PMC:7100305 / 18822-22445 JSONTXT

{"project":"2_test","denotations":[{"id":"32226719-27070380-45162367","span":{"begin":488,"end":492},"obj":"27070380"},{"id":"32226719-26931360-45162368","span":{"begin":744,"end":748},"obj":"26931360"},{"id":"32226719-27093860-45162369","span":{"begin":930,"end":934},"obj":"27093860"},{"id":"32226719-27070380-45162370","span":{"begin":1179,"end":1183},"obj":"27070380"},{"id":"32226719-27093860-45162371","span":{"begin":1314,"end":1318},"obj":"27093860"},{"id":"32226719-27224278-45162372","span":{"begin":1649,"end":1653},"obj":"27224278"},{"id":"32226719-27224278-45162373","span":{"begin":2046,"end":2050},"obj":"27224278"},{"id":"32226719-26931360-45162374","span":{"begin":2562,"end":2566},"obj":"26931360"},{"id":"32226719-27060396-45162375","span":{"begin":2977,"end":2981},"obj":"27060396"},{"id":"32226719-27070380-45162376","span":{"begin":3283,"end":3287},"obj":"27070380"},{"id":"32226719-27091724-45162377","span":{"begin":3552,"end":3556},"obj":"27091724"},{"id":"T32148","span":{"begin":488,"end":492},"obj":"27070380"},{"id":"T60091","span":{"begin":744,"end":748},"obj":"26931360"},{"id":"T9319","span":{"begin":930,"end":934},"obj":"27093860"},{"id":"T72307","span":{"begin":1179,"end":1183},"obj":"27070380"},{"id":"T83867","span":{"begin":1314,"end":1318},"obj":"27093860"},{"id":"T51812","span":{"begin":1649,"end":1653},"obj":"27224278"},{"id":"T75489","span":{"begin":2046,"end":2050},"obj":"27224278"},{"id":"T85837","span":{"begin":2562,"end":2566},"obj":"26931360"},{"id":"T29633","span":{"begin":2977,"end":2981},"obj":"27060396"},{"id":"T21753","span":{"begin":3283,"end":3287},"obj":"27070380"},{"id":"T24101","span":{"begin":3552,"end":3556},"obj":"27091724"}],"text":"The Socioeconomic Distribution of Disease\nSimilar to the above outbreaks, the people who were most affected by Zika were in some way socially marginalized, the poor, and more specifically, poor women. At the global level, it was the poorer countries and communities within those regions that were most impacted: those with precarious and/or inconsistent access to health care services, lacking the resources and infrastructure to prevent, diagnose, and treat the virus (Plourde and Bloch 2016; Slavov et al. 2016). No wonder the impact of the outbreak was more devastating in Brazil, which was already financially strained prior to the emergence of the Zika virus, with limited human resources: doctors, nurses, and other specialists (Hennigan 2016), as compared to higher income countries who were more protected from the effects of the Zika virus given effective prevention programs, funding, and infrastructure (Gyawali et al. 2016). Easy and extensive access to mosquito repellants, air conditioning, effective waste management programs, and low rates of urban crowding protect more economically developed countries, such as the USA from Zika transmission (Plourde and Bloch 2016). Consequently, Zika virus has aptly been labeled an “infectious disease of poverty” (Gyawali et al., 2016, p. 3) (Gyawali et al. 2016).\nSome of the literature attributed the lack of public health infrastructure and resources to respond to the Zika outbreak in Brazil to these inequalities with regard to who is most affected. Contrasting Zika with HIV, since HIV/AIDS initially affected the prestigious population, such as celebrities, doctors, scientists (Lotufo 2016), they were able to advocate and secure increased public funding of HIV interventions from the Ministry of Health and State Departments of Health. However, this seems to have happened at the expense of funding for vector control programs, such as those controlling mosquito vectors responsible for the transmission of dengue and Zika viruses, which mostly affected poorer communities (Lotufo 2016).\nAmong the poor populations, women who were either pregnant or considering pregnancy were also more vulnerable to the effects of Zika, as the virus is considered to be a teratogen (Mazzu-Nascimento et al. 2017). Government programs in Brazil that intend to provide free mosquito repellent to pregnant women do not consistently reach some of the poorest communities, such communities are remote and often lack accessible quality health care facilities due to distance and poor physical infrastructure (Hennigan 2016). Access to quality reproductive health care is essential given the accumulating evidence linking the Zika virus to a rise in cases of infants born with microcephaly—an unusually small head for age and sex (World Health Organization 2017a). Conditions related to poverty, such as poor sanitation and increased exposure to larvicides and insecticides, which may cause mutation, have also been implicated (Diniz 2016).\nThe relationship between the Zika virus and pregnancy is further implicated by social inequalities in the context of reproductive rights and freedoms. Access to reproductive health services, such as contraception and abortion are discouraged or illegal in many epidemic countries (Plourde and Bloch 2016). Tavares \u0026 Foster (2016) suggest that “this public health emergency offers a window of opportunity to advance national policies and practices to ensure that Brazilian women have access to a full range of reproductive health services” (p. 109) (Tavares and Foster 2016). This speaks to the inherent politicization of the Zika epidemic."}