Description of HIV
HIV is a viral infection transmitted through specific bodily fluids which weaken an individual's immunity. It results in a decrease of CD4 cells, and over time, the disease results in the destruction of many CD4 cells, making the patient prone to several infections.
Causes and transmission
The human immunodeficiency virus causes HIV infections. As already stated, its transmission occurs through bodily fluids such as infected blood, semen, or lymphatic fluids. A considerable number of individuals get the virus through having unprotected sexual contact with an individual that has HIV (Center for Disease Control and Prevention, 2017). It can also be transmitted from mothers to their children at the time of pregnancy, birth, or breastfeeding.
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Symptoms
The symptoms of HIV are different depending on the stage that a patient is in. At the first stage, referred to as primary infection stage, the patients display symptoms that are similar to those of the flu within several months after the patients are exposed to the virus. This stage lasts for a few weeks. The symptoms are usually very mild, making it difficult for any individual to notice them, and they involve:
Fever
Headache
Joint pain
Sore throat
Swelling in the lymph glands
The second phase, known as the clinically latent phase, does not have particular signs and symptoms. However, some patients do complain of lymph nodes swollen across an extended period. This stage usually lasts for ten years or several decades. In the last stage, when the virus becomes symptomatic, patients may be affected by mild infections or chronic symptoms which include;
Fever
Exhaustion
Diarrhoea
Loss of weight
Shingles (herpes zoster)
Oral thrush
Complications
People in the third phase of HIV have a high susceptibility to different types of infections, also called opportunistic infections. These complications are due to the severe decrease of CD4 cells and include cancers, tuberculosis, pneumonia, MAC, histoplasmosis, Herpes, severe diarrhoea, and candidiasis.
Treatment
Antiretroviral therapy (ART) refers to the utilization of HIV medicines for the treatment of the disease. Patients on ART are taken provided with several HIV medications (referred to as an HIV treatment regimen) that they have to take on a daily basis. The HIV treatment regimen of each individual is structured by their doctor base on their unique conditions. The treatment regime has been created to slow down the progression of the virus within the body. When a healthcare provider realizes that the HIV treatment regime for a patient is not effective, the healthcare provider can change the regime to a treatment course that it is more suited to the patient.
Demographic of Interest
By the end of 2016, around 1.1 million adults (older than 13 years old) had HIV within the country. In 2018, the death of 770,000 individuals was as a result of the infection. A large number of patients exist in developing countries, with an estimation of about 68% living in the African continent. Moreover, approximately 20.6 million individuals live in East and Southern Africa, which had an occurrence of 800,000 new HIV infections in the same year.
Social Determinants of Health
Social determinants of health refer to aspects that affect the health, functioning, and quality of life of individuals. They are the environmental components in which individuals exist. One of these determinants is employment conditions, which refer to the employment and working conditions of individuals (Alder, Glymour & Fielding, 2016). In cases of high unemployment, individuals may resort to sex work, resulting in a higher likelihood of transmission. This increases the exposure of the sex workers and their clients to HIV as these working conditions are usually associated with unprotected sex.
The second determinant is social exclusion, which refers to the access that an individual has to resources, capabilities, and rights, which may lead to health inequalities. Social exclusion may result in irresponsible behaviours, such as excessive drinking and unprotected sex. This type of irresponsible behaviour would facilitate the transmission of HIV from individuals who are infected to those who are not infected. Health systems refer to innovative approaches in the health system, which incorporate action on health equity outcomes. For example, innovative approaches are required during labour periods and birth of children with HIV-positive mothers. Hence, when these health systems are absent, the risk of infection is then increased, resulting in a higher prevalence of the virus.
Gender inequality affects the physical and mental health of a significant portion of the female gender across the globe. This makes women and gender equity an essential social determinant of health. Lack of gender equality affects the services that women and girls can access, including services such as education or proper labour clinics. In such cases, women are then exposed to the transmission of HIV infections from their sexual partners.
Lastly, public health programs structured for the achievement of health targets also act as an essential factor that affects the quality of health of the individuals (Adler, Glymour, & Fielding, 2016). An absence of public health programs that properly educate and inform individuals on causes and modes of transmission of the infection usually results in the increased spread of the disease. Lack of educational public health programs also translates to the lack of awareness by patients regarding existing treatment regimes, which may result in increased incidences of death from the disease that would otherwise have been avoided.
Hence, based on these social determinants, HIV transmission becomes highest among the groups that are socially marginalized. Some of these examples include sex workers, drug users that inject drug substances, same-gender sexual relations. The highest number of infections are among the youth as most of the members of marginalized groups are within this societal age group. The presence of stigma and discrimination also affects the ability of HIV-infected individuals to access the necessary healthcare facilities that they require.
Epidemiological Triangle
The epidemiological triangle is a model used for the explanation of the organism that causes the disease and the conditions that allow its reproduction and spread (Potean et al., 2016). It is made up of three sections; agent, host, and environment. Through a better comprehension of how HIV is transmitted, epidemiologists have been able to facilitate advancements regarding methods and programs for treating and preventing the HIV epidemic.
Agent
The human immune system is the target of the viral infection. This way, HIV increases the vulnerability of the immune system to other forms of infection. As the virus is centralized on decreasing the immune system itself, the body then loses its capability to combat the viral infection on its own effectively (Potean et al., 2016). The communication or transmission of the disease takes place through direct contact with the bodily fluids of an individual that is infected. Primarily, it has been identified to spread through sexual contact or the sharing of needles.
Host
The transmission of the infection occurs when bodily fluids are exchanged, such as blood coming into contact with a damaged skin tissue or an open wound. The primary host, therefore, is the human being as the form of infection in human beings can only be transferred between individuals or any other animals (Potean et al., 2016). Hence, there are no secondary hosts.
Environment
Several existing socioeconomic factors affect the transmission of HIV within a community. Communities characterized by a high level of STDs and decreased cases of patients seeking care, due to issues such as social pressure or stigma, are a supportive platform for the extended transmission of the viral infections (Potean et al., 2016). Poverty or low-income condition limits the accessibility of care and treatment by individuals, and stigma can result in the discouragement of individuals from receiving the necessary care.
The Role of the Community Health Nurse
Community health nursing refers to a discipline that integrates evidence-based research with advancements in science and new approaches for the improvement of health. It considers the cultural and socioeconomic factors of individuals in the community for the provision of appropriate interactions and sensitivity while providing care to individuals. The main role of a community health nurse is the provision of treatment to patients (Chin & Kim, 2016). Moreover, a community health nurse also provides education to community members regarding the maintenance of health so that they can minimize the occurrence of diseases and death.
The nurse ensures that health services are provided and acts as a direct care provider to groups and populations. The nurse engages in the assessment of the needs of the client, and planning and organizing different resources to meet these needs. They act as managers during the overseeing of the client care, the management of cases, and conducting community health assessment projects.
Another significant role of community health nurses is the facilitation of collaboration between essential partners. As community health work requires the cooperation of several stakeholders, community health nurses work with several individuals, including the clients, nurses, social workers, nutritionists, and psychologists, to foster collaboration for the provision of quality medical care (Chin et al., 2016). Lastly, community health nurses take part in the system investigation, collection, and analysis of data to solve problems and improve community health practices. This involves investigation and interpretation of facts, analyzing data interpreting the results, and communicating their findings for better health planning.
The Elton John AIDS Foundation
The Elton John AIDS Foundation (EJAF) is a non-profit company. The organization is led and by and based in the various communities it serves within the country. Its mission is to end the AID epidemic through the information of different individuals and facilitating channels for the prevention of infections (Care & Ferraro, 2019). EJAF provides the funding needs to help individuals living with HIV to have increased accessibility to medical care and treatment of greater quality. It conducts several activities to avail funds research-based programs and policies consistently.
EJAF conducts mobilization programs in different communities for the education and training of community members regarding HIV/AIDS channels of transmission, symptoms, and existing treatments. By targeting specific programs, the foundation is able to customize its education to the different social determinants of health of the particular community. EJAF also prioritizes the reduction of stigma directed towards infected individuals and strengthening the skills of those who care for people with HIV.
Moreover, the foundation also funds other organizations working towards similar goals, which include the improvement of the health of individuals living with HIV or bring impacted by HIV. It also funds an organization that upholds the right of those living with and affected by HIV while addressing the social and economic needs of HIV patients (Care et al., 2019). Lastly, the foundation has been engaged in advocating for enhancing industry and government and health policies and funding.
Hence, EJAF is a national non-profit organization that has structured several programs to enhance the education of individuals regarding the transmission of HIV and existing treatment. Furthermore, in addition to its community-based interventions, the foundation also raises money to fund other organizations that share similar goals, objectives, and missions. This has been considerable in enhancing existing awareness regarding the disease and revolutionizing government policies that regulate the treatment of the disease.
Global Implication
Across the world, almost 36 million individuals have HIV infections, with cases of death, from the disease being up to 20 million patients. HIV is endemic to East and Southern Africa, which has 7.1% adult HIV prevalence, with 19 million people living with HIV. This is followed by West and Central Africa, which has a 2.2% adult HIV prevalence, with 6.5 million individuals living with HIV (Autenrieth et al., 2018). In these countries, there is a significant commitment to fighting the spread of the disease. However, a large number of nations still rely on external donors to financially facilitate HIV responses. In most of these countries, unprotected heterosexual sex and mother-to-child transmission are the main channels of HIV infections.
In the Asia and Pacific region, 240,000 individuals are living with HIV, with a less than 0.1% adult HIV prevalence (Autenrieth et al., 2018). Across each affected country, the main populations that are affected have a high degree of vulnerability. Eighteen countries have declared same-sex activities criminal activities, and drug detention centres punish individuals that abuse drugs while denying any access to existing treatment regimes. In the Middle East region, HIV transmission occurs mainly through drug injections, while in Latin America & the Caribbean, a majority of the HIV funding comes from domestic sources, which aim to demonstrate the commitment of the governments to the HIV response. Lastly, in the European and Asian regions, drug addicts and transgender individuals are at a greater risk for the disease, which has resulted in the scaling up of IV testing for early diagnosis.
References
Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health and health inequalities. Jama , 316 (16), 1641-1642.
Autenrieth, C. S., Beck, E. J., Stelzle, D., Mallouris, C., Mahy, M., & Ghys, P. (2018). Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020. PloS one , 13 (11), e0207005.
Carè, R., & Ferraro, R. (2019). Funding Innovative Healthcare Programs Through Social Impact Bonds: Issues and Challenges.
Centers for Disease Control and Prevention. (2017). HIV and viral hepatitis. South Carolina State Documents Depository .
Chin, Y. R., & Kim, H. (2016). The role of community health nurse in assay written by a nurse practitioner of primary health care post. Journal of Korean Public Health Nursing , 30 (2), 300-310.
Poteat, T., Scheim, A., Xavier, J., Reisner, S., & Baral, S. (2016). Global epidemiology of HIV infection and related syndemics affecting transgender people. Journal of acquired immune deficiency syndromes (1999) , 72 (Suppl 3), S210.
