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Human Immunodeficiency Virus: Epidemiology

Introduction

HIV, or human immunodeficiency virus, is a virus that attacks and damages the immune system. HIV infection has become an acute problem in the past thirty years. Even though there are prevention methods and strategies, a growing number of people become affected by the virus every year. In some countries, contamination has become an epidemic. The reasons for it are the lack of information, the stigma around HIV testing, and reduced access to health care. Currently, HIV is incurable but is treated by antiretroviral therapy. This paper studies the aspects of the virus contamination, the factors that contribute to its development, the role of nurses in the care of HIV-infected patients, and the national and global implications of the disease.

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HIV: Causes, Symptoms, Treatment

HIV can only survive in a human cell. The virus contamination has three phases: acute HIV, or primary infection, that lasts up to three months, chronic HIV, or latent clinical infection, that can last for several decades, and acquired immune deficiency syndrome (AIDS). Typically, HIV does not progress to AIDS in developed countries due to better access to antiviral treatments. The virus was possibly transmitted to humans with chimpanzee meat and later transformed into its present form.

According to Gitachu (2017), since the HIV epidemic started in the middle of the twentieth century, around 78 million people have become HIV-positive. About 35 million of them have died due to AIDS, especially during the first years after the virus was discovered. By the end of 2016, more than 36,5 million people were living with the illness, and more than 18 million people were receiving antiretroviral therapy (“Global Health Observatory (GHO) data,” 2016). The same year, one million people died of illnesses caused by HIV. In 2014, 129 countries reported that 150 million people took HIV testing that year. Currently, less than 50% of HIV-infected individuals have access to treatment (Gitachu, 2017).

The symptoms of HIV infections are not specific and can be caused by other diseases, which complicates the detection of the virus. Rosenberg, Pilcher, Busch, and Cohen (2015) note that some of them include fever, rashes, diarrhea, and vomiting. These symptoms can only occur during the first weeks of contamination. It is clear that diagnosing HIV requires blood testing as it is impossible to detect the virus solely based on the symptoms. The commonly used methods are antibody and antigen tests. The nucleic acid test is used for people who had been knowingly exposed to the virus. It can often be impossible to identify HIV within the first three months of infection.

The human immunodeficiency virus is transmitted in bodily fluids: blood, semen, breast milk, and vaginal and rectal fluids. The greatest transmission risk is blood transfusion; it is equal to 95% if a donor’s blood is contaminated (Patel et al., 2014). Another high risk of contamination is mother-to-child transmission through pregnancy, labor, or breast milk. It is estimated by 2,200 cases per 10,000 exposures (Patel et al., 2014). Contrary to popular opinion, HIV cannot be transmitted through a kiss, skin-to-skin contact, saliva, air, or water. HIV treatment involves the daily use of antiretroviral therapy (ART). It controls viral replication and improves the number of CD4 cells (Rosenberg et al., 2015). The factors increasing the risk of transmission are acute (first) and late-stage of infection, sexually transmitted diseases, and a high level of viral load. Preventive HIV testing, condom, and sterile drug injection can reduce the risk of HIV infection. The factors that determine the virus development will be discussed below.

HIV infection and AIDS are notifiable conditions in the United States. Any detectable HIV viral load should be reported to local jurisdictions, the physician performing the testing is responsible for it. Local health jurisdictions should notify the Department of Health within 21 days. It is crucial that individuals request medical help if there is a risk of HIV contamination.

Health Determinants Contributing to HIV Development

Many factors determine the health-related quality of an individuals’ life. These factors include not only individuals’ health but also their social and economic status, education, and access to health services. Social factors play the most significant role in HIV development. For example, Edwards and Collins (2014) note that stable housing reduces the risk of drug use, needle sharing, and unprotected sex, which eliminates the chances of exposure to HIV. People of low economic status or those who depend on their partners financially are at a higher risk of contamination, too, since often they do not use contraception or cannot afford healthcare services. Finally, many people do not have access to information on methods of the prevention of virus infection due to the lack of knowledge related to HIV.

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Some individual health factors can contribute to the development of the virus and determine the health-related quality of HIV-infected people’s life. Degroote, Vogelaers, and Vandijck (2014) report that low physical health scores are associated with a lower CD4-cell count. The presence of other sexually transmitted diseases can also force the development of the disease. Notably, mental health is a contributing factor in HIV development too. Consequently, a low mental health score is associated with a lower CD4-cell count (Degroote et al., 2014). However, the combination of HIV infection and other serious diseases creates barriers to successful treatment as it greatly affects the immune system.

Even though medical professionals should not be preconceived against people of low economic or social status, it is crucial to note that these groups are at higher risks of HIV infection and should be educated on the modes of transmission. It is necessary to address the HIV determining factors to eliminate the number of new contaminations. The role of healthcare staff in data consideration and analysis will be discussed below.

Epidemiologic Triangle

In the case of HIV, the agent factor of the epidemiologic triangle is the human immunodeficiency virus subtype (A, B, C, D, or E), and the host is a human. The issues addressed above represent the environmental factor. They include social and economic determinants, the risk of exposure within a particular society, the presence of other diseases, and availability of information about the condition. Notably, the individuals’ health is not a sufficient environmental factor compared to other HIV determinants.

It is crucial that information about HIV and its modes of transmission is available as a part of school educational programs. Currently, the disease is not correctly addressed, which causes stigma and underestimation of its adverse outcomes. Individuals should be aware of the possible negative circumstances when they change sex partners, have unprotected sex, or use needles and prevent them. It is crucial to do HIV testing even if a person does not consider themselves exposed to infection risks. Couples that are planning to have children also should take HIV tests to avoid mother-to-child transmission during pregnancy or eliminate its risks. If an individual is aware of their positive status, they must inform their partner to reduce the chances of contamination. HIV must be perceived as a condition that needs cautiousness.

The Role of Community Health Nurses

Nurses play a significant role in slowing the HIV epidemic and decreasing the number of individuals living with HIV. They perform various functions that linking community members to medical care, referring them to testing and other services, and providing psychological support (Busza et al., 2018). Nurses providing services to HIV-infected people should have the proper training for both their professional skills and psychological capacities.

It is crucial that nurses are aware of the groups of people who have more significant risks of contracting HIV. Those include patients whose partners have been diagnosed with HIV or AIDS-related illnesses, people with sexually transmitted diseases, sex workers, and drug users. Nurses should educate these groups on the importance of testing, proper sex habits, and available treatment. Medical professionals are expected to know the classification of HIV, stages of its progression, and have an understanding of how the immune system works to support the information they provide to patients.

It is crucial that the specimen is collected correctly. Nurses should adequately use collection techniques, as well as standard precaution methods, such as the disposal of needles. If an individual is tested for the first time, medical workers should suggest a second visit in three months since detectable HIV antibodies only appear within 12 weeks after infection (Gitachu, 2017). Nurses can use several data analysis modes to detect HIV. The choice of the method should depend on whether a patient is at the risk of contamination or testing is a preventive measure. Nurses are responsible for reporting the cases of HIV even if an individual prefers not to disclose their positive status. It is crucial that medical professionals realize their significance in HIV prevention and treatment as they are the primary sources of information regarding the disease.

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National and Global Implication of Disease

Several national organizations contribute to reducing the impact of HIV. For example, the US Department of Health and Human Services (DHHS) has established an HIV/AIDS Bureau to manage and prevent the disease. It provides primary health care to economically disadvantaged individuals living with HIV that do not have access to medical treatment. The Bureau also funds training for medical workers to explain how to identify the epidemic factors in high-risk populations. Some other American organizations are AIDS Research Alliance and the AIDS Healthcare Foundation. Currently, they are working on HIV reservoir elimination. Many other organizations in the US provide help within the states.

In some areas, HIV, its causes, and means of transmission are not properly addressed, which results in a critical number of people affected by the virus. For example, Sub-Saharan Africa currently is considered an epicenter of the virus epidemic. Of 34 million infected people, 68% are Sub-Saharan Africa residents (Musheke et al., 2013). Less than 60% of the population living with HIV in the area know their status (Musheke et al., 2013). The reasons that put individuals at risk include unavailability of antiretroviral therapy, perceived low risk of HIV infection, the stigma around HIV testing, fear of social exclusion, and low quality of testing services. Many people from Sub-Saharan Africa prefer not to take tests because they perceive testing as shameful, as well as expect a low level of competence of medical staff. HIV-positive status is associated with death, which makes testing unpopular.

Clearly, HIV is not properly addressed in some countries since there are conspiracy theories promoting the idea that the virus is an invention and a tool the West uses for manipulation (Musheke et al., 2013). Notably, HIV tests are available in many Sub-Saharan Africa settings free of charge, which means that there is an opportunity for individuals to learn their HIV status and slower the spread of the disease. It is clear that the stigma around the virus infection is based on ignorance and the lack of communication between medical professionals and their patients. To change the situation, it is necessary to address why HIV needs to be detected and what makes it dangerous for humans.

Conclusion

The spread of the human immunodeficiency virus is an acute problem that has to be addressed on many levels to eliminate the number of new infections. Currently, it is an incurable disease, which makes it necessary to prevent the risks of contamination. HIV is primarily spread in the countries of Sub-Saharan Africa; almost 70% of all people living with the disease reside there. Nurses play an important role in testing and prevention of the disease; it is crucial that they discuss the problem and the ways of its prevention with their patients. Even though antiretroviral medications are successfully used for HIV treatment, they do not restore individuals’ health completely. This is why medical professionals need to address the methods of virus infection prevention and promote the necessity of regular HIV testing.

References

Busza, J., Dauya, E., Bandason, T., Simms, V., Chikwari, C. D., Makamba, M.,… & Ferrand, R. A. (2018). The role of community health workers in improving HIV treatment outcomes in children: Lessons learned from the ZENITH trial in Zimbabwe. Health Policy and Planning, 33(3), 328-334.

Degroote, S., Vogelaers, D., & Vandijck, D. M. (2014). What determines health-related quality of life among people living with HIV: An updated review of the literature. Archives of Public Health, 72(1), 40.

Edwards, A. E., & Collins Jr, C. B. (2014). Exploring the influence of social determinants on HIV risk behaviors and the potential application of structural interventions to prevent HIV in women. Journal of Health Disparities Research and Practice, 7(SI2), 141-155.

Gitachu, I. (2017). Key competences essential for nurses in HIV/AIDS care. Web.

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Musheke, M., Ntalasha, H., Gari, S., Mckenzie, O., Bond, V., Martin-Hilber, A., & Merten, S. (2013). A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health, 13(1), 213-220.

Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk: a systematic review. AIDS, 28(10), 1509-1519.

Rosenberg, N. E., Pilcher, C. D., Busch, M. P., & Cohen, M. S. (2015). How can we better identify early HIV infections? Current Opinion in HIV and AIDS, 10(1), 61.

Global Health Observatory (GHO) data. HIV/AIDS. (2016). Web.

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