offenders 5) Implementation of laws that enforce all HIV positive individuals to report for testing every six months if they are drug addicts; identification of HIV+ patient in each neighborhood by listing their names on the internet.

RESULTS: HISPANIC The six unique, appropriate and effective structural interventions against HIV/STI in Hispanic communities were as follows: 1) Enforce abstinence among Hispanic school-age children 2) Mandatory screening of Hispanic young adults seeking visa to enter United States 3) Mandatory partner notification; stringent sentence for not notifying sexual partner

HISPANIC RESULTS con’t 4) Enforce the law involving statutory rape; or having sex with an unsuspecting minors 5) Criminalization of non-disclosure of one’s HIV status by sexual partners and other 6) Individuals who have sex with men (MSM)

Incidence of Syphilis in Chicago, Illinois- Race

Incidence of Chlamydia in Chicago, Illinois- Race

Incidence of Syphilis in Chicago, Illinois- Race

Incidence of Gonorrhea in Chicago, Illinois- Ethnicity

Incidence of Syphilis in Chicago, Illinois

Incidence of Gonorrhea in Chicago, Illinois

HIV DEATH RATES

DISCUSSION From this preliminary report, Blankenship et al 1 have argued that structural intervention works by altering the context within which health is reproduced. Structural interventions locate the source of public health problems which are germane to social, economic and political environment which shape or constrain individual., community, and social health outcomes

DISCUSSION Structural interventions locate the source of public health problems which are germane to social, economic and political environment. SI also includes factors which shape or constrain individual, community, and social health outcomes.

DISCUSSION They also identified two dimensions in which structural interventions can vary. They may identify the source of health problems in factors relating to availability, acceptability or accessibility. Secondly, they may be targeted at the individual, organization or environmental levels.

DISCUSSION Sanchez 2 insist that regulating sex is a pertinent structural interventions that has not be effectively implemented in the United States. Henderson 3 is of the opinion that the war against sex trade demands more stringent structural intervention to become more effective.

CONCLUSION In providing the framework for structural interventions, culturally sensitive and ethnically specific interventions are needed. More comprehensive research investigations are needed to identify what interventions are best suited for each cultural groups.