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Description of HIV
Human Immunodeficiency Virus (HIV) is a virus that weakens and destroys the immune system of the body so that the body cannot defend the infection. HIV positive person also possesses AIDS (Acquired Immunodeficiency Syndrome), and if HIV is treated at its early stage, the risk of AIDS can be averted.
If an HIV-positive person is diagnosed with AIDS, it means that the complete destruction of the immune system has been accomplished by the HIV and that increase the vulnerability of the patient towards various opportunistic infections. The quantity of CD4+ cells below 200 cells/mm3 confirms the inception of AIDS (Lloyd, 1996).
HIV can be transmitted mainly through unprotected sexual contact (vaginal, anal, and oral) between two persons. HIV spread through body fluids that include certain body fluids such as blood, vaginal secretions, semen and breast milk. Other situations that contribute to HIV transmission include sharing the injection equipment, transmission of infection to the child from an infected mother and exposure to infected blood. HIV positive people normally do not show any signs or symptoms. Evidence has shown that 70-90% HIV positive people experience flu type symptoms after infection.
HIV is a retrovirus that integrates its genetic material into the host DNA with the help of its unique enzyme, a reverse transcriptase that facilitates its reproduction inside the host cell along with the transcription of viral RNA into host DNA. The infected and mutated DNA replicates and produces 50 million to 2 billion virus particles every day that impact the other components of the circulatory system and immune system, leading to the high vulnerability towards opportunistic infections and other complications.
After 3-4 weeks of infection, the body may develop fever, body and muscle ache, and sore throat. It is an acute infection stage that indicates the primary immune response of the body against infection where the virus production increases and CD4 cell count falls. It is a suitable phase to start antiretroviral therapy (ART). Next stage is asymptomatic stage producing the virus continually, though virus reproduces slowly, it is active and transmissible. This stage can last for decades but can be controlled through timely ART. AIDS is the most advanced stage of infection when the destruction of the complete immune system occurs.
Now Governments have started many preventive and control measures that keep strict and active surveillance to the communities. The HIV can be diagnosed by any healthcare practitioner at local health care center. It is a responsibility of the community nurse to provide eduction of timely diagnosis and resources to the patient. An FDA approved self-test kit known as Home Access HIV-1 Test Kit is also available in the market. The other diagnostic tests for HIV include CD4 and RNA analysis; PCR test HIV antibody screening (ELISA) based test and viral protein p24 identification test. Western blot test is recommended if HIV antibody test is positive ("HIV/AIDS Basics", 2017).
The advancements of medicines have enabled us to improve the quality of HIV-positive patients, even through an early prophylaxis the condition can be controlled. Now HIV is a chronic and controllable ailment with proper adherence to the recommended guidelines and medications schedules. ART are prescribed with appropriate interventions that mostly consist of (NRTIs) nucleoside reverse transcriptase inhibitors, protease inhibitors or non-NRTIs (Bertozzi et al., 2006).
Demographics of HIV
According to CDC, 39,513 people were diagnosed with HIV in 2015 in the US while 1.2 million people are HIV positive. The WHO states that around 36.7 million people have HIV, out of which 1.8 million are children under the age of 15. The newly diagnosed cases of HIV at the global level has been 2.1 million in 2015 out of which 150,000 were children. Most of the newly infected children are from Sub-Saharan region, and all of them have transmitted this disease from their mothers. It is estimated that only 60% of the infected people are aware of their condition while 40% needs to be screened yet. The highly affected population belongs to middle and low socio-economic status covering Sub-Saharan province, and Western Africa. The mortality data of HIV shows 1.1 million deaths in 2015 due to HIV and related comorbidities ("HIV/AIDS", 2017).
The major risk factors for HIV or AIDS include unsafe sex, especially between men. Use of illicit drugs and alcohol may indirectly increase the transmission risk due to less inhibition. The risk of transmission increases 7.25 times on having sexual contact during the acute infection stage. Having an STD or sexually transmitted disease doubles the risk of infection ("HIV/AIDS", 2017).
The role of community nurse in HIV prevention and Care
The roles of nurse professionals in delivering care services to HIV positive patients as well as HIV susceptible communities vary according to the stage of nursing levels that starts from case finding, reporting, data collecting, analyzing and follow-ups. The most basic role and responsibility of a community nurse are providing education and counseling regarding the HIV sensitization and associated risk factors. A community-based education and facility based training are a mandatory requisite to spread awareness of HIV consequences. Providing an active surveillance and appropriate testing involves a multi-step process that involves helping in recognizing HIV-related illnesses, conducting a pre-test counseling, executing and interpreting HIV tests, and offering counseling post-HIV tests. At preventive level, community nurse plays a significant role that involves proper education of community of preventing STI, Managing STI, counseling on safer sex, screening and counseling for pregnant and lactating mothers, as well as clinical management of HIV. Data collection and reporting the HIV stats to the local or higher level health care center is also a responsibility of nurse practitioner. Preparation of ART, managing medications from health centers, explain the benefits, risks, and outcomes of ART to the patients, encouraging the patient to strictly adhere to the suggested medication regime and motivate him to keep the adherence for the long term, these are the important roles of community nurse at analyzing step. Next important step is the follow-up that is a mandatory part of providing care to the HIV patients. It includes the early follow-ups for three months of ART as well as long-term follow-ups three months post-ART, dispensing medications and follow-up visits, gathering vital signs and maintaining data, CD4 cell count tests and analyzing ART side effects (Celletti et al., 2010).
Apart from these responsibilities community nurse is also responsible for clinical management of HIV-positive expecting mothers, children, and newborns. Keeping surveillance on their nutrition, weight, behaviors, offering palliative care to the patients as well as providing education to the caregivers and the family members of the affected person (Celletti et al., 2010).
Role of CDC in addressing and resolving the impact of HIV
There are many national and international organizations that are working on preventing and managing HIV, local as well as global level. World health Organization and CDC are the main bodies that release guidelines time to time regarding the care and preventive strategies on such communicable diseases. CDC Division of HIV/AIDS Prevention program targets to improve the quality of life through preventing HIV infections and related morbidities in the US. This public health mission collaborates with communities, states, as well as national and international partners in research, reconnaissance, prevention and assessment strategies. It has been successful in increasing the longevity of affected persons, improving the quality of life, and reaching those who still need proper HIV screening in the US ("About the Division of HIV/AIDS Prevention (DHAP) | HIV/AIDS | CDC", 2017).
References
About the Division of HIV/AIDS Prevention (DHAP) | HIV/AIDS | CDC. (2017). Cdc.gov.
Retrieved 22 January 2017, from https://www.cdc.gov/hiv/dhap/about.html
Bertozzi, S., Padian, N. S., Wegbreit, J., DeMaria, L. M., Feldman, B., Gayle, H., & Isbell, M.
T. (2006). HIV/AIDS prevention and treatment. Disease control priorities in developing
countries, 2, 331-370.
Celletti, F., Wright, A., Palen, J., Frehywot, S., Markus, A., Greenberg, A., & Samb, B.
(2010). Can the deployment of community health workers for the delivery of HIV
services represent an effective and sustainable response to health workforce shortages?
Results of a multicountry study. Aids, 24, S45-S57.
HIV/AIDS Basics. (2017). Aids.gov. Retrieved 22 January 2017, from https://www.aids.gov/hiv-
aids-basics/
HIV/AIDS. (2017). World Health Organization. Retrieved 22 January 2017, from
http://www.who.int/gho/hiv/en/
Lloyd, Andrew. (1996). HIV infection and AIDS. Papua New Guinea Medical journal, 39(3),
174-80.
