Epidemiology of HIV in Florida

Introduction 

HIV and AIDS is a non-curable disease that weakens the human immune system when they are infected. The disease develops gradually, showing no specific signs and symptoms in the early days of infection and it can take up to years for the first signs to appear. It is an epidemic that affects a significant number of people in the United States. Florida is among the states that have a long history of HIV infections and resulting deaths. Between 2001 and 2010, it was among the top states where morbidity and mortality were high compared to other states. Although the cases go down at times, the disease is still a menace in Florida, and the latest Centre for Disease Control (CDC)'s report shows that Florida leads in new cases of HIV infections and deaths associated with the disease. The numbers are too high as compared to other states, and there is need to look into it and salvage the situation. 

Background (Prevalence Rates by Your Geographic County, State, and National Statistics) 

Human Immunodeficiency Virus (HIV) is a lentivirus that attacks and weakens the human immune system by destroying the CD4 cells in the body. If the virus infection is not managed, it leads to a destroyed immune system. The full blown stage of the disease is characterized by some symptoms and is referred to as the Acquired Immune Deficiency Syndrome (AIDS). The virus spread mainly by unprotected sexual intercourse with an infected person. It can also be acquired by sharing sharp and piercing objects such as razors and needles with an infected person. A person who receives unscreened blood during transfusion also risks acquiring the disease. Mothers can also pass the virus to their babies during birth and when breastfeeding them. 

Several signs and symptoms have appeared when one is infected. According to the National Health Service (NHS) (2016), the signs and symptoms differ from one step of progression to another. A few weeks into the infection, the signs are similar as to those caused by flu and many people may fail to diagnose them. Fever, body rash and sore throat, fatigue, joint pains and swollen glands are some of the early signs of HIV infection (NHS, 2016). The early signs are then followed by a long period (up to 10 years) of no sign and symptoms, and one feels well. The disease matures and weakens the immune system significantly. The symptoms and signs that follow include loss of body weight, chronic diarrhea, sweating at night, skin diseases, and recurrent infections (NHS, 2016). One may also feel extreme fatigue and swollen lymph nodes. 

According to Center for Disease Control (2015), 1 out of 6 (15.8%) of HIV-infected people in the US do not know that they are living with the HIV. Also, the number of new diagnoses reported in 2013 was about 47,165 people. HIV and AIDS have caused the deaths of 636, 000 individuals in the US since the disease was first diagnosed. Throughout the US, about 1.1 million people are living with HIV and AIDS (Care Resource, 2017). 

In 2013, Florida was ranked the first in HIV infections in the US with 5,364 adults and adolescents diagnosed with the disease (CDC, 2015). The number of people living with HIV and AIDS was 104,554 in Florida as of January 31, 2014. Of the total number, 71% were male while 29% were female, the male accounting for over two-thirds of the people infected by the Virus. The blacks in Florida rank the first regarding numbers of people living with HIV and AIDS at 48% of the total infected population. The whites follow at 29%, and the Hispanics are third at 21%. The most common mode of HIV transmission in Florida is men who have sex with men at 43 %. Heterosexual intercourse rates at 34% (Care Resource, 2017). The infections are high because of the behaviors that put the people at the risk of acquiring the disease. In Florida, 48.2% of the adolescents had sexual intercourse by 2013. 63.8 % of those who had engaged in sex did not use protection during their last intercourse (CDC, 2015). 

Florida and Miami-Dade vs The US 2013 HIV Rates 

Sub-group	The US	Florida	Miami -Dade
Male  Female	76  24	71  29	72  28
White  Black  Hispanic  Other	32  43  20  5	29  48  21  2	12  45  42  1
Age 0-24 years  24-49 years  50+ years	5  55  40	4  52  44	-  -  -
Man having sex with man  Hetero sexual  Other	52  26  22	47  38  15	47.5  -  -

Modified from Florida Health: HIV Disease: United States vs. Florida (2011) and AIDSVu: Miami (Miami-Dade County) Highlights. (n.d) 

Miami – Dade County is ranked the first in the number of new cases and total infections in Florida. 1 in 99 persons in the county is HIV-infected. The rates are high in men, 1 in 67, as compared to women, 1 in 178. 

Current Surveillance Methods and Any Mandated Reporting Methods 

The method of surveillance of a particular disease depends on the disease characteristics. The prevalence and the effects of the disease are some of the factors that dictate the method to be used. HIV and AIDS are highly prevalent in Florida. The numbers have been increasing due to a spike in new cases of infection of HIV and AIDS. The Florida Department of Health uses the sentinel surveillance method to establish the causes of the increase in new infection. Sentinel surveillance is used in situations where high-quality data about a given disease (World Health Organization, 2017). The National HIV Surveillance System (NHSS) is the primary method of collecting data on HIV prevalence and trends in the United States, including Florida. The data collected is also used developing prevention measures to curb the spread of HIV and AIDS, allocate the resources and develop policies for management of HIV and other diseases. Reporting is done using the HIV and Perinatal HIV Exposure Reporting Case Report Forms. The forms are used to collect data on morbidity and mortality of HIV and the related perinatal exposure (CDC, 2016). 

Descriptive Epidemiology Analysis. Include Financial and Social Costs 

In the state of Florida and the Miami-Dade County, the most affected people are men. This is because of the increased number of men who indulge in men to men sexual activities. The number of gays in the US, particularly Florida has been on the rise in the recent past. These sexual relationships between men have been a significant contributing factor to the spread of HIV, especially in cases where protection is not used. Another group that is in the spotlight is the school going adolescents who engage in sexual activities at an early age. They may not be ready for such activities and in most cases and do not know the risk and consequences of risky sexual behavior. As a result, almost half of them (48.2%) have had sex, and of them, 63.8% didn't use protection during the last act. African Americans affected more than any other race in the state. The reason for the increase in the number of blacks with HIV and AIDS is because most of them tend to have sexual intercourse with people from the same ethnic background. This leads to the disease spreading amongst them like any other race. Most of the blacks also live in poverty as compared to any other race. As a result, they do not access high-quality care and rarely are they tested. Therefore, they live without knowing their HIV status and may spread the disease without knowledge (CDC, 2017). African- Americans who indulge in man to man sexual activities are a good group to target when considering a prevention plan because they have the highest risk than any other race. 

HIV and AIDS have social and economic implications on the patient, their families, the state and the federal government. Some of the economic (financial) costs include increased expenditure on medication, expenditure on healthcare workers, less labor supply as the person is weak or bedridden, and reduced family savings. The federal government spends significantly on the acquisition of anti-retro viral drugs so as to help keep the labor force inactive. A lot is also invested in research on ways to prevent the spread of the problem depriving other sectors of the economy. Persons who live with HIV and AIDS may quit their jobs and lose what they used to earn. The result is a poorer family as they spend their savings on the patient or use up what was saved before. In the end, it the infected person or the family becomes poorer than before. The people living with AIDS are also dependent on government and families; some view this as a loss of dignity and thus choose to hide other than reveal the problem to people. Concealing their statuses burdens their close friends and relatives. 

A Review of How the Disease is diagnosed 

HIV infection can be diagnosed by taking an HIV test. The HIV test is a two-step process where one's body fluid is screened and then confirmed if it turns positive. The screening usually tests for the presence of antibodies, antigens or the viral load in the body. It is often referred to as the ELISA (Enzyme-Linked Immunosorbent Assay) test. If the test turns positive, the Western blot test is carried pout to confirm the infection (University of California San Francisco, n.d). In the US, screening for HIV and AIDS is free and for people who are willing to get tested. No person is forcefully tested though there is increased advocacy and linkages of the people thought to be at risk of being infected. 

The ELISA test is one that is used to screen for the presence of HIV in the blood. It works by producing enzyme color changes when they detect the presence of antibodies or antigens. ELISA tests are highly sensitive to antigens and antibodies present in the sample. However, they are not as specific as the western blot which works by separating the proteins based on their sizes. As a result, the ELISA tests may detect antigens or antibodies that are not HIV- specific. Modern ELISA tests have been developed to be more specific and are gaining use as confirmatory tests. The positive predictive value of ELISA tests varies with the type of the kit. The values are high due to the improvements made to the kits in the recent past. The kits are cheaper than the Western blot or other methods such as the full blood sample screening. Many people opt for ELISA kits for screening and during rapid assessment because they are cheaper. ELISA tests are used on the people who test for the first time. 

A Brief Plan to Address the Disease 

HIV and AIDS is a problem that affects many people in the country and Florida. The three actions to undertake include involvement of the community members, economic empowerment of the African-Americans and promotion of safer sexual behavior among the high-risk populations. The community members understand their problems and can share experiences with the other members of the community within which they live. Those who have the disease can tell their stories and ordeals associated with HIV and AIDS. Economic empowerment of the blacks can also be used to change the situation around the state. Making sure that they get educated and offering jobs to those who are qualified so as to help alleviate their poverty levels is also another method. Once financially stable, they can seek better medical care and know their statuses so that the infected do not spread the disease unknowingly. Discriminative sexual behavior can also be used to curb the spread of the disease among sexually active populations. The people of Florida can be educated on the need of knowing the HIV status of the people with whom they engage in sexual intercourse and use of protection where they are not sure of the partner's status. 

Conclusion 

HIV and AIDS is a problem that has been on the rise again in the recent past. Though there are measures by the government to curb its spread and reduce new incidences, there are more people are still infected in Florida than any other state in the US. Miami-Dade County in Florida ranks the first in the state and the country regarding the numbers of people affected and the new cases reported. One of the reasons why HIV has proved difficult to prevent and eradicate in the shift in infection patterns. Today, more men than women are infected in Florida because of the increasing same sex activities in the state. Preventive measures have to be shifted to the risk population, rendering the previous plans less effective. HIV is diagnosed by taking an HIV test which involves a two-step process, the screening process, and the confirmatory test. One of the methods used for screening is the ELISA test which is used in both hospital settings and the rapid assessment settings. Western blot is an example of the confirmatory test. Community involvement, economic empowerment, and creation of awareness about safe sex are some of the methods that can be used to slow down and stop the rates of infection. 

References; 

AIDSVu. (n.d). Miami (Miami-Dade County) Highlights. Retrieved April 4, 2017 from: https://aidsvu.org/state/florida/miami/ 

Center of Disease Control. (2015). Florida – 2015 State Health Profile. Retrieved April 4, 2017 from: https://www.cdc.gov/nchhstp/stateprofiles/pdf/florida_profile.pdf 

Center of Disease Control. (2016). HIV Case Reporting and Surveillance. Retrieved April 4, 2017 from: https://www.cdc.gov/hiv/guidelines/reporting.html 

Center of Disease Control. (2017). HIV among African Americans. Retrieved April 4, 2017 from: https://www.cdc.gov/hiv/group/racialethnic/africanamericans/ 

Florida Health. (2014). HIV Disease: United States vs. Florida Retrieved April 4, 2017 from: http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/_documents/fact-sheet/2014/2014-us-vs-fl-fact-sheet.pdf 

Florida Health. (n.d). HIV/AIDS Surveillance Program Guides Public Health Services. Retrieved April 4, 2017 from: http://www.floridahealth.gov/%5C/diseases-and-conditions/aids/surveillance/index.html 

National Health Service (2016). HIV and AIDS – Symptoms. Retrieved April 4, 2017 from: http://www.nhs.uk/Conditions/HIV/Pages/Symptomspg.aspx 

University of California San Francisco, (n.d). HIV Diagnosis. Retrieved April 4, 2017 from: https://www.ucsfhealth.org/conditions/hiv/diagnosis.html 

World Health Organization. (2017). Sentinel Surveillance. Retrieved April 4, 2017 from: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/sentinel/en/ 

Care Resource. (2017). HIV/AIDS Statistics. Retrieved April 4, 2017 from: http://www.careresource.org/hivaids/statistics/