From Exceptional to Chronic Illness: New Challenges in HIV Prevention in the UK

NB: We do not resell your papers. Upon ordering, we do an original paper exclusively for you.

NB: All your data is kept safe from the public.

Table of Contents

Introduction
Rationale
Body
Conclusion
References List

Introduction

The HIV pandemic is a growing concern worldwide. It is estimated that more than 33 million persons are infected with HIV. Of these, nearly half are women (Wagner, Hart, Mohammed, Ivanova, Wong & Loutfy 2010) despite efforts by various nongovernmental organizations (NGOs), faith-based organizations (FBOs), and respective governments to avail antiretroviral drugs to individuals living with HIV/AIDS. However, when the highly active antiretroviral therapy (HAART) and several other preventive measures were introduced in the market, there was a change in perception among the population that the illness was not as fatal as once feared but rather, a chronic illness that could be managed like say, type 2 diabetes mellitus. The change in perception has largely been informed by advances in new methods of prolonging the lives of patients. The use of protective methods such as condoms helps to overcome undesirable consequences associated with sex such as unplanned conception and HIV infection. Nonetheless, the sexually active generation (who are mainly the youth) rarely use condoms and this could perhaps explain the high prevalence rates of HIV/AIDS among the population. This is one of the major challenges faced by the relevant authorities in trying to reduce the levels of HIV infection in the UK. Other challenges involved include exposure of age-related diseases (such as diabetes, dyslipidemia, and cardiovascular disease) to HIV-infected patients and less knowledge or awareness among the people.

Although HIV/AIDS has emerged as a chronic illness, it is nonetheless a manageable illness. For example, the use of antiretroviral (ART) increases the life expectancy of the person infected by the virus. Nonetheless, there is a stigma attached to the use of drugs and this could be attributed to fear of discrimination by society. The current paper is an attempt to analyze the shift in the perception of HIV from an exception to a chronic illness and the new challenges experienced in HIV prevention in the UK.

Rationale

The topic has been chosen due to the following reasons:

Despite the presence of highly active antiretroviral therapy (HAART), there are still new challenges in HIV prevention.
HIV remains a key global concern in the 21st century.
HIV in the UK is high among the bisexual, gay, and other men-who-have-sex-with-men.
There has been a paradigm shift in HIV from a fatal and sub-acute infection to chronic illness as a result of medical advances.

The essay has been inspired by the new challenges in HIV prevention such as stigma, exposure to age-related diseases, negligence in the use of condoms, and lack of adequate knowledge. This is despite the presence of highly active antiretroviral therapy for use by HIV-infected patients. HIV remains a global concern in the 21st century. For example, there are more than 33 million persons infected with HIV across the globe. HIV in the UK is high among bisexuals and gays. Given that society discriminates against this group, members find it hard to participate in HIV prevention practices. As a result, this has resulted in a major challenge in HIV prevention in the UK (McDaid & Hart 2012). According to Wagner et al. (2010), “the advent of highly active antiretroviral therapy (HAART), HIV has changed from a subacute and fatal infection to an important but chronic illness in the developed world (p. 208). What this means is that the introduction of HAART means that HIV is no longer perceived as a dangerous disease but rather a chronic illness.

Body

The concept of ‘exceptionalism’ was adopted in the 1980s when AIDS was perceived and treated as an exceptional disease. At the time, AIDS was labeled as ‘exceptional’ since it was not treatable and resulted in the deaths of infected persons (Whiteside 2010). The major means of transmission included sharing of injections, men having sex with men (MSM), and unprotected sex. The affected persons were shunned by the rest of the community and any form of standard public health intervention was deemed risky as it was feared that such kind of intervention would drive the infected people away due to the stigma attached to the illness. Although mobilization was carried out to come up with new intervention methods, it was largely considered exceptional in comparison with other communicable diseases. As a result, public health officials and advocates came to an agreement that an HIV policy was vital as it would accommodate the uniqueness of the HIV epidemic (Whiteside 2010). The ‘exceptionalist alliance’ gained prominence when it receive support from gay movements who were also advocating for public health awareness and intervention as regards the HIV pandemic.

The advent of the HIV epidemic treatment through scientific research, drugs, and therapies resulted in a paradigm shift. As an increasingly higher number of people in Europe had access to medication, this effectively brought to an end AIDS exceptionalism. However, the available medication was still costly. This has been reflected in a study carried out by Wagner et al. (2010), who found that the dawn of highly active antiretroviral therapy (HAART) created a transition of HIV from an exceptional and fatal infection to a chronic illness. The ability to access treatment and antiretroviral drugs has been the major cause of this shift. In developed countries like the UK, HIV/AIDS is described as a chronic disease (Scandlyn 2000) as there were drugs and resources set aside to treat the disease. According to Scandlyn (2000), AIDS in the UK is described as a chronic illness because of the shift in priority in the national health policy and the allocation of resources for its treatment. The situation has normalized as more people continue to publicly state their HIV status. Compared to the 1980s, HIV/AIDS is no longer a fatal epidemic but rather a life-threatening and chronic illness that is controllable.

HIV/AIDS has emerged as a chronic disease because it is easily manageable like any other chronic disease. The scaling up of the ART programs in the public health sector has closed the treatment gap and as a result, “HIV is at least on its way to no longer being a fatal acute disease but instead a manageable, long-term condition” (Colvin 2011, p.2). Consequently, persons infected with HIV/AIDS are no longer at risk of early death as they can use ARVS and other medications to prolong their lives. Scandlyn (2000) opines that chronic illness is associated with a stigma which makes HIV/AIDs one of them. Nonetheless, the advent of more effective ART has over the last two decades resulted in increased life expectancy of the HIV-infected population (Rockstroh, Guaraldi & Deray 2010). As such, an HIV-infected population is safer although it is currently prone to age-related diseases such as diabetes. Compared with the normal population, the HIV-infected population is more prone to age-related diseases which are considered chronic.

Prevention of HIV in the UK and specifically in Scotland has emerged as a major challenge since most of the HIV-infected patients are homosexual men, gays, and men who have sex with other men (McDaid & Hart 2012). In their study, McDaid and Hart (2012) found that there is a need to develop new strategies to prevent the HIV epidemic among men having sex with men in the UK. In their research, most of the men (78.2%) were willing to participate in HIV prevention studies in the future while the rest were not willing. However, most of the men were not willing to participate in behavior change research and circumcision which are some of the methods of preventing HIV among MSM. On whether to be part of the team for an HIV vaccine project, most men were not willing to participate in this exercise especially those at risk of getting HIV. Therefore, the willingness to participate in HIV research studies is a form of challenge in preventing HIV in the UK due to fear.

Over the last decade, the HIV Prevention Trials Network (HPTN) has undertaken behavioral and clinical studies with the objective of enhancing HIV prevention. Although the HPTN is guided by ethical guidelines, it is still a challenge to follow these ethical requirements. According to Rennie and Sugarman (2010), protecting people with HIV especially intravenous drug users (IDU) and those enrolled in HIV prevention research has proven to be very difficult as the IDUs are usually referred to as criminals by community members, local police authorities, and local governments. As such, research involving IDU is sometimes discouraged. In the case where research is carried out, the IDUs are closely monitored by the government and the local police. As a result, participants are at risk because their confidentiality is not protected. Other than creating stigma, inadequate ethical consideration of research on HIV prevention practices is jeopardized.

The common perception is that HIV is more prevalent among the youth compared with older people. However, according to the Centers for Disease Control and Prevention (CDC), 11 percent of new HIV patients in the U.S are usually older persons aged 50 years and above (Brooks, Buchacz, Gebo & Mermin 2012). Although the morbidity rate and mortality rate have reduced in Europe and North America, older adults are more likely to be diagnosed with HIV/AIDS, and this acts as a prevention challenge since the elderly are normally diagnosed with HIV when it is already too late. Moreover, the fact that they are advanced in age means that their immune system is also easily compromised.

Moreover, at this age, the number of CD4 cells is low and the use of ARVS could not be effective. Another challenge in the prevention of HIV is the poor prognosis of elderly people infected with HIV, thereby making it hard to control the spread of HIV. Poor prognosis and late diagnosis among HIV/AIDS people reduce the lifespan because the persons lack improved treatments.

In the UK, the number of teenagers having unprotected sex is very high. According to Evans (2005) and Evans (2005a), most of the youths do not use condoms despite their availability in healthcare facilities. Moreover, teenagers are liberal and have a permissive attitude towards sex which makes them prone to unprotected sex. As such, it has proven quite difficult to prevent HIV/AIDS in the UK. Besides, the intervention of HIV/AIDS through the use of condoms has been hindered by the belief that they are only useful when preventing pregnancy. Another hindrance is the low levels of awareness on HIV/AIDS transmission and prevention especially among MSM, bisexuals, and young gays. Evans (2006) opines that there are many problems associated with the use of condoms which makes it hard to prevent the rapid spread of HIV in the UK. For example, most people use condoms for pregnancy prevention rather than contra-infection. Moreover, there are cultural barriers to condom use and they are not freely and easily available for most males (Evans 2005a).

The stigma associated with chronic diseases such as HIV/AIDS makes HIV intervention more complicated as HIV-affected people are afraid to come out especially in the rural areas for diagnosis and prognosis. This has been reflected in a case study conducted by Varni, Miller, and Solomon (2012) in rural New England where the findings showed that the frequency of HIV/AIDS continues to increase despite the presence of ART programs. Moreover, the research established that experiences of stigma and increased HIV perception made it impossible to engage people in safer sex such as through the use of condoms. Although HIV-affected persons may use disengagement strategies to avoid the spread of HIV, some of the affected persons may engage in unprotected sex because of the stigma and stress. In their conclusion, Varni, Miller, and Solomon (2012) noted that there has been an increased prevalence of HIV/AIDS in some areas in New England because there are no support groups to engage the affected people in a more positive way. HIV-related stigma is a major setback despite the medical advances in the treatment and care of people living with HIV (PLWH). This poses a challenge in HIV prevention because it leaves limited room for the testing of HIV, prevention, and care (Florom-Smith & De Santis 2010). This challenge is dimensional and affects most of the developed nations such as the UK.

Although the media is used to spreading safer sex messages, there is fear that people fear unplanned pregnancy more than contracting HIV/AIDs. Evans (2005) observes that it has become hard to prevent HIV/AIDS because after having unprotected sex, the emergency (hormonal) contraception or “the morning-after pill” is largely used rather than using ‘postexposure prophylaxis’. Postexposure prophylaxis is preventive medicine that is used within a period of 72 hours in case a person comes into contact with the HIV virus. Despite its benefits, the cost of these drugs is expensive which makes it unaffordable to most people especially MSM, gay, and bisexual men, hence the high HIV prevalence.

The shift from exceptional to chronic illness has brought with it new challenges in HIV prevention in the UK due to increased exposure to age-related diseases such as diabetes, cardiovascular diseases, and glucose intolerance, among others. This observation has been supported by multiple research studies not only in the UK but in other developed nations (Rockstroh, Guaraldi & Deray 2010; Susan et al. 2012; Brooks, Buchacz, Gebo & Mermin, 2012). With respect to research carried out by Brooks et al. (2012), HIV-infected adults suffer chronic illnesses as they get older compared to the rest of the population. Due to the complications involved, there has been a shift in the causes of death in people diagnosed with HIV. Moreover, complications associated with the antiretroviral drugs and toxicities and host-related factors among HIV affected have risked the intervention for HIV in the UK. Rockstroh et al. (2010) opine that despite the fact that ART drugs and other treatments increase the life expectancy of HIV-infected patients it is hard to intervene in the case of older persons with HIV because of the existing complex interrelationship among ART, infection, and coinfection.

Conclusion

In conclusion, there has been a paradigm shift in the perception of HIV/AIDS from exceptional to chronic illness and this has resulted in new challenges in efforts to prevent HIV infections in the UK. It was regarded as exceptional because other than being fatal, HIV was also not treatable. Moreover, people infected with HIV were shunned away as they lived in stigma. However, the establishment of health policy and advocacy accommodated the uniqueness of the HIV epidemic. The paradigm shift was a result of the advent of HIV epidemic treatment through scientifically research drugs (such as highly active antiretroviral therapy and antiretroviral) and therapies. In developed countries such as the UK, HIV/AIDS is no longer a fatal epidemic but is rather a life-threatening and chronic illness that is manageable and has a controllable lifespan.

There are numerous new challenges associated with HIV prevention in the UK such as stigma. For instance, most of the affected individuals ARE men having sex with men, gays, and bisexuals who shun away from participating IN HIV research studies geared towards care, prevention, and HIV treatment. HPTN has ethical guidelines that are challenged since intravenous drug users are closely monitored by local police authorities and local governments. As such, no IDU is willing to participate in HPTN. Other challenges include poor prognosis and late diagnosis of HIV/AIDS among the old, inadequate Information, and permissive attitude of youth towards sex which makes them prone to unprotected sex. Lastly, complications associated with the antiretroviral drugs and toxicities have hindered HIV intervention strategies in the UK.

References List

Brooks, J T, Buchacz, K, Gebo, K A, & Mermin, J 2012, ‘HIV Infection and Older Americans: The Public Health Perspective’, American Journal of Public Health, vol.102, no. 8, pp. 1516-1526.

Colvin, C J 2011, ‘HIV/AIDS, chronic diseases and globalisation’, Colvin Globalization and Health, vol. 7, no. 31, pp. 1-6.

Evans, D T 2005, ‘Sex, drugs and HIV prevention: a case for PEPSE, Nursing in Practice, pp. 54-58.

Evans, D T 2005a, Clever dicks condom” Sexual Health, 26-34

Evans, D T 2006,’ Life is sexually transmitted: Live with it’, Practice Nursing, vol. 17, no. 8, pp. 401-406

Florom-Smith, AL & De Santis, J. P 2012, ‘Exploring the Concept of HIV-Related Stigma’, Nursing Forum, vol. 47, no. 3, pp. 153-165.

McDaid, L M & Hart, G J 2012, ‘Willingness to participate in Future HIV prevention studies among gay and bisexual men in Scotland, UK: A challenge for intervention trials’, AIDS Behaviour, vo. 16, pp. 1420–1429

Rennie, S & Sugarman, J 2010, ‘Developing ethics guidance for HIV prevention research: The HIV Prevention Trials Network approach’, Journal of Medicine & Ethics, vol. 36, no. pp. 810-815.

Rockstroh, J, Guaraldi, G & Deray, G 2010, ‘HIV and the body: a review of multidisciplinary management’, HIV Medicine, vol. 11, no.2, pp. 1-8.

Scandlyn^,J 2000, ‘When AIDS became a chronic disease’, Western Journal of Medicine’, vol. 172, no. 2, pp. 130–133.

Varni, S E, Miller, C T & Solomon, S E 2012, ‘Sexual Behavior as a function of stigma and coping with stigma among people with HIV/AIDS in Rural New England’, AIDS Behaviour, vol. 16, pp. 2330–2339

Wagner, A, Hart, T A, Mohammed, S, Ivanova, E, Wong, J &. Loutfy, M R 2010, ‘Correlates of HIV stigma in HIV-positive women’, Arch Women’s Mental Health, vol. 13, pp. 207–214

Whiteside 2010, Is AIDS Exceptional?’ aids2031, Working Paper No.25, University of KwaZulu-Natal

Click Here To Order Now!