HIV/AIDS - A Global Perspective

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Protecting health and preventing illness in populations and communities

1. In case scenario 3, prevalence and incidence statistics are reported. What do these terms mean? How are these data of use in understanding HIV epidemics?

Prevalence, as in medicine, is a proportion of the population, which or who have had a specific illness, or a condition, in a particular time period. Prevalence is calculated when one has information about a particular group of the population, depending upon samples or surveys. The samples collected through prevalence are taken as a sort of representative for the entire population/study group of interest. Prevalence is expressed in percentage.

Incidence, on the other hand, is defined by the number of ‘new incidences’ or new cases reported for a particular illness, in a given time period. Hence, the major difference between Prevalence and incidence is that while the former gives us an idea about the percentage of the population with the illness, incidence gives an accurate number of individuals affected in a time period.

Here, we are dealing with an epidemic, which has a low or sometimes zero cure rate, and thus, prevention works better than the therapy. Thus, in such cases, knowing the prevalence rate, which is the percentage of the population affected, although helpful, will not be of much significance as the incidence rate. Since with so much prevention plans and campaigns conducted for HIV/AIDS and its awareness, having an effective knowledge about when and how many new cases are reported can be useful.

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Take the case of Kenya, for instance, where effective incidence rates of occurrence of new HIV cases are available. Hence, one can predict or assess if help in the form of spreading awareness or by other means, as conducted by campaigns is really being effective, and reaching the right crowd. Although prevalence is as much important in assessing the standard data, and how much prevalent is the disease in an area (or a particular group of population), it cannot give us credential data about the effectiveness of care and awareness campaign conducted. Also, the incidence data will ensure it gives us up-to date situation related to the HIV / AIDS epidemic.

2. In HIV epidemics, the vulnerabilities of key populations are noted as of particular concern. What are the vulnerabilities for men who have sex with men? How could these factors pose barriers to providing HIV services including preventative services?

The vulnerabilities that the HIV affected face in the society ranges from social, and structural to legal as well as economic problems. To expand on the fact, the population or the group affected by the epidemic belongs to different cultural and socioeconomic groups. Therein lies the problem of discrimination, and stigma attached to them. Say, for instance, there is still some section of society which does not look upon HIV/AIDS as an illness, but consider them to be avoided at all costs. For these and also for those people who are homeless and poor, and do not have any means of predicting the illness, the good work on AIDS or even medications are not accessible. Hence, these factors make them more vulnerable and restrict them from seeking HIV services for help.

The problem is more pronounced for the men who have sex with men. Although many countries have accepted them, there are several parts of the world where they are a taboo. Moral policing, social stigma and discrimination are all they come across, even in HIV clinics and help centres. This vulnerability or the problems faced by them can pose a serious threat to the good work that HIV services are offered worldwide.

Since the men who have sex with men are more aware of the social stigma attached to their relationships, they are more apprehensive in bringing problems and doubts to the clinics. Many such men, who have contracted the epidemic, are not even aware of their health concern, and are simply scared to talk to the relative authorities or come for initial tests.

Such a group of men, (whose numbers, with respect to contracting the HIV virus are alarmingly raising), is a real challenge to the HIV services and the preventive measures they are planning. The first step in identifying the number of such people in a locality, who are prone to the disease, itself might be difficult. Then, bringing them into the system, and teaching them the preventive measures can pose a serious challenge to those involved.

3. The WHO (2016) note that understanding the specific needs of key populations is important in preventing HIV epidemics and in protecting health. The WHO suggest that partnerships with key populations is an important strategy. Explain the rationale behind this recommendation.

The World Health Organisation brought in some serious suggestions to deal with the HIV affected population. Among them was a note that identifying the specific requirements of the population under study (or of interest) and also partnering with them for offering HIV services can be a significant act. This may be quite true, because, every continent, country, or even a locality is different, and so are the people living in them.

What can work in the USA or the UK might not work out for those living in Kenya, or the Asian countries. Apart from the fact that people in such areas may have opinions and medicines on their own to stick to, they may also not be receptive to a person who cannot relate to their culture and traditions. This is where seeking help in the form of partners within the community comes into the picture.

Hence, every population needs to be handled as per the requirements of socioeconomic situations, their cultural differences as well as the specific requirements, such as monetary concerns. This way, it will be easier to understand the requirements of the population (those affected by the epidemic and those who might require preventive measure) before dealing with them.

Similarly, engaging the help of one of their own in the HIV service can act as a booster in bringing people who require attention into the system. A person, from the population itself, might be able to relate to them in a better way, and also be able to guide the others in HIV services to act wisely to give help. Thus, the suggestion given by the WHO is an extremely wise and significant one, and can help in better utilization of HIV services.

4. What is pre-exposure prophylaxis? What is the rationale behind this form of HIV prevention?

PrEP is a technique in which the individual uninfected by HIV takes an ARV or antiretroviral drug against HIV. The reason behind the administration of the ARVs is to build a concentration of medications in the blood of at high risk groups of individuals to HIV acquisition. This medicine has been shown to lower the risk of acquiring HIV by this targeted population.

PrEP is an empowering technique for receptive partners and helps to control the HIV risks. It forms a vital part of the “combination prevention strategy” targeting people who have multiple partners and are the identified as high-risk populations to contract HIV.

Prescriptions for Prep include everyday treatment with tenofovir disoproxil fumarate (TDF) which is formulated along with emtricitabine (FTC). Extensive data for safety of the administration of these drugs are present. This PrEP treatment has been found as effective in the prevention of acquisition of HIV in men who have sex with men in the “Pre-exposure Prophylaxis Initiative trial”, and in heterosexuals who have multiples partners as evidenced by the “Partners PrEP and TDF2” trials. Resistance to antiviral agents that are normally witnessed were uncommon in these trials.

5. What is post-exposure prophylaxis? What is the rationale behind this strategy in health protection regarding HIV?

Post-exposure prophylaxis or PEP is the technique that involves taking ARTs or antiretroviral medications after having been exposed potentially to the human immunodeficiency virus or HIV. This measure is a prevention strategy to prevent one from becoming infected with HIV soon after exposure to the virus.

After one has been recently exposed to HIV, the PEP must be administered within 72 hours. Only during emergency situations PEP is normally taken. When a person has been exposed to HIV while having sex or by sharing of contaminated needles, the doctor must be consulted immediately and PEP can be started on the person.
The sooner the PEP is started after exposure to the virus, the better it is for the individual to develop resistance. However, the PEP is effective when it has been started within 72 hours after exposure to HIV. Later than 72hours of PEP administration in a person having been exposed to the virus shows that PEP has little or no action on the person’s resistance.

PEP prescription requires the person to take the medicine once or twice every day for 28 days. The side effects PEP causes are mild such as nausea and can be treated. The side effects due to PEP are not life threatening.

6. How would access to sterile injecting equipment prevent HIV infection? What is important about needle and syringe exchange programs?

People who inject drugs can relatively lower the risks of transmitting or getting HIV by using a sterile needle for every injection they make. The syringe service program (SSP) strives to provide sterile syringes and needles without a prescription.

The SSPs have also been known as sterile exchange programs or SEPs or needle–syringe program or needle exchange programs. These services help with safe disposal of used needles and syringes and help to provide sterile needles and syringes for those without a prescription and injecting drugs.

According to the CDC, the SSPs are an integral and vital component of an approach towards prevention of transmission of HIV. The SSPs also provide prevention material like sterile water vials, alcohol swabs and condoms apart from educating and referring people to substance abuse treatment programs and testing and counseling them for HIV. Many of the SSPs are known to provide access to HIV diagnosis, treatment, PReP, and PEP services, while also helping to prevent mother-to-child transmission of HIV.

7. How come the WHO (2016) recommend HIV testing be conducted together with counseling? What are the advantages and disadvantages of this approach?

HIV testing and counseling, also known as HTC, has the following objectives:

  • The proper and effective counseling and testing for HIV in healthcare setups by providers on a continual basis.
  • Increasing the coverage and access of services to provide effective and equal care to one and all.
  • Maximizing equality and impact by combining various HTC services on the basis of social and epidemiological contexts.

Rapid testing is being incorporated into HTC in many parts of the world. With rapid testing in place, the result of HIV tests is known in 20 minutes. In regular blood ELISA test, there is the possibility that many people do not return to obtain their tests results. This number of people who do not receive their test results can be lowered using rapid testing.

In HTC, client-centered counseling is put in place. Also, a holistic risk assessment of HIV is taken that can lead to future referrals to specialized services.

This program called HTC is aimed at allowing people know their HIV status. Knowing their HIV status is important to prevent further transmission of the virus and also enables the people infected to access medical care and appropriate counseling.

The disadvantage of the HTC program is that merely knowing one’s HIV status does not slow down the HIV epidemic. More concentrated efforts should be put in place to allow access to high-quality services and medical care. Efforts should also be put in for alcohol treatment programs, employment and housing services, and syringe exchange programs.

8. List potential roles for community nurses in HIV prevention. Explain your rationale for including these roles. Consider roles targeting individuals and those targeting communities.

Community-based nurses play a vital role in providing greater access and increasing uptake of public health services aimed at, for example, people who inject drugs. Community nurses by way of providing non-discriminatory health care services help to build the unique trust while dealing with addicts who inject drugs themselves. These community-based nurses thus, play a bridge-like role between the people who inject drugs, the law personnel, health care specialties and political stake holders.

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On the contrary, community-based nurses are prone to burnouts due to long hours of work and limited human resources. HIV prevention has been shown to be impacted positively by community nurse in different parts of the world including the developing countries. Increasing the support offered to these community-based nurses can help for strengthening the existing programs that aim for the welfare of people who inject drugs.

References

  • Colbert, J.A. (2012). Preexposure prophylaxis for HIV prevention. The New England Journal of Medicine, 367, 462-465.
  • DeCarlo, P. & Truax, S.R. (2004). HIV counseling and testing. Retrieved from https://caps.ucsf.edu/library/hiv-counseling-and-testing/
  • Centers for Disease Control and Prevention (2016). Syringe services programs. Retrieved from https://www.cdc.gov/hiv/risk/ssps.html
  • Centers for Disease Control and Prevention (2016). PEP. Retrieved from https://www.cdc.gov/hiv/basics/pep.html
  • Limbu, B. (2008). The role of community-based nurses in harm reduction for HIV prevention: a South East and South Asia case study. Int J Drug Policy, 19(3), 211-213.
  • National Institute of Mental Health (nd.). What is prevalence? Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/index.shtml
  • Advanced Renal Education Program (2012). Incidence and prevalence. Retrieved from http://advancedrenaleducation.com/content/incidence-and-prevalence
 
 
 
 
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