Cultural Immersion

William Palmer
Linda Payne
AHS 8100

History: The Beginning

The history of HIV and AIDS in America dates back to the early 1980s. The United
States of America was the first country to officially recognize a strange illness among a small
group of homosexual men. During this time various reports began to emerge in California and
New York of a small number of men who had been diagnosed with rare forms of cancer and
pneumonia. The cancer, known as Kaposis sarcoma, would normally affected elderly men of
Mediterranean, Jewish heritage, and young adult African men. The pneumonia, Pneumocystis
Pneumonia Carinii (PCP), is generally only found in individuals with seriously compromised
immune systems. However, the men were young and had previously been in relatively good
health. The only other characteristic that connected them was that they were all gay (Avert ,
2014).
The first report of this strange illness came in June of 1981, in Los Angeles, CA from the
U.S. Centers for Disease Control and Prevention (CDC). Entitled Pneumocystis Pneumonia
Los Angeles, the report detailed the cases of five young homosexual men who were hospitalized
with a serious case of PCP, cytomegalovirus, and disseminated candida infections. Nearly a
month after the CDC announced the report in Los Angeles; the New York Times reported that
41homosexual men had been diagnosed with Kaposis sarcoma, eight of whom had died less
than 24 months after the diagnosis was made. Closer to the end of 1981, reports of 5 to 6 new
cases of the disease were being discovered each week. In 1982, the condition had acquired a
number of names GRID (gay-related immune deficiency), gay cancer, community-acquired
immune dysfunction and gay compromise syndrome. By June of 1982, 355 cases of Kaposis
sarcoma and serious opportunistic infections in previously healthy young people had been
reported to the CDC. 20 states across the country had reported cases that were affecting people

who did not identify as homosexual. Heterosexual men and women were now being diagnosed
and had used intravenous drugs at some point in time (Avert , 2014).
July of 1982, a meeting in Washington D.C is where the disease received the acronym
AIDS (Acquired Immune Deficiency Syndrome). The CDC used the term for the first time in
September 1982, when it reported that an average of one to two cases of AIDS were being
diagnosed in the USA every day. In December the CDC reported that three heterosexual
hemophiliacs had died after developing PCP and other opportunistic infections. There was
nothing to suggest that the patients had acquired AIDS through homosexual contact, or
intravenous drug use. What was significant was that all of the patients had received Factor VIII
concentrates a blood transfusion product made by pooling blood from hundreds of donors
(Avert , 2014).
Later, the CDC begins to receive reports that the AIDS disease has been detected in
migrants from the Caribbean island of Haiti. The media had describe the AIDS disease as the
four H club homosexuals, heroin addicts, hemophiliacs and Haitians even though there had
been cases among people who did not fall into one of these groups (Avert , 2014).
History: The Stigma
AIDS was associated with stigmas and discrimination due to the group in which it was
linked with. Groups such as gay men and intravenous drug users, who were already highly
stigmatized, but also because evidence-based information about what was causing AIDS and
how it might be passed on was in short supply. During the investigation stage of the disease,
most scientists suspected that it was related to sexual contact and the transfer of contaminated
blood. At that point there was no definitive evidence to prove these were the only routes of

transmission. The American government completely ignored the emerging AIDS epidemic, while
non-governmental organizations took action. Organizations such as The Kaposis sarcoma
Research and Education Foundation in San Francisco (later renamed the San Francisco AIDS
Foundation) and, in New York, Gay Mens Health Crisis (GMHC). In 1982 GMHC distributed
50,000 free copies of its first newsletter about the syndrome to hospitals, doctors, clinics and the
Library of Congress. By the end of 1983, the number of AIDS diagnoses reported in the USA
had risen to 3,064 and of these people, 1,292 had died (Avert , 2014).
History: The Introduction of Antiretroviral Treatment
In September of 1986, a drug that was first developed to treat cancer, showed signs of
slowing the attack of HIV. This drug was known as AZT (zidovudine) was approved to be used
in a clinical trial. The clinical trial consists of two groups: one given the drug AZT and the other
given placebo. Six months later, only one death occurred for patients taking AZT, while 19
deaths occurred among those who were given placebo. The clinical trial was stopped early,
because it was thought to be unethical to deny the patients in the placebo group a better chance
of survival. U.S. Food and Drug Administration (FDA) approved AZT as the first antiretroviral
drug to be used as a treatment for AIDS in 1987. The following year, frustration grew over the
length of time it took the FDA to approve the drug AZT and approving access other experimental
AIDS drugs. Later that year the FDA announced regulations to cut the time it took for drugs to
be approved. Results from a major clinical trial known as ACTG019 was introduced in 1989.
This trial showed AZT could slow progression to AIDS in HIV-positive individuals with no
symptoms. The initial optimism was short-lived when the price of the drug was revealed. A
years supply for one person would cost around $7,000, and many Americans did not have
adequate health insurance to cover the cost. By August 1989, more than 100,000 people

diagnosed with AIDS had been reported to the CDC. The proportion of AIDS diagnoses among
women had increased, and smaller cities and rural areas were increasingly affected (Avert ,
2014).
History: A Breakthrough in HIV Treatment
Thousands of HIV-positive people had been prescribed the AZT drug, since its approval
by the FDA in 1987. In 1991, results from a federal study shows the drug had very little effect
and was know being questioned by doctors. The study showed that those who took AZT before
they had any AIDS-related symptoms lived no longer than those who delayed taking it until they
showed symptoms. Doctors questioned whether or not to prescribe their patients with the
medication and from there confusion over AZT effectiveness escalated. In 1991, the FDA
approved a second nucleoside reverse transcriptase inhibitor (NRTI) - dideoxyinosine (DDI) - for
treating patients who were intolerant or whose health had deteriorated while on AZT. At the same
time, a third antiretroviral drug was authorized by the FDA. Dideoxycytidine (DDC) was
approved only for investigational use in patients with AIDS and advanced AIDS-related
complex. In 1992, a study comparing the effectiveness of DDC against AZT was canceled due to
an increase in deaths for those who were taking DDC. Early results showed that the number of
deaths was higher amongst those taking DDC than those taking AZT (Avert , 2014).
DDC was used in combination with AZT, which was the first successful use of
combination drug therapy for the treatment of AIDS in the USA that year. The FDA approved the
use of this new therapy for adult patients with advanced HIV infection who were continuing to
show signs of clinical or immunological deterioration. In 1993, AIDS was reported as the fourth
leading cause of death among women aged 25-44 years in the USA. That same year, 1000-2000

new cases every year were being reported in children through mother-to-child transmission
(Avert , 2014).
A study conducted in November 1994 ACTG, showed that AZT reduced the risk of HIV
transmission from infected mothers to their babies by two thirds. A number of studies in the early
1990s had shown that HIV could quickly become resistant to AZT and that the drug had no
benefit for those in the early stages of the disease. FDA later announced on that the drug 3TC
(lamivudine) had been approved for use in combination with AZT in treating AIDS and HIV.
clinical trials had shown that taking a combination of 3TC and AZT was more effective than
taking AZT and DDC or AZT on its own (Avert , 2014).
Prevention
The USA's first HIV/AIDS Strategy was released in July 2010. The Strategy placed a
strong emphasis on the impact of the Affordable Care Act (the health reform bill) on dealing with
health inequalities. Changes implicated in the Affordable Care Act that were mentioned in the
Strategy included expanded Medicaid eligibility, protection for people with pre-existing
condition or chronic illnesses (such as HIV/AIDS) that will allow them to access health
insurance, and increased access to tax credits. In early 2013, guidelines were updated to
recommend that HIV treatment is initiated in all patients diagnosed as HIV-positive, but
prioritizing those with CD4 cell counts of 500 or less, rather than the previous 350 or less. This
increases the number of patients on ART, but evidence shows that early initiation of treatment
leads to greater control of the HIV virus. In August 2013, the FDA approved the first rapid HIV
test. It detects both HIV-1 p24 antigens, and antibodies to HIV-1 or HIV-2. It is hoped that people

will be able to begin treatment more quickly, as a test like this will increase earlier
HIV diagnoses in the country (Avert , 2014).
Immersion Activity: Movie Philadelphia
The movie Philadelphia was used as a guide in the process of creating this cultural
immersion assessment. This movie was directed by Jonathan Demme and written by Ron
Nyswaner. The main character in this movie is Andy Beckett, who is play by actor Tom Hanks.
Denzel Washington plays a young lawyer by the name of Joe Miller. Other cast members for this
movie would include Jason Robards, Charles Glenn, Antonio Banderas, and Mary Steenberger.
Philadelphia is the first major movie to deal with the subject of AIDS. It is about a Philadelphia
lawyer who practices business law, Andy Beckett, who is fired from his job after he starts to
become sick. The law firm where he works claims that they fired Andy because he was no longer
a good lawyer, but Andy is convinced that the real reason he was fired is because his bosses
found out that he had AIDS.
In the United States, it is illegal to fire someone due to a disease that they may have.
Andy decides to sue the law firm for illegally firing him due to his illness. For Andy and his
family, the lawsuit will come to represent a major fight against prejudice, and thus a fight for
justice.
This film is as much about Joe Miller, Andy's African-American lawyer, as it is about
Andy himself. At first, Joe refuses to work for Andy, in large part because he is himself
prejudiced against both homosexuals and people with AIDS. But eventually Joe comes to realize
that the discrimination Andy faces is both illegal and unethical, just as it is with discrimination
against blacks. He agrees to take Andy's case, and over the course of an exhausting trial, sets out

to prove that Andy was fired not because he was a bad lawyer, but because he was a victim of
illegal discrimination (Demme, 1993).

Reflection
After viewing this movie my initial reaction was excitement. To see justice served is
always a good feeling, especially when it comes to unjust matters. Seeing the strength of Andy
going through such a rigorous process of trial, while dealing with his illness was inspiring. I am a
strong believer in equality regardless of race, religion, culture, life style, gender, or sexuality. The
way you live your life has very little to do with your ability to preform the task and duties of
your job. As a society, we get wrapped up in the perspective in which people view us. The law
firm Andy worked for was more concerned about the image of the organization than anything
else. During this time period, homosexually was not accepted and the AIDS disease was fairly
new. Firing Andy does not solve the problem that lies ahead for the organization or society.

Joe Miller taking on Andys case, despite his own basis shows the strength in character.
Putting aside personal feelings is hard for any human being to do, however, Joe showed that it is
not impossible to do. As a young black lawyer, Joe had to deal with unjust treatment during the
trial. This movie gives inspiration on so many different levels. Here you have racial and sexuality
discrimination of to men who earned their place in society. To see the jury award Andy justice is
a test to how we as society can come together and fight for justice.
Immersion Activity: Book Ryan Whit- My Own Story
Ryan White was a teenage boy who acquired AIDS from a blood transfusion, and later
died. Ryan was born with hemophilia, which forced him to have the blood transfusion. Ryan was
determined to live a normal life just like any other teenage would. Getting the blood transfusion

was the only way to make that dream a reality. Because of his disease, Ryan faced obstacles from
environments children his age normally would not face. The school Ryan attended barred his
attendance, neighbors and friends shunned him and his family. Moving from Kokomo, Ind., to
friendlier Cicero, Ryan struggled for the right to be educated and treated like any other kid even
as he fought a daily battle against AIDS and hemophilia. He was expelled from school once
administrator got hold of his diagnose. He was just thirteen when he found out he had AIDS, in
1984, and was given six months to live, though he lived for another five years. During that time,
he became a poster child for the disease and frequently appeared on television and in public to
answer questions from people of all ages about AIDS. He wanted to make people understand
how the disease was and was not spread (White & Cunningham, 1992).
Application of Cultural Knowledge
City of Philadelphia Office of Supportive Housing (OSH) has many different departments
that help the overall function of organization. There are departments that focus directly on clients
and their wellbeing, funding, program compliance, and the operation of city shelters. Working
with the department of long-term housing, I was not fortunate enough to work with directly with
clients. Department of long-term housing is charged with the duties of making sure all programs
who receive fund from the department of Housing and Urban Development (HUD) through OSH
meet all required qualifications for funding. I was, however, fortunate enough to visit a program
called Calcutta House, which receives funding from OSH. Calcutta House provides housing and
other highly supportive services for people living with AIDS in Philadelphia and the Delaware
Valley region.
This mission of Calcutta House is based on the premise that housing is the foundation for
the most effective and compassionate treatment, management, and prevention of the disease.

Customized support services, responsive to the individual, are delivered with the conviction that
self-empowerment will advance attainable goals enabling a resident to realize his/her full
potential while adhering to treatment and care plans. Calcutta House is located in the North
Philadelphia area of the city, which is accessible by public transportation. Although Calcutta
house offers health services, clients have access to St. Josephs hospital which is located across.
The neighborhood in which Calcutta House is located has many different shopping mall, schools,
other nonprofit organizations, community centers, and local businesses that provide many other
services (Calcutta House , 2013).
Access & Receptivity
Calcutta House is a residential program, which means all clients who receive services,
also receive housing. Residents within Calcutta House program access programs within the city
by public transportation and septa paratransit. In accordance with the Americans with Disabilities
Act (ADA), SEPTA provides comparable service for people with disabilities who are
functionally unable to use regular accessible fixed-route bus service for some or all of their
transportation needs.
Walking into Calcutta House as a client, I would feel comfortable and very welcome.
Clients are greeted at the door when entering Calcutta House by staff located in the front office.
Sitting in the residents lounge had a disconnected feeling in regards to staff and residents. There
was a dead silence when a particular staff member walked pass during floor rounds. Staff
members made it easy to get comfortable and extended themselves as residents filed into the
lounge area. The dcor was very bland, which gave off a sense of depression with the color
scheme. Information about the program and its services were aligned along the wall on a table
and post onto a bulletin board. Information was two years out of date, which can mislead a new

client. Information was provided in English, which is stand for the program. The overall
operation makes it easy for anyone to transition into the program.
Administration & Funding
Dealing with such a vulnerable population, it is important for organizations and its staff
members to stay updated on new policies, procedures, trainings, certifications, and standards of
service. Staff members within the organization are required to attend trainings on continuum of
care, administrating medication, crisis management, case management, and daily living for
people with HIV/AIDS. Staff members are to attend trainings for each at least once per year
unless directed otherwise. The organization does not seem to have any members of their staff that
also identify as a member of the population in which the organization serves.
Funding is an important aspect of an organizations cause, mission, and operation.
Calcutta House operates on several different types of funding, which are government,
foundations, corporate, and private funding. Regardless of government funding for services to
people living with HIV/AIDS, Calcutta House, nevertheless, must rely on privately raised funds
to close the financial gap between those funds and the actual costs for providing the premier
housing and highly supportive services and programs that have been a hallmark of Calcutta
House since its founding in 1987.
Effort & Quality
This program is specifically for individuals with HIV/AIDS who are homeless. The
criteria for this program reflect on the need of services for this population. This is one of the
most underserved populations in the city of Philadelphia. Calcutta House serves anyone who
meets the basic criteria of being homeless living with HIV/AIDS. Programs are tailored to the
needs and wants of the clients at Calcutta House. Providing onsite services such as case

management, health services, psychological, and psychiatric consulting services gives clients a
great chance at getting their needs met.
Effectiveness & Efficiency
Calcutta House has a limited number of units in which they can offer to clients. Clients
seem to be grateful that a place like Calcutta House exists considering the concerns and stigmas
that come with having HIV/AIDS. The attention thats provided to their needs is whats most
important to the clients. There is 24 hour care for clients who live within the program at Calcutta
house, which comes with complaints about meals and snacks. Due to the conditions of their
illness, clients are put on special diets. Connecting clients to other programs takes the pressure
off, so Calcutta does its best to identify and locate services for its clients. The staff members are
there through every step of the process for those who seek outside services. Calcutta has
partnerships with many organizations within the City of Philadelphia such as Project houses,
Philadelphia Housing Authority, Red Cross, Department of Health, Department of Public
Welfare, and Office of Supportive Housing. Calcutta continues to build the network of resources
as time progress and as new organizations are formed.
Standard for Cultural Competence
We will take a look at the National Organization for Human Services ethical standards for
human service professionals. Standard 13 States Human service professionals stay informed
about current social issues as they affect clients and communities. If appropriate to the helping
relationship, they share this information with clients, groups and communities as part of their
work.
The agency in which I intern for (OSH) continues to adjust policies, procedures, and
contracts that would benefit those who live with HIV/AIDS and face homelessness. OSH

continues to collect data on individuals who are homeless and living with this illness. With new
research being developed every day, OSH continues to seek understanding on how to best serve
this vulnerable population. OSH is responsible for communicating changes in policies,
procedures, and any other practices that pertain to homeless individuals living with HIV/AIDS.
Calcutta House is responsible for informing clients of any new changes in policies,
procedure, and program practices. Calcutta continues to inform clients of new medications,
housing programs, and any other services that they may qualify to receive. The organization
requires staff members to stay updated on all trainings and qualifications that are needed to
service this specific population.
Closing
While we as a society progressed a great deal, there are still things we face on a daily
basis. Research on deadly diseases such as HIV/AIDS has progressed in the last 20-40 years.
With this research, we as a society should hope to have a cure for this disease. Millions of people
are live with this illness and are not afforded the services that are needed to survive. As funding
and other resources become scares, we as human service professionals must found better ways to
service all of humanity.

References
Avert . (2014). U.S History of HIV/AIDS. Retrieved April 16, 2015, from Global
Epidemic: USA: http://www.avert.org/history-hiv-aids-usa.htm

Calcutta House . (2013). History: About . Retrieved April 19, 2015, from Calcutta
House : http://www.calcuttahouse.org/site/about-us
Demme, J. (Director). (1993). Philadelphia [Motion Picture].
White, R., & Cunningham, A. M. (1992). Ryan White: My Own Story . Penguin Books.