Hepatitis C and HIV Among Intravenous Drug Users

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Significance of the health issue as a health concern

Description of the health issue

Hepatitis C and HIV outbreaks are likely to occur in drug users. Miller et al. (2005) define high-risk youth as young people who inject drugs into their bodies, engage in sex work, or those, who have a history of sexual abuse. This report is concerned with intravenous drug users as the target demographic. It has been shown that HIV infections are quite high among poly-drug users. Vulnerability to HCV infections is also immensely high among people who inject cocaine on a daily basis, require assistance in the injection of the drugs, or are involved with a partner who injects drugs regularly.

Evidence of the existence of the health issue in Canada

An analysis carried out by Miller et al. (2005) shows that there is an elevated increase in HCV and HIV among vulnerable youth in Vancouver. The analysis was done among two hundred and forty-one youth who had been enrolled in a previous study; they were all injection drug users. The analysis revealed that eleven percent of the participating youth went on to become HIV positive. On the other hand, forty-four percent of the youth developed HCV. This is indicative of the fact that injection drug use does increase susceptibility to HCV and HIV.

Plitt (2008) provided further evidence of the existence of this health issue in Edmonton. An analysis of injection drug users was done in 2005. Their blood samples were taken and analyzed. It was found that almost a quarter (23.9%) of the participants were HIV positive. This was a tremendously high prevalence rate when compared to national values. Furthermore, two-thirds of the group had HCV. This was roughly 66.1% of the injection drug users. Such findings indicate that injection drug users are highly susceptible to HCV and HIV.

Relevance to community nursing practice

Community health nurses association of Canada (2008) explain that “a community health nurse combines knowledge from public health science, health care, nursing science, and social sciences; focuses on promoting, protecting and preserving the health of populations; focuses on populations and links health and illness experiences of families and communities; recognizes that a community’s health is closely linked with the health of members and practices in increasingly diverse settings, such as community health centers, schools, street clinics, youth centers and nursing outposts.” (p 8).

In relation to this health issue of HIV and HCV, the community health nurse has the responsibility of promoting health among intravenous drug users. They need to work with these youth in order to assess their health needs. Community nurses should determine the root cause of such high levels of HCV and HIV in the identified group. This ought to be followed by a planned intervention of the health program. Here, some strategies that will facilitate the transition to healthier choices should be considered. The community health nurse has the responsibility of using various media channels such as social marketing in order to build support from the public on this health issue (Community health nurses association of Canada, 2008).

Plitt (2008) found that most of the participants in the study were already aware of their HIV status but were not aware of their HCV situation. Community nurses ought to collaborate with intravenous drug users in order to offer programs that suit their circumstances. They could test the intravenous drug users for HCV, and offer them treatment plans for that need. Outreach programs would particularly work for this group. This can come in the form of youth treatment centers and other similar interventions. Nonetheless, community nurses may not have the financial resources to set this up by themselves; they can still use policy arms and legislative bodies to drive change. In this regard, they will be acting as health advocates (Community health nurses association of Canada, 2008).

Implications of this health issue on the health of the individual, group (family), community, the population affected or at risk

Using illicit substances intravenously places individuals at an immense risk of contracting HIV and HCV. This is detrimental to their health. The absence of treatment centers in certain areas of Canada that have a high number of injection drug users can lead to even greater numbers. Such youth will continue suffering from these health issues. It has already been shown that high risk youth tend to develop HIV within their first four years of using intravenous drugs, and contract HCV in the first two years of drug use. Most of them will keep placing immense pressure on the Canadian health system if their numbers increasing. It will be quite disturbing for these vulnerable youth to suffer from health conditions that can be prevented (Miller et al., 2008).

The health issue also has repercussions on community and other populations as it can lead to the spread of the disease among non drug users. This is because individuals who purchase sexual services from at-risk females may get infected (Plitt, 2008).

The health issue initiative

The health initiative is a health promotion initiative. The health promotion involves the provision of harm reduction services through an organization called ‘Insite’. It provides a healthy environment for drug users to administer their drugs (Lightfoot et al., 2009).

This will ensure that the incidences of overdose do not occur, harm is reduced (especially with regard to discarded needles and crime), social and health services are offered to drug users and legal, social and incarcerations costs of drug use are minimized. The main benefit is that Insite will reduce disease transmission through needle sharing or use of discarded needles. Education and health support services will also help in achieving this goal. Stanhope et al. (2008) explain that a health promotion initiative needs to have a biomedical component. Insite offers pharmacological treatments to HIV and HCV patients. Health promotion also involves behavioral strategy management because lifestyle choices contribute to health problems. Insite will use communication and education in order to deal with the circumstances that cause HIV and HCV among injection drug users. It will also have a socio environmental component by dealing with social isolation (Stanhope et al., 2008).

Analysis of the community nursing health initiative using the Population Health Promotion Model

Rationales for the determinant of population health, level of action and health promotion strategy targeted by the initiative (6 marks)

The determinant of population health was deduced from the evidence found in research on the prevalence of HIV and HCV among intravenous users. The population health promotion model requires one to ask ‘why’ a certain action needs to be taken. This decision ought to be consistent with community needs and resources (Public Health Agency of Canada, 2001). The level of action will involve health services, literacy and education, social support and coping skills. In the health promotion model, the decision on ‘What’ one can take action on is determined by the specific areas that will be directly be improved (PHAC, 2001). Lastly, health promotion strategy chosen was strengthening community action through Insite. This harm reduction and needle exchange program assists patients by improving personal health practices.

Whether a biomedical, behavioral/lifestyle or socio-environmental approach predominates in the initiative

This initiative is dominated by a behavioral approach. The underlying assumption is that lifestyle choices affect people’s health. Since substance abuse is leading to high HIV and HCV prevalence, then the use of health education, communication and support are needed in order to minimize the circumstances that lead to infection (Stanhope et al., 2008).

Implications of the initiative for improving/protecting the health of the individual, group

The Supreme Court of Canada allowed the existence of Insite, so this is an initiative that is consistent with nursing practices. The concepts of supervised injection and harm reduction are all goals that are accepted in nursing care. This initiative will offer safe environments for drug users so as to minimize transmission of blood related diseases like HIV and HCV. It is therefore likely to succeed. Additionally, since nurses offer a trusting and dignified environment, patients are likely to be empowered (Lightfoot et al., 2009).

Obstacle

One obstacle that could affect the effectiveness of this strategy is the lack of trust among drug users. Such a situation may have been created by the continued criminalization of drug users, categorization of the group as ‘drug user’ and cultural barriers created by their social-economic status. This lack of trust could prevent drug users from seeking health treatment from Insite.

A plan to mediate the impact of the obstacle

Three (3) detailed strategies and rationales

The first strategy will involve learning the values and cultures of the drug users so as to provide care to them in a manner that they relate to. Creating an atmosphere of encouragement and acceptance will increase the number of participants, and trust among intravenous drug users. The second strategy will be enacting community outreaches for community nurses in Insite. They could inform street drug users about the services available at the institute. The third strategy involves collaborating with law enforcers in order to minimize obstacles that they create with regard to Insite.

Connection of each strategy to one of the three (3) PHPM dimensions, with rationales

The first strategy that involves learning the values and cultures of the targeted drug users is provision of social support and thus caters to the ‘what’ in the PHPM model. Learning the cultures allows one to create trust and this gives them support. The second strategy is carrying out a community outreach on the services at Insite. This strengthens community action and responds to the ‘how’ dimension. The third strategy is working with law enforcers. This entails the ‘how’ dimension because it aims at creating a supportive environment (Public Health Agency of Canada, 2001)

Goal or outcome statement for each strategy.

The goal of the first strategy is to create an atmosphere of trust between drug users and Insite. The second goal is to inform people about the dependability of Insite. The goal of the third strategy is to minimize law enforcement interference in Insite services.

Identify if the strategy is a biomedical, behavioral/lifestyle or socio-environmental approach.

The first strategy is social environmental as it deals with cultural barriers; the second strategy is behavioral because if drug users are to come to Insite, they need to know that their behavioral choice i.e. substance abuse is a health problem. The third strategy is social environmental since it involves a certain level of advocacy (Stanhope et al., 2008).

Analysis of the community nursing health initiative

The Standard from the CCNSoP that is particularly relevant.

Standard three is particularly relevant because it entails building relationships. Insite involves offering a supportive environment that will empower the drug users. This deals with caring, which is an important part of building relationships. Insite would entail connecting with the target group through active participation. This is also a role carried out in standard three. (Community health nurses association of Canada, 2008)

Implications for a community health nurse

The community health nurse would need to work on his or her communication methods in order to build relationships in Insite well. The person will need to trust the intravenous drug users to be able to solve the problem. He or she must also involve other community organizations like volunteer services that deal with detoxification or rehabilitation (Lightfoot et al., 2009).

References

Community Health Nurses of Canada. (2008). Canadian community health nursing standards of practice. Web.

Lightfoot, B., Panessa, C., Hayden, S., Thumath, M., Goldstone, I., &Pauly, B. (2009). Gaining insite: harm reduction in nursing practice. Canadian Nurse, 105(4), 16-22.

Miller, C., Spittal, P., Frankish, J., Li, K., Schechter, M., & Wood, E. (2005).HIV and hepatitis C outbreaks among high-risk youth in Vancouver demands a public health response. Canadian Journal of Public Health, 96(2), 107-108.

Plitt, S., Gratrix, J., Hewitt, S., Conroy, P., Parnell, T., Lucki, B., &… Singh, A. (2010). Seroprevalence and correlates of HIV and HCV among injecting drug users in Edmonton, Alberta. Canadian Journal of Public Health, 101(1), 50-55.

Stanhope, M., Lancaster, J., Jessup-Falcioni, H., &Viverais-Dresler, G.A. (2008). Community health nursing in Canada. Toronto: Mosby Elsevier.

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