The advancement in technology and the field of medicine have increased the development of medicine and the prevention of deadly diseases. One of the fatal diseases which impact people globally is HIV/AIDs. Different countries are opting for strategies to improve people’s health and reduce the incidence of HIV/AIDS cases. Two developing countries, India and China, are working hard to battle HIV/AIDS. According to a study by the World Bank, there are 2.40 million people in India who have HIV/AIDS, and 83% of them are between the age of 15 years to 49 years (“HIV/AIDS in India”). Two of the primary sources of this increase is the unprotected sex and the use of injections for drugs. Unprotected sex, homosexual sex, injection use for medicines, low status of women, and stigmatization of the diseases are the risk factors for the high prevalence of HIV/AIDS. However, on the other hand, China is a rapidly developing nation and is also facing HIV/AIDS issues. According to 2012 estimates by Chinese state media, 68,802 cases of HIV/AIDS were reported in the year 2012 by October (Park). The government is taking several steps to reduce the instances of HIV/AIDS and improves the lives of the people with HIV/AIDS.
The government of India responded efficiently to the first case of HIV/AIDS case and established a National AIDS Control Program (NACP) in 1986 (“HIV/AIDS in India”). In the year 1991, the focus of this program was to provide safe blood, raise awareness among the general public and high-risk populations and improve surveillance. In the second phase of the program which was from the year 1998 to the year 2006, the program expanded at the same level with more education and involvement of NGOs. In the third phase of the program, the intervention programs were increased, and the partnership of the civil society was improved. In the third phase, several workshops were conducted with civil society members, experts from public health, and other departments such as education and others.
On the other hand, the Chinese government has also stepped in for HIV/AIDS cases, and one of the leading examples is the ban lifted in the year 2010 for HIV/AIDS foreigners to visit China. Also, China has even started antiretroviral treatment for HIV/AIDS and the number of patients receiving the treatment has increased over the past few years. The Chinese government has also formed a policy where the motto of the policy was “Four Frees, One Care” for the prevention of HIV/AIDS. The policy is aimed to provide free blood tests, free educational facilities for Orphan AIDS patients, free consultation and screening tests, and free antiretroviral therapy for pregnant women (Park).
In India, there are several non-governmental and community-based organizations that are working to cater to the issues related to HIV/AIDS at the community, regional and national levels. These organizations work on raising awareness among the general population, high-risk groups, and people living with HIV, as well as Orphan children with HIV. These organizations are working towards the general taboo among community related to HIV and provide education programs to tackle the stigma related to HIV. As HIV/AIDS is a global concern, so there are several donor agencies that provide funding to developing countries with a high percentage of HIV cases. The donor agencies providing funding to India to tackle HIV/AIDS issue in the country are United Nations (UN) partners and other bilateral agencies. For example, World Bank funded the NACP in the third phase. Other charity-based organizations are also working for AIDS, such as Bill and Malinda Gate Foundation’s Avahan program, Clinton Health Access Initiative, UNAID, UNICEF, and others (“HIV/AIDS in India”). However, there are certain challenges which are hindering the country from controlling the cases of HIV/AIDS, such as the institutional capacities of the country at the managerial and structural levels. Societal stigmatization related to HIV/AIDS can influence the programs implemented by the government as these taboos hinder people from acquiring treatments and consultation for AIDS. The targeted population would be difficult to attain as there is a population that is neglected for consultation because of discrimination and stigmatization, such as sex workers, drug users, and men having sex with other men. Because of this, the country is not able to reach the people who are more at risk and also provide safe sex awareness for men having sex with men.
To conclude, HIV/AIDS is one of the major health concerns and is a pandemic because it is prevalent both in developed and developing countries. The prevalence of HIV/AIDS is rapidly increasing in China and India, and both countries have reformed their policies and designed intervention programs to promote the treatment and prevention programs within their respective countries. The government of both countries has been actively working to reduce the cases and provide efficient health services to HIV/AIDS patients, and also raise awareness about the issue among the general population. However, there are several institutional and societal issues that are hampering the implementation of those programs.
The advancement in technology and the field of medicine have to increase the development in the area of medicine and prevention of deadly diseases. One of the most deadly diseases which impact people globally is HIV/AIDs. Different countries are opting for strategies to improve the health of people and reduce the incidence of HIV/AIDS cases. Two developing countries, India and China, are working hard to battle HIV/AIDS. According to a study by the World Bank, there are 2.40 million people in India who have HIV/AIDS, and 83% of them are between the age of 15 years to 49 years (“HIV/AIDS in India”). Two of the primary sources of this increase is the unprotected sex and the use of injections for drugs. Unprotected sex, homosexual sex, injection use for drugs, low status of women, and stigmatization of the diseases are the risk factors for the high prevalence of HIV/AIDS. However, on the other hand, China a rapidly developing nation, is also facing HIV/AIDS issues. According to 2012 estimates of Chinese state media, 68,802 cases of HIV/AIDS were reported in the year 2012 by October (Park). The government is taking several steps to reduce the instances of HIV/AIDS and improves the lives of the people with HIV/AIDS.
The government of India responded efficiently to the first case of HIV/AIDS case and established a National AIDS Control Program (NACP) in 1986 (“HIV/AIDS in India”). In the year 1991, the focus of this program was to provide safe blood, raise awareness among the general public and high-risk populations, and improve surveillance. In the second phase of the program, which was from the year 1998 to the year 2006, the program expanded at the same level with more education and involvement of NGOs. In the third phase of the program, the intervention programs were increased, and the partnership of the civil society was improved. In the third phase, several workshops were conducted with civil society members, experts from public health, and other departments such as education and others.
On the other hand, the Chinese government has also stepped in for HIV/AIDS cases, and one of the leading examples is the ban lifted in the year 2010 for HIV/AIDS foreigners to visit china. Also, China has even started antiretroviral treatment for HIV/AIDS, and the number of patients receiving the treatment has increased over the past few years. The Chinese government has also formed a policy where the motto of the policy was “Four Frees, One Care” for the prevention of HIV/AIDS. The policy is aimed to provide free blood tests, free educational facilities for Orphan AIDS patients, free consultation and screening tests, and free antiretroviral therapy for pregnant women (Park).
In India, there are several non-governmental and community-based organizations that are working to cater to the issues related to HIV/AIDS at community, regional and national levels. These organizations work on raising awareness among the general population, high-risk groups, and people living with HIV, as well as Orphan children with HIV. These organizations are working towards the general taboo among community-related about HIV and provide education programs to tackle the stigma related to HIV. As HIV/AIDS is a global concern, so there are several donor agencies that provide funding to developing countries with a high percentage of HIV cases. The donor agencies providing funding to India to tackle HIV/AIDS issue in the country are United Nations (UN) partners and other bilateral agencies. For example, World Bank funded the NACP in the third phase. Other charity-based organizations are also working for AIDS, such as Bill and Malinda Gate Foundation’s Avahan program, Clinton Health Access Initiative, UNAID, UNICEF, and others (“HIV/AIDS in India”). However, there are certain challenges that are hindering the country from controlling the cases of HIV/AIDS, such as the institutional capacities of the country at the managerial and structural levels. Societal stigmatization related to HIV/AIDS can influence the programs implemented by the government as these taboos hinder people from acquiring treatments and consultation for AIDS. The targeted population would be difficult to attain as there is a population that is neglected for consultation because of discrimination and stigmatization, such as sex workers, drug users, and men having sex with other men. Because of this, the country is not able to reach the people who are more at risk and also provide safe sex awareness for men having sex with men.
To conclude, HIV/AIDS is one of the major health concerns and is a pandemic because it is prevalent both in developed and developing countries. The prevalence of HIV/AIDS is rapidly increasing in China and India, and both countries have reformed their policies and designed intervention programs to promote the treatment and prevention programs within their respective countries. The government of both countries has been actively working to reduce the cases and provide efficient health services to HIV/AIDS patients and also raise awareness about the issue among the general population. However, there are several institutional and societal issues that are hampering the implementation of those programs.
Anorexia Nervosa is one of the psychiatric illnesses related to eating, most common in females (1). The mother of Annette, the client, started to observe changes in her behavior regarding eating when she was no longer taking the breakfasts and eating on time. Therefore, she was clinically assessed because anorexia nervosa patients also save themselves and lead to weight loss (2). From a cognitive behavioral therapy perspective, cognitive behavioral therapy is a treatment for cases of anorexia nervosa patients (3). Cognitive behavioral therapy techniques are aimed at reducing the maladaptive thought and presumptions of the clients (4). Annette said that her change in behavior is because her image of being fat is disturbing her, and her aim of becoming a cheerleader is not going to work until she has lost the weight, so anorectic systems are also related to a physical presence of a person (2). Body image is a complex phenomenon and has several ideal setups, and these images are constructed interpersonally with friends and cultural expectations (5), and as a result, Annette has been trying to look slim and starve herself. There is a lot of emphasis on body image in a western society where fat people have issues with fitting in the culture, and because of that image, Annette was starving herself to fit in the body image to fit in the real image of cool and stylish (5). Self-perception is the way in which a person internalizes physical appearance as a mental appearance, and in the case of the client, she thinks her physical image is not really the real portrayal of herself (5). People with anorexia tend to isolate themselves and focus on losing weight with the concept that losing weight will decrease their distress and being slim with social acceptance (6). Annette’s mother tried to motivate her to involve in social conditions by understanding her situation as for anorexics, the attention and support from the parents become a positive reinforcement (6). According to cognitive theory, aberrant thinking can result inexorably and predictably, as Annette thought that being thin would give her a place in the street dancers group, and she would ultimately have a boyfriend (6). According to Cognitive behavioral therapy (CBT), women who have eating disorders such as anorexia nervosa perceive their body size as more massive and therefore have a negative evaluation of their looks. Annette thinks that being overweight, she is not attractive and thus cannot approach boys, and losing weight would give her fame (5).
Psychodynamic therapy is also essential to understand the underlying behaviors and desires which lead to a behavior, such as the desire of Annette to become slim in one way or the other (7). Psychodynamic therapy provides a more in-depth understanding of the development, interactions with other people, physical state, and mental conflict that an individual goes through (7). Psychodynamic therapy works on the symptoms and relationship patterns of those individuals with other people, and those who have anorexia tend to view depending on someone as a sign of weakness (8). When the primary focus is on losing weight or maintaining the body image, then the concept is self-sufficient as Annette thinks that her mother is trying to control her life and she said this during her session with the school psychologist (8). She views that if her mother stops managing her life and lets her do whatever she wants to, then it will be better for both of them, and people who have anorexia tend to believe that their primary aim is essential and other relations are secondary (9). The primary purpose of psychodynamic therapy is to understand how an individual’s context plays a role in understanding his relationships and functioning (10). To realize one’s behavior in the context of a person’s behavior functioning of human nature and how the actions disturb the individual’s social life and outlook on life (10). The way Annette’s life was troubled and how her relationships with other people were unhealthy shows that her behavior and her unconscious desires were impacting her socialization, and rigid limitation of food can affect her health (7). People tend to have difficulties in getting into therapies and consider that their behavior is not an issue and because of this, they lack maintaining their relationships with other people (11). For example, Annette has her ultimate aim to attain the attention she needs. Therefore, she has maintained a world isolated inside herself and anything that is being said to her even for her benefit, so she thinks every other person is controlling her, and this is disturbing her behavior (11). The psychodynamic context therapy focuses on the individual just the way her therapy session was solely focused on her and her fantasies and disturbances connected to her eating behavior (12). Because of a lack of interaction with her mother, she was not able to try out how she could lose weight like intentional vomiting, and that void is not filled by communication (12).
Both of the frameworks chosen to explain Annette’s health are used widely to describe eating disorders, and in both therapies, there are several steps to analyze the situation of the patients or the clients (13). For example, in the initial phase of the psychodynamic therapy process, patients tend to be defensive, detached, and exhaustive, as was observed in the case of Annette when she thought she did not need a therapy session and was reluctant to provide any information (11). In anorexia, the symptoms are based on over-expectations and over-valued ideas about one’s personal self, body shape, and weight (2). The second phase of the treatment is to understand the cognitive-behavioral therapy of the person instead of letting them know that their behavior is not right and in the case of Annette if the psychologist would have directly criticized her then it would have led to more negativity (14). Cognitive behavioral therapy is proven to work for patients with eating disorders and helps in developing and maintaining the relationship with the client (13). Anorexia patients need the help of therapists to build a diet that is helpful for their daily dietary intake (15). Cognitive behavioral therapy is both cognitive and behavioral therapy as it undertakes both emotional and behavioral concerns. The treatment provided by a psychologist to Annette was comprised of a discussion about what she thinks, her behaviors, her relations with her mother, and other aspects which are impacting her behavior (16). Whereas the therapy of psychodynamic is emotion-based and cognition understands the underlying and asks questions that make the patient think about the concern rationally (11). The psychodynamic approach is focused on the factors which contribute to the life of the patients and their risky behaviors, as in the case of the current patient and her peers, her understanding that being slim would get her into street dancer groups and the factors which are promoting the anxious behavior in her (17).
Cognitive behavior therapy is essential as it provides the understanding to the patient of their behavior and also to the therapist that their work has been implemented for the betterment of their client. The therapy can be recommended the Annette as she has been thinking about fitting into society (3). Cognitive behavioral therapy is one of the leading evidence-based treatments for eating-related disorders such as anorexia, and it stresses the importance of thought and actions at the same time in the client’s case thoughts of being slim and fitting in society were leading to her less eating, intentional vomiting and misinterpreting her mother’s behavior as control (18). There are three phases to the therapy, and the first one is the behavioral phase in this phase psychologist will work with the patient to manage the feelings and actions which are developed in a reaction as Annette and her psychologist have a discussion about her feeling to attract boys, be a part of cheerleaders and how her mother’s behavior was discussed (18). The second phase is the cognitive restructuring phase where the therapist tries to trigger the patient about their behavior and then probe them in a way that is challenging to their logic and intellect such as asking about the importance of losing weight and how it will impact their life (11). During this phase, the psychologist tends to address the concerns related to body image, peer pressure, socialization, and relationship with the patient (2). The third phase of this therapy is to help the individual maintain the behavior and have a positive outlook on the idea that things will work best even when they do not starve themselves (18). Many people with anorexia nervosa have difficulties in attaining any kind of help and especially when the support requires putting the fear of body imaging in front of a person who is not known to you, and these people are not willing to change their behavior (19). The response of Annette was similar where she thinks that her mother should let her do whatever she is doing and should not interfere in her life as she is grown up and she was in denial that this could put her life at risk (19). In other words, cognitive behavioral therapy has a primary focus on negative thoughts which are associated with eating, weight, and body shape, and this therapy would best fit the situation of the client of this research (20). People often go mood swings, low self-esteem, and the idealization of being a female and having a female body which is perpetuated in society (21).
Psychodynamic therapy is a different approach to handling people with anorexia nervosa as it views that people have conscious and unconscious desires, which can lead to deviant behavior (17). Focal psychodynamic therapy was devised as a standard version of time-oriented psychodynamic psychotherapy, and the recommended therapy for Annette’s case is focal psychodynamic psychotherapy because the treatment which is time-oriented can really impact understanding the unconscious conflicts of mind and body that result in the disorder which is evident that her battle is her thought the being slim is better and she is fat in real (20). In the first phase of psychodynamic treatment, patients will be reluctant to open up as they will be undergoing several emotions and feelings as a result of starvation, overthinking, and finding ways to make things work such as Annette was having a hard time understanding that not eating would lead to other health issues but instead she was in the belief that her mother is controlling her and there was no need of therapy (11). In the second phase of psychodynamic therapy, the factors which are contributing to the behavior are explored and discussed to find out alternative strategies for coping (11). According to therapists, the contributing factors are what result in a rigid approach to fit into the ideal image of society (11). The last phase of this therapy is reconnection because those who are undergoing therapies or treatment might be feeling left out so it is important to let them merge in society and help them reconnect (11). Behavioral therapy looks at what people are doing and how they are doing but psychodynamic theory looks at why they are doing it, and it is viewed that behavior is the result of previous and current situations (12).
Several clinical research and randomized trials have been carried out to treat anorexia nervosa with cognitive behavioral therapy and psychodynamic therapies. For example, the Anorexia Nervosa Treatment of OutPatients (ANTOP) study was carried out in Germany (17). In this study, patients from 10 different universities were enrolled in 10 monthly treatment programs, focal psychodynamic (FPT) and cognitive behavioral therapy (CBT), and a combined group, and it was found that cognitive behavioral therapy was effective in improvement in eating disorders and quick weight gain among patients (17). Another study was carried out to explore the efficacy of focal psychodynamic (FPT) and cognitive behavioral therapy (CBT) and a control group in treating anorexia nervosa (20). In another randomized controlled trial, both psychodynamic therapy and cognitive behavioral therapy are proven to be effective in treating social anxiety disorders, and this indicates that they can be helpful in treating anorexia (22). A study on UK-Italy patients was carried out to explore the impact of enhanced cognitive behavioral therapy on patients, and 99 patients were enrolled in the treatment (3). 40 sessions were provided to the participants over the period of 40 weeks, and it was concluded that enhanced cognitive behavioral therapy could be effective in treating anorexia patients (3).
