Place
Introduction
HIV is considered as a major global health issue. Approximately 38.1 million people have been affected by HIV since 2000 and over 25.3 million are known to have died due to HIV/AIDS associated health issues (Vermund, & Leigh-Brown. 2012).The global prevalence of HIV is 0.8% with nearly 36.9 million people to have been living with HIV as per a 2014 report. Nearly 2.6 million people have been infected with HIV. The number of HIV victims is high in low-income and middle-income nations. As per the 2014 data, nearly 1.2 million have died due to HIV associated diseases. As per the global data for HIV burden nearly 70% of HIV victims are from sub-Saharan Africa accounting to over 25.8 million people. Nearly 54% of the people in the whole world would know that they are suffering from HIV. Almost 2 million new HIV infections were reported in 2014 and over 220,000 were children. Infected children often belong to sub-Saharan Africa and were often victims of HIV due to breastfeeding or an HIV-positive mother (Vermund, & Leigh-Brown. 2012).
The global impact of HIV is observed in all nations and with many challenges in line, there has been a significant rise in the number of treatment for HIV victims, especially in patients from low-income countries. Nearly 15 million people with HIV have received antiretroviral treatment accounting to 41% of the infected population which would include 823,000 children as of March 2015 (Vermund, & Leigh-Brown. 2012).Of the total treated people, nearly 13.5 million have been associated with low and middle-income nations. There has been research on the treatment and management for prevention of mother-to-child transmission of HIV. Due to rising intolerance, 73% of women were successfully treated in order prevent HIV transmission to their child. A total of $20.2 billion was granted for HIV programmes around the globe. However, nearly $24 billion would be required to cater to the growing number of HIV victims worldwide (Vermund, & Leigh-Brown. 2012).
Health Determinants of HIV
The determinants of health with respect to HIV are linked with social, economic and environmental factors that are correlated with the individual health status. The determinants of health as per the Global Public Health Agency include: (a) Social status and income (b) Literacy and education (c) Social support (d) working and employment conditions (e) health practices (f) Physical environment (g) Child Development (h) Biological aspects (i) Genetic factors (endowment) (j) Gender (j) Health Services, and (k) culture (Sharp, & Hahn. 2011).
Some of the key factors associated with HIV infection include society, poverty, physical or sexual abuse, education and illiteracy, addiction, mental health issues, violence, stigma, powerlessness, unemployment, legal irregularities, social insecurity, lack of choice, and unorganized healthcare system. These key factors have a direct impact on people who live with HIV and would want to receive care, support, and treatment (Sharp, & Hahn. 2011).
An example of the impact of health determinants on HIV prevention and treatment includes an individual with low-income (poverty) would have a negative impact on the community and his/her own self-esteem. It would also make the individual feel helpless and prevent from building relationships (Rosenberg, Khosropour, & Sullivan, 2012). These factors would have a direct impact on the individual’s judgement and could prevent him/her from HIV prevention or treatment. There have been many structural approaches for HIV prevention that could be linked due to the social, physical, organizational, cultural, economic, community, and legal factors. Structural interventions are aimed to bring about change in the individual’s contribution towards risk and resilience. These interventions are also linked with key policies and programs that would help change people’s lives and have a social or political impact. Lastly, these interventions have an impact on the individual’s behaviour towards HIV treatment and prevention. (Rosenberg, Khosropour, & Sullivan, 2012).
Epidemiological Triangle of HIV
The epidemiological triad of HIV comprises of 5 chains (Figure 2) which are :
(a) Infectious agent: The Human Immuno deficiency virus is the main agent involved in the spread of HIV/AIDS. There are five types of the virus and all are known to have similar virulence. However, each of the subtypes are known to have phenotypic and genotypic differences followed by varying antiretroviral resistance (Sharp, & Hahn. 2011).
(b) Susceptible Host: The host and the rate of infection is based on the genetics, stage of infection, type of antiretroviral therapy, other reproductive infections, use of contraception, male circumcision, and pregnancy. Humans are the predominant host of HIV. However, apes and other primates have been known to be infected with HIV before humans.
(c) Reservoirs: The key environmental factors that are addressed with HIV include the socioeconomic status, sex-partner rates, prevalence of the disease with respect to local exposure, and other risk factors such as behaviour etc. (Sharp, & Hahn. 2011).
(d) Portal of re-entry and exit: HIV develops into AIDS wherein the immune system of the individual is compromised and would eventually suffer from communicable and infectious diseases leading to death (Sharp, & Hahn. 2011). HIV is spread among people through unprotected sex, exchange of body fluids, and sharing of needles and syringes from an infected individual. The exit or spread of the disease is similar to the entry.
(e) Means of transmission: HIV can only be spread to direct transmission. An infected individual could spread the disease through unprotected sex or exchange of body fluids. Healthcare professionals consider indirect routs through which HIV could spread such as sharing of needles/injections of an infected HIV patient with other individuals etc. Pregnant women with HIV could spread HIV to the unborn child (Sharp, & Hahn. 2011).
Role of Community Health Nurse
Ever since the HIV/AIDS pandemic was observed, nurses have played a key role in the treatment and management of affected victims. Nurses were involved in the care of patients even before the antiretroviral therapy was introduced in the market (McCarthy, et al. 2013). Nurses at this stage were found to help patients by providing quality education and information (McCarthy, et al. 2013). Nurse have a key understanding of the disease progression and act as educators and advocators for HIV patients. Similar to the inception of the antiretroviral therapy that changed the face of HIV/AIDS, nurses have also changed the dimension through which HIV/AIDS was overseen by patients (McCarthy, et al. 2013).
Some of the key role of nurses in HIV include: (a) Patient education is on top priority for nurses since it is important for patients to understand the disease progression, treatment, management, and diagnosis (b) Patient advocacy forms a key role of the nurse in advising the patient on latest medication and interventions for management based on evidence (c) Research and development are key areas that nurses should explore in order to find new concepts and interventions that would benefit the society with respect to HIV (d) Developing guidelines and policies would only benefit the healthcare system and reduce the burden of the disease through effective interventions and recommendations and (e) Evidence-based care and HIV awareness are key factors that nurses would play an important role. Applying evidence-based research and clinical insights would help in reducing the burden of the disease and improve health outcomes (McCarthy, et al. 2013).
International Aids Society (IAS)
International AIDS Society (IAS) was founded in 1988 and is currently the world’s largest organization/entity to have HIV professionals. The IAS comprises of members from over 180 countries and have been associated with the IAS in different fields and work for the global AIDS response. The IAS has funded 2 main conferences for HIV: IAS Conference on HIV Science and International AIDS Conference. Both conferences are attended by global leaders and policy makers to fight HIV by applying knowledge, skills, and expertise. The IAS is involved in promoting HIV research and advocacy to address key areas of issue through campaigns, initiatives, and programmes. The two initiatives are as follows:
Towards an HIV Cure: The initiative was implemented to bring about global scientific research and accelerate the process for new drug development and innovative breakthrough in the field of HIV/AIDS. It has also focused on advocating and funding for such causes.
Collaborative Initiative for Paediatric HIV Education and Research (CIPHER): A global initiative to cater to the needs of infants, children, adolescents, and young adults affected with HIV. It provides and supports clinical management and resources for the treatment and management of paediatric HIV (Wainberg, Kippax, Bras, & Sow, 2014).
Figure 1. Epidemiological Triad for HIV
Figure 2. The five chains of HIV
References
McCarthy, C. F., Voss, J., Verani, A. R., Vidot, P., Salmon, M. E., & Riley, P. L. (2013).
Nursing and midwifery regulation and HIV scale-up: establishing a baseline in east, central and southern Africa. Journal of the International AIDS Society, 16(1), 18051. http://doi.org/10.7448/IAS.16.1.18051
Rosenberg, E. S., Khosropour, C. M., & Sullivan, P. S. (2012). High prevalence of sexual
concurrency and concurrent unprotected anal intercourse across racial/ethnic groups among a national, web-based study of men who have sex with men in the United States. Sexually Transmitted Diseases, 39(10), 741–746. http://doi.org/10.1097/OLQ.0b013e31825ec09b
Sharp, P. M., & Hahn, B. H. (2011). Origins of HIV and the AIDS Pandemic. Cold Spring
Harbor Perspectives in Medicine:, 1(1), a006841. http://doi.org/10.1101/cshperspect.a006841
Vermund, S. H., & Leigh-Brown, A. J. (2012). The HIV Epidemic: High-Income Countries.
Cold Spring Harbor Perspectives in Medicine, 2(5), a007195. http://doi.org/10.1101/cshperspect.a007195
Wainberg, M. A., Kippax, S., Bras, M., & Sow, P. S. (2014). The 20th International AIDS
Conference: where do we go from here? Journal of the International AIDS Society, 17(1), 19331. http://doi.org/10.7448/IAS.17.1.19331
