Last week a 43yo male presented to clinic with a chief complaint of "weakness." He also reported weight loss and decreased appetite. He had suffered from a diarrheal illness over the last few days prior to presentation. He weighed 92 pounds, his pulse was 107, his systolic blood pressure was 71. He was the sickest patient of the day.
He mentioned that he spent much of the year working in the sugarcane fields. That bit of history immediately set off alarm bells.
The sugarcane industry, despite what its flattering industry funded website may indicate, does not have a reputation for being a particularly employee-friendly workplace. It does not appear on any "Best Places to Work" lists. Work in the sugarcane fields is demanding. An article (1) evaluating the connection between chronic kidney disease and work on the sugarcane plantations of Guatemala summarized the worker's experience in the following way:
"Each work week is 6 days long with a worker's daily shift averaging 10 hours in the field. Cutting sugarcane is intense labor... Workers are bused to and from the fields. They cut cane by swinging a machete from shoulder level to ground level to cut the cane and then workers lift, trim, and stack the cane."
Sugarcane workers are at increased risk for a myriad of health maladies including infectious diseases such as HIV. Much of this increased risk is related to "social determinants of health," which the CDC defines as:
"Socioeconomic status; transportation; housing; access to services; discrimination by social grouping (e.g., race, gender, class); and social or environmental stressors."
The website HIV.org (managed by the U.S. Department of Health & Human Services) adds:
"Social determinants of health can affect an individual's probability of acquiring an infectious disease, such as HIV, through influences on behavior, limited access to preventive measures, and limited access to healthcare providers or testing sites."(2)
Paul Farmer, in Infections and Inequalities: the Modern Plagues, adroitly summarizes the situation:
“Increasingly, what people with AIDS share are not personal or psychological attributes. They do not share culture or language or a certain racial identity. They do not share sexual preference or an absolute income bracket. What they share, rather, is a social position—the bottom rung of the ladder in inegalitarian societies.”
Our patient's work-up included a Rapid HIV test.
He tested POSITIVE for HIV.
Our patient resides on the "bottom rung of the ladder" in an "inegalitarian society." To be clear, sugarcane did not give him HIV. However, his social determinants of health without a doubt increased his risk of contracting HIV. On the day he presented to our center, he was in dire need of acute medical care. He will require ongoing care of his chronic condition.
But, there is hope for our patient and others in similar straits.
Consider joining us in combating social determinants of health and the devastation they reap by compassionately spreading hope and healing.
Join us in ensuring that hope is not a limited resource.
top photo from: dreamstime.com
Butler-Dawson J, Krisher L, Asensio C, Cruz A, Tenney L, Weitzenkamp D, Dally M, Asturias EJ, Newman LS. Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala. J Occup Environ Med. 2018 Jun;60(6):548-558. doi: 10.1097/JOM.0000000000001284. PMID: 29370016; PMCID: PMC5991184.
https://www.hiv.gov/blog/social-determinants-of-health#:~:text=Social%20determinants%20of%20health%20can,healthcare%20providers%20or%20testing%20sites.