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This study looks at the connection between structural violence (social arrangements that put individuals and populations in harms way) to the spread of HIV/AIDs in America and abroad. Instead of looking at HIV/AIDs as a disease that is spread due to an individual’s lifestyle and decisions, it approaches the disease as something that aggregates disproportionately in impoverished communities. This same methodology is applied to the prevalence of pediatric aids in Rwanda, looking at which mothers have access to the appropriate healthcare equipment and why.

The authors are Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. All of whom work for Partners in Health. Paul Farmer, the primary author, is a physician and an anthropologist who has deeply investigated human rights and health. He also works with low-income neighborhoods and cities within the US as well as abroad. 

Emergency response is discussed more in terms of prevention. While the PIH model was used as a response to the high prevalence of disease in the area, it can be used to show how emergency response may require reaction using a model or system that can be long-term. Prevention is explored using the concept of structural violence and how inherrent structures within our society are causing spread of disease. The paper offers the idea that identifying issues within a society could help response to further emergencies. 

This study was published in PLOS Medicine, and publishes studies across the spectrum of medical science. It is peer-reviews, and authors pay a publishing fee. It goes against the “cycle of dependency that has formed between the journals and the pharmaceutical industry.” In 2014, PLOS Medicine was given an impact factor (which measures how often studies published in the journal are cited in other studies) of 14.429, ranking 7th out of 153.

The authors received no special funding for this article.

Methods used by Farmer, et al include collecting data from the study done in Baltimor in the 1990's. They analyzed the statistics and observations found as main points of their argument. The model used in Haiti and the results from other methods implemented by physicians in those areas are also used as arguments to strengthen the article. 

Social forces such as racism, gender inequality and poverty impact health issues, determining who becomes ill and who can access proper healthcare. This interaction is imperative to understand when looking at broader public health. While understanding the molecular basis of disease will help us prevent illness, addressing biosocial phenomena is critical to public health

The entire study is focused on vulnerable populations – particularly those who due to racial or economic divides, do not have proper access to healthcare, or may be affected by factors such as poor housing and malnutrition.

1. “…large­-scale social forces—racism, gender inequality, poverty, political violence and war, and sometimes the very policies that address them—often determine who falls ill and who has access to care.”
2. "the holy grail of modern medicine remains the search for the molecular basis of disease."
3. "In some senses, the model is simple: clinical and community barriers to care are removed as diagnosis and treatment are declared a public good and made available free of charge to patients living in poverty."
4. "The poor are the natural constituents of public health, and physicians ... are the natural attourneys of the poor."

1. I first did further research on Paul Farmer through the PIH website, as he is a cofounder. Through there I also looked at their story and mission to further my understanding of the organization. 
2. I looked into the Baltimore study further and read some anecdotes and stories about AIDS patients living in the Baltimore area and the circumstances under which they contracted HIV. The concept "survival sex" was used to describe situational circumstance that forced men and women into prostitution. These positions are tied to structural violence, as noted by Farmer in the article.
3. I read excerpts from one of Farmers other articles referenced in this one entitled, "The major infectious diseases in the world - to treat or not to treat?" This paper was studied among 6 countries and looked at the cure rates among patients with Tb and highlights the need of equal access to care around the world.