Category: AIDS

The evaluation plan is designed for HIV/AIDS among the Kenyan community as this country was severely affected by HIV/AIDS. About 1.5 million people live with this infection, so the need to improve the situation is obvious (ICF Macro and National Coordinating Agency for Population and Development 1).

The designed programs should be evaluated to see its value and improve when necessary. My evaluation plan concentrates on the question, “Can the program decrease the number of people with HIV/AIDS in the Kenyan community?”. This question is important as it correlates with the main topic, and its answer includes the most relevant information regarding it. It reveals the number of people with infection, the way the population will be treated in order to prevent further expansion and the expected results of the program.

To evaluate the program, the evaluation design is to be chosen. The pretest/posttest design is considered to be the best variant as it allows us to collect all necessary data before the intervention and after it (Issel 418). The information that was gained before the program shows the real situation regarding HIV/AIDS among the Kenyan community. When the program is adopted, it influences the participants and changes the results. Thus, the data gathered later shows whether the difference between the information is substantial or not and if it proves the value of the program.

This kind of evaluation design has its advantages and disadvantages. Among the positive factors is its easiness in usage. The ability to control the main knowledge gained by the participants is also of advantage. Moreover, it shows accurate evidence of the effectiveness or inefficiency of the program. However, it enables us to distinguish the non-program impact on the results. To use self-reporting, in this case, is also a bad idea. The participants may overestimate themselves during one of the tests and change the results in this way. It is even possible that posttest data might be lower than the pretest one (“Types of Evaluation Designs” par. 3).

To reduce such threats, I would take some precautions. First of all, I would ask the participants to note the information and its sources if they get some within the program. I would also use the objective measures for the tests in order to minimalize the human factor interaction.

According to the process – outcome orientation, my design is concentrated on the outcome. It proves whether the expected results were achieved and to what extent. The outcomes are divided into short-term, intermediate, and long-term.

(“Introduction to Program Evaluation for Public Health Programs” par. 16).

The outcomes deal with a range of changes. These changes include the attitude of the participants towards the HIV/AIDS and people who are infected; possible risks and protective actions, changes in such spheres as policies, regulations, social norms, and other things connecting with the society; and increase or decrease in morbidity and mortality. The central question that stays unsolved in this situation is connected with the assurance that the program was the thing to bring the effectiveness, and not some other events happening around it (“Introduction to Program Evaluation for Public Health Programs” par. 10). As it was said earlier, the best way out that I can apply in this case is to insist on taking all necessary notes and generalize the information mentioning that some other things that were happening at that time might also partially influence the outcome. Thus, the focus will be on the results, but not the activities that created them.

There are various methods that can be used in order to answer the evaluation question basing on its context and content. It is better to combine the methods that will provide both qualitative and quantitative data. For a pretest, it is better to use exciting information through the method of document review and analysis, which is one of the easiest and accurate. A lot of researches is done regarding this topic. It is even possible to compare the information gained in different years. Moreover, some conclusions and predictions might be in the text, which will help to deepen the topic. The sources of existing information are articles from the newspapers and journals, annual reports, etc. If it is possible to get the current year paper, it can be used in the posttest; if no, then other methods should be chosen.

As people are commonly considered a good source of information, their knowledge can also be used. Among the best variants are an interview and a test. They are relatively easy and quick. The results are seen almost immediately, and a little time is needed to evaluate them. These methods can be conducted personally, which is not very convenient when a lot of people participate in the program. With the help of e-mail, I will not be that limited in time and location. However, the best variant is to use a telephone. I believe that it is the quickest method. The participants can be chosen randomly, which proves impartiality. The process can be controlled as the conversation will happen on the spot (Pulliam-Phillips and Stawarski 23).

I believe that the existing instrument may need modification if the progress in the goal achievement is not vividly seen. Some outdated sources are to be excluded as the peculiarities of measurement might change. For example, the number of people who are living with HIV/AIDS at the begging of the epidemics and now are treated differently by the scientists of that time and nowadays. If during the program, some changes in population and people’s condition happened, the existing records should be adopted, and the data should be modified to meet the requirements. If it occurs that the participant misunderstood the task, the data provided by one should be changed or excluded. The instruments are to be changed if, in the process, it occurs that they do not satisfy the expectations and are not well adapted for the current user. It should be done as such things are likely to influence the outcome and ruin the program.

The results are likely to influence the population as they provide people with data that shows their poor condition regarding HIV/AIDS. The program’s utility depends on the results of the evaluation as only they can prove that the work was not done in vain and show improvement with the help of the contrast of pretest and posttest evaluation. The quality of the program will also change, as the accurate data proves its value and makes it look more authoritative. If the program had some imperfections, it would be clearly seen in the evaluation plan.

Works Cited

Developing an Evaluation Plan n.d. Web.

ICF Macro, and National Coordinating Agency for Population and Development 2011, Effects of the Community Response to HIV and AIDS in Kenya: Final Report. Web.

Introduction to Program Evaluation for Public Health Programs: A Self-Study Guide. 2012. Web.

Issel, Michele. Health Program Planning and Evaluation, Burlington: Jones & Bartlett Publishers, 2014. Print.

Pulliam-Phillips, Patricia, and Cathy Stawarski. Data Collection: Planning for and Collecting All Types of Data, San Francisco: John Wiley & Sons, 2008. Print.

Types of Evaluation Designs. 2006. Web.

The term AIDS was coined in 1982. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a worldwide epidemic that requires prompt intervention (Carr as cited in Timewell, Minichiello & Plummer, 1992). The Human Immunodeficiency Virus (HIV) is the etiologic agent for AIDS. The virus compromises the body’s immune system in 3 to 7 years (Raper & Aldridge, 1988; Webb, 1997). HIV was discovered between 1979 and 1981 in the US (Raper & Aldridge, 1988).

The virus spread fast to the rest of the globe (Commonwealth of Australia, 1989). The World Health Organization (WHO) (as cited in Walraven, 2011) indicates that 17,000 cases of AIDS had been registered by 1985 in 71 countries. Statistics from 144 countries in 1989 showed that 151,790 cases had been documented by the WHO (Commonwealth of Australia, 1989).

Approximately 7.7 million cases of AIDS had been documented by 1996, and close to 22 million HIV infections were registered. This is according to reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS) (as cited in Webb, 1997). HIV infections have increased year by year, with 2.5 million cases being reported by 2007. Cases of mortality from AIDS and related illnesses stood at 2.1 million as of 2007. There was a sharp increase in the number of infected persons to 33 million by 2011 (Walraven, 2011).

The main HIV transmission modes are mother-to-child transmission, sexual contact and contact with infected blood (Timewell, Minichiello & Plummer, 1992; Commonwealth of Australia, 1988; Grmek as cited in Maulitz & Duffin, 1990). Sexual transmission of HIV can occur via two ways. Unprotected sex with an infected partner of the opposite sex is the first way. The second way is sexual contact with an infected partner of the same sex.

Mother-to-child transmission is also called vertical transmission, whereby the infant is infected by the HIV positive mother via the placenta or through breast milk. Blood-borne HIV transmission happens when contact is made with infected blood during blood transfusion, contact with HIV-positive body fluids and piercing with infected instruments (Commonwealth of Australia, 1988; Webb, 1997).

AIDS evolved to be a global health epidemic since it spread uncontrollably. Australia’s first HIV-AIDS case was registered in 1982 in homosexuals who had sexual contact with gay men in the US. The gay community later spread HIV to the rest of the population in Australia (Timewell, Minichiello & Plummer, 1992).

South Africa’s first HIV case was also reported in 1982 (Webb, 1997). It is evident that cases of HIV infection and deaths resulting from AIDS continued to increase globally during the early years of HIV discovery in the 1980s, including in Australia and South Africa, but the trend has been reversing as a result of various measures being implemented effectively.

This essay will examine four policies including condom use policy, privacy policy, nutrition strategy, needle exchange policy and factors affecting implementation of AIDS control strategies adopted by Australia and South Africa to control the spread of HIV-AIDS.

The four policies are compared and contrasted, before evaluating the factors that affect implementation of the strategies for both countries. Finally, the paper will comment on the need for global cooperation and combined efforts to avert HIV-AIDS spread instead of an individual approach, more so in the developing world.

Both Australia and South Africa champion the use of condoms as one of the most effective ways of curbing HIV spread. Condoms are used to prevent contact with infected body fluids during sexual contact (Commonwealth of Australia, 1988). Both countries have used this strategy effectively.

The Australian government has promoted availability and use of condoms by waiving all restrictions on advertising, sale and distribution of condoms (Commonwealth of Australia, 1989). The government has banned the sale of condoms that have no expiry date stated, as well as condoms that are of low quality (Commonwealth of Australia, 1988).

To enhance awareness on correct use of condoms, condom manufacturers are mandated to indicate guidelines on how to use condoms on the packets (Commonwealth of Australia, 1988). South Africa has also registered increased uptake in condom use (Abdoolkarim & Abdoolkarim, 2010). Statistics indicate that approximately 75% of young females use condoms compared to 87.4% of young men (Abdoolkarim & Abdoolkarim, 2010).

South Africa’s success in condom use can be attributed to the ease of access to both male and female condoms, as well as the knowledge on how to use the condoms. There are 3 sources of condoms in South Africa (Abdoolkarim & Abdoolkarim, 2010). The National Department of Health provides condoms freely to the public through health centres and AIDS Training, Information and Counselling Centres (ATICCS) among other public avenues.

Condoms are also availed by governmental and NGOs such as Planned Parenthood Association of South Africa (PPASA) through social marketing initiatives. Individuals and organizations are licensed to distribute condoms through local stores. The third source of information on condom use is use of condom commercials to generate public awareness (Abdoolkarim & Abdoolkarim, 2010). There has been a whooping increase in condom distribution by the SA government since 1994 (Abdoolkarim & Abdoolkarim, 2010).

It is reported that 270 million condoms were distributed in 2001-2002. In 2006-2007, the number of condoms distributed nationally increased to 380 million. This widespread distribution has stemmed HIV infections significantly (Abdoolkarim & Adoolkarim, 2010). There is no doubt that both Australia and South Africa have taken substantive steps in their campaigns on use of condoms in preventing the spread of HIV/AIDS, which is a great step in stemming the spread of HIV.

Australia and South Africa also use privacy as an AIDS control policy. Privacy in AIDS control is paramount since breaching confidentiality exposes the infected person to stigma and discrimination (Timewell, Minichiello & Plummer, 1992).

Australia’s privacy law on HIV infected persons is weak since government staff and health professionals have ease of access to the information. The New South Wales state recently approved a new law allowing disclosure of a person’s HIV status by health providers (Timewell, Minichiello & Plummer, 1992).

While this disclosure is meant for health related use, there is no guarantee that the privacy of the infected person would not be exposed to public limelight (Timewell, Minichiello & Plummer, 1992). Similarly, HIV-infected persons in South Africa are wary about disclosing their HIV status even with medical personnel out of fear of breach of confidentiality (Kauffman & Lindauer, 2004).

For instance, Galeshewe Clinic has two condom distribution points. A contraceptive nurse first engages a person in an environment that lacks privacy of conversation, before accessing condom dispensers that are openly situated at the waiting bay. This lack of privacy deters people from accessing condoms since they feel uncomfortable (Kauffman & Lindauer, 2004).

There are gaps in privacy policies in both countries in regard to securing patient confidentiality as a way of curbing the spread of HIV/AIDS. This calls for both countries going a step further in making reinforcing the existent privacy policies to safeguard privacy of HIV/AIDS in order to eradicate HIV/AIDS related stigma, especially among health professionals.

Both Australia and South Africa also employ the nutrition strategy for AIDS patients in control of HIV. Proper nutrition is meant to enhance the quality of life for HIV/AIDS patients (Commonwealth of Australia, 1988). Observing proper nutrition in the initial stages of HIV infection improves the health of the infected person by delaying progression to AIDS. A good diet for HIV-positive persons can greatly prevent weight loss (Timewell, Minichiello & Plummer, 1992).

Most Australian health care facilities provide diets that are rich in protein for AIDS patients to curb and treat weight loss (Timewell, Minichiello & Plummer, 1992; Commonwealth of Australia, 1988). South Africa also has nutrition care services (NCS) where AIDS patients are assessed on their nutrition and given appropriate counselling (Oketch, Paterson, Maunder & Rollins, 2005).

Nutritional support helps in providing sufficient body energy and strengthening the patient’s immune system (Commonwealth of Australia, 1988; Abdoolkarim & Abdoolkarim, 2010; Sahn, 2010). It is very encouraging that both Australia and South Africa have enacted nutritional policies given the importance of proper nutrition in managing AIDS, and these efforts should be upheld and improved.

Australia and South Africa differ in the needle exchange policy in controlling HIV transmission. Australia has set up programs targeting drug users, where drug users are informed that sharing needles can transmit the HIV virus. Drug users connect with service networks and learn how to use and dispose needles and syringes safely (Commonwealth of Australia, 1989; Timewell, Minichiello & Plummer, 1992).

There are needle exchange programs that advocate for ease of access to needles for drug users without discrimination. Information on sharing needles as potential risk to the transmission of hepatitis and other blood-borne disease is also disseminated (Commonwealth of Australia, 1989; Abdoolkarim & Abdoolkarim, 2010). The New South Wales, for instance, distributes close to 2 million needles and syringes annually (Timewell, Minichiello & Plummer, 1992).

The only legal distribution channels in Australia are authorised pharmacies and needle and syringe exchange programs (NSEPs) (Timewell, Minichiello & Plummer, 1992). Addition, it is very bureaucratic to set up a new NSEP outlet. It takes 4-5 months to set up a new NSEP outlet in Victoria State. South Africa, on the other hand, does not criminalise the distribution of drug paraphernalia.

The needle exchange program in South Africa, therefore, is able to reach more drug users and educate them on the risks associated with sharing needles and syringes. Moreover, NGOs and private organizations take needles to the location of drug users. Australia needs to adopt a less bureaucratic approach in distribution and exchange of needles and syringes to drug users to realize the success that South Africa has achieved in the control of HIV spread in its needle exchange policy.

Australia has registered better progress in implementing AIDS prevention programs compared to South Africa. There has been a steady decline in AIDS cases diagnosed in Australia, with the 954 cases registered in 1992 dropping to 144 cases by 2001. There was an 85% decrease in the total number of diagnosed cases from 1992 to 2001 (McDonald, Li, Dore, Ree & Kaldor, 2003).

South Africa, on the other hand, registered a sharp increase of 75% in new AIDs cases; 1.3 million cases in 1992 rose to more than 4.3 million cases in 2001 (Nyabadza, Mukandavire & Hove-Musekwa, 2011). Implementing AIDS policies in both countries mainly depends on the politico-economic systems of the countries.

South Africa’s poor implementation of the AIDS control policies can be attributed to the fact that the AIDS epidemic coincided with the time when South Africa was transiting to a democratic republic. Failure to implement the programs successfully also resulted from lack of a good structure (Marais, 2000 as cited in Kauffman & Lindauer, 2004), under-utilization of the money allocated for HIV/AIDS prevention, and the fact that the government took over as the primary funder of AIDS program from donors.

This resulted in under-funding of AIDS prevention programs (Kauffman & Lindauer, 2004). Conversely, Australia achieved great success in curbing spread of HIV due to a stable political system. The states take the role of implementing national strategies, including overseeing NGOs that are involved in provision of health services.

Commonwealth, on its side, funds the states (Timewell, Minichiello & Plummer, 1992). For instance, the first funding toward the HIV epidemic by the Commonwealth was done in 1984 with an initial fund of $5 million (Commonwealth of Australia, 1988). More funds would be obtained depending on the number of HIV cases in a state. There was smooth collaboration among all stakeholders, and this resulted in effective policy implementation.

Australia is a perfect case of success in preventing HIV/AIDS spread due to a stable and financially able government, while South Africa showcases the hardships experienced in implementing HIV/AIDs prevention programs in countries that are struggling politically and economically. It is, therefore, clear that the role of political goodwill, economic ability and the political stability of a nation are significant factors in seeing to it that HIV/AIDS prevention policies are implemented.

In conclusion, this essay has established that both Australia and South Africa have used the condom use strategy effectively to control HIV spread. Condoms act as barriers from contact with HIV-positive body fluids.

Provision and distribution of high quality condoms has been observed by both governmental and non-governmental bodies in both countries. Both countries also have similar nutritional approaches in effective management of AIDS. Proper diet that is rich in proteins at the early stages of infection has been advocated in management of AIDS.

The paper has also established that the needle exchange program in Australia is highly restricted and left to a few authorised bodies only. However, South Africa has liberalized provision and distribution of drug paraphernalia. While Australia had a stable political and economic system during the HIV/AIDS epidemic, South Africa was undergoing a political shift accompanied by tough economic times. Australia is, therefore, more successful than South Africa in implementing the HIV/AID control strategies.

It is recommended that a global approach, instead of individual country approach, should be taken to tackle the AIDS pandemic successfully. Such an approach would, for instance, see South Africa get financial and strategy support from Australia. Sharing experiences and resources on successful and failed policies among countries will hasten the global efforts of controlling the spread and effects of HIV/AIDS.

References

Abdoolkarim, S., & Abdoolkarim, Q. (2010). HIV/AIDS in South Africa. Cape Town: Academic Press.

Commonwealth of Australia (1988). AIDS a time to care a time to act. Canberra: Australian Government Publishing Service.

Commonwealth of Australia (1989). National HIV/AIDS Strategy. Canberra: Australian Government Publishing Service.

Grmek, M., translated by Maulitz, R., &Duffin, J. (1990). History of AIDS. Princeton, NJ: Princeton University Press.

Kauffman, K. D., & Lindauer, D. L. (Eds). (2004). AIDS in South Africa: the Social Expression of Pandemic, (p. 141). Quincy, MA: Palgrave Macmillan.

Mcdonald, A., Li Y., Dore, G., Ree, H., & Kaldor, J. (2003). Late HIV presentation among AIDS cases in Australia, 1992-2001. Australian and New Zealand Journal of Public Health, 27(6), 608-613. doi: 10.1111/j.1467-842X.2003.tb00607.x

Nyabadza, F., Mukandavire, Z., and Hove-Musekwa, S. (2011). Modelling the HIV/AIDS epidemic trends in South Africa: Insights from a simple mathematical model. Nonlinear Analysis: Real World Applications, 12(2011), 2091–2104. doi: 10.1016/j.nonrwa.2010.12.024

Oketch, J., Paterson, M, Maunder, E., & Rollins, N. (2005). Too little, too late: Comparison of nutrition status and quality of life of nutrition care and support recipient and non-recipients among HIV-positive adults in KwaZulu-Natal, South Africa. Health Policy,99(2011), 267-276. doi: 10.1016/j.healthpol.2010.08.018.

Raper, J., & Aldridge, J. (1988). What every teacher should know about …AIDS. Childhood Education, 64(3), 146-149. doi: 10.1080/00094056.1988.10521523

Sahn, D. E. (Ed) (2010). The socioeconomic dimensions of HIV/AIDS in Africa. Ithaca, NY: Cornell University Press.

Timewell, E., Minichiello, V., & Plummer, D. (1992). ‘AIDS in Australia.’ In A. Carr (Eds.), What is AIDS? (p. 3). NSW: Prentice Hall.

Walraven, G. (2011). Health and poverty(p.32). London: TJ International.

Webb, D. (1997). HIV and AIDS in Africa. (p. 1). Redwood City, CA: Redwood Books.

Introduction

Ever since the first case diagnosed in the United States in 1981 on the West Coast scientist and researchers have been working to find a permanent and inexpensive treatment for people suffering from HIV/AIDS. There has been great progress in finding a cure for HIV/AIDS but unfortunately, it remains manageable but incurable. (Jeffrey, 2006) Researchers, working in Germany, lately claimed a potential advancement in the attempt to cure HIV infection. The most current issue of the journal Science reported that researchers working with an enzyme were able to eliminate HIV’s genetic material from host cells. While this is beginning research, if confirmed by further study it might be an important landmark in the battle to cure HIV/AIDS. (Bauer, 2007).

Current HIV drugs aim either viral enzyme which is naturally vital proteins or holds up with HIV’s access to a cell. This approach has been extraordinarily doing well at managing HIV disease and radically reducing both illness and HIV-associated deaths. The critical limitation of this approach lies in HIV’s combination of its genetic code into a cell’s genes. When this takes place in a cell that is at a latent state, it permits HIV to escape these drugs, which only work in cells that are vigorous and manufacturing new copies of HIV. (Nathanson, 2007) Since the latent cells have a longer life and occur to be an invulnerable reservoir of infectious virus, efforts to clear the body of HIV called suppression have been ineffective.

Much more study and improvement are needed to turn this breakthrough into efficient treatment for people living with HIV/AIDS. One of the key obstacles will be to find a harmless and efficient way to establish the enzyme into resting cells. After that, it will be necessary to design identical enzymes which will target the other parts of the HIV/AIDS genome. This might take more than ten years to turn into generally accessible treatment. However, this study may lead to the vital goal of curing HIV/AIDS infection.

Gene Therapies

Several treatments are being developed to obstruct genes used by HIV/AIDS. One of them, mifepristone, also known as RU486 produced by Viral Genomix, interferes with the viral protein vpr. It is in a Phase I/II trial.

Maturation Inhibitors

A new type of drug slows down the expansion of HIV’s internal arrangement in a new virus. The bevirimat (PA457) by Panacos Pharmaceuticals is the first maturation inhibitor. (Strauss, 2007) It is at present in Phase II trials. The early outcome shows strong antiretroviral action. Side effects are serene. PA457 will most likely be a once-a-day drug.

Antisense Drugs

VIRxSYS is also working on a gene treatment product, VRX496, which is in a Phase II trial. The VIRxSYS engages in altering a patient’s CD4 cells with an “antisense” cause and then reintroduced to the person with HIV.

Integrase Inhibitors

After HIV’s genetic code is altered from a single thread to a double-strand by the reverse transcriptase enzyme, it gets included in the genetic code of the infected cell. Then the HIV genetic code gets “read,” fabricating new viruses. Scientists hope that combination will be an additional point in the HIV life cycle which can be treated with medicines. (Levy, 2007).

Raltegravir (Isentress, MK-0518) by Merck is being studied in Phase III trials. It is accessible through a prolonged access program. An FDA assessment on approval of raltegravir is anticipated in mid-October 2007. (Duesberg, 2007).

Elvitegravir (also known as Gilead 9137 and JTK-303) has concluded a phase II study. The drug is used with ritonavir. It is eradicated almost completely via the feces so no dose regulation is required for patients with kidney problems.

Conclusion

While many researchers are doubtful about any possibility of curing HIV/AIDS, Project Inform remains tightly devoted to finding a cure for HIV. Since the last decade, HIV/AIDS has transformed from an almost unanimously incurable disease to a somewhat persistently manageable disease that has been in enormous development. But this development is not enough scientists and researchers need to find a long-lasting solution. Life-long and managed treatments are not a solution. It is too costly and inaccessible to everyone. Research and development in the treatment of HIV/AIDS is the only hope for people suffering from this disease.

References

Bauer, Henry H. (2007) The Origin, Persistence, and Failings of HIV/AIDS Theory. McFarland & Company.

Duesberg, Peter (2007) Inventing the AIDS Virus. Regnery Publishing, Inc.

Jeffrey Beal & Joanne Orrick, (2006) HIV/AIDS Primary Care Guide. Crown House Publishing.

Levy, Jay A. (2007) HIV and the Pathogenesis of AIDS ASM Press.

Nathanson, Neal (2007) Viral Pathogenesis and Immunity Second Edition. Academic Press.

Strauss, James H. (2007) Viruses and Human Disease, Second Edition. Academic Press.

AIDS was first reported in Thailand in 1988. The first casualties were prostitutes and their male clients. Patronage of prostitution resulted in the rapid spread of the disease among young men and pregnant married women. The government responded by advocating for the use of condoms. Condom use campaigns targeted prostitutes and their male customers through mass commercial advertising. It was unlawful to violate the condom program or to employ children as prostitutes. With increased condom use, there was a decline in the number of sexually transmitted disease infections, in addition to fewer people testing HIV positive.

Prostitution in Thailand had been illegal since 1960. However, the government had not been completely successful in its eradication. The solution lay in control. Prostitutes in Thailand work in establishments such as brothels, bars, massage parlors, and restaurants. This made it easy for the government to maintain CSE (commercial sex establishments) records/rosters, unlike when prostitutes work freelance on the streets. This provided information on commercial sex trends such as the types of CSEs in existence, the number of sex workers, and the price of sex. Furthermore, it helped in the control of STDs. All CSEs were recorded, and all the prostitutes were documented as well. The findings were such that most CSEs were located in towns, though the rosters showed a higher number than was the case. However, in larger towns as Bangkok, the CSE and, by extension, the CSW was more. The major drawback lay in the enumeration of the sex workers. Sometimes, the numbers were overstated or understated. There is no reliable documentation on the sex prices. CSE’s were offering services either directly (brothels) or indirectly (night clubs). The upper northern area of Thailand had more reported cases of HIV primarily because of sex patronage and instances of low fee sex workers.

Ultimately, it was possible to document changes in prostitution. There was a decline in the numbers of CSW and CSE’s. This was attributed to fewer sex workers being hired, the direct CSE’s becoming indirect CSEs but nonetheless offering the same services, and the coming up of new CSE’s that charged higher prices in addition to relocating the sex services elsewhere. However, the decline in the number of sex workers was attributed to the fear of AIDS. With fewer women willing to become prostitutes, there was also less patronage of prostitutes by men. The government condom campaign served to discourage women from engaging in prostitution even more. The economy was doing well, offering more occupational choices to women. However, shortages in the labor industry resulted in foreign sex workers, especially from Myanmar. The successful family planning program carried out in the ’60s and ’70s had altered the demographics. It resulted in more young people in the ’90s, more so young women, some of whom ended up as prostitutes. Despite the growing economy, most prostitutes would still have ended up as unskilled laborers with very little pay. The consequence of this is that they chose to remain in prostitution.

With fewer CSWs, HIV and STDs were less transmitted. The condom campaign was indispensable. The challenge remains that of controlling the shift to indirect prostitution where there is less condom use but the high transmission of HIV and STDs. Moreover, there are more foreign prostitutes who need advice on condom use.

References

Hanenberg, R. & Rojanpithayakorn, W. (1998). Changes in prostitution and the AIDS epidemic in Thailand. AIDS Care. Vol 10(1) pp 69-79. 2008. Web.

Magazine Article on HIV+AIDS

Jessica Bennett (2008) reported in a Newsweek article that while advances in medicine slows the progress of the disease and, in turn, allow more people living with HIV+AIDS (PLWHA) to live longer, it brought on new sets of challenges. The author described how a near-death patient bounced back to life after having successfully recovered with the introduction of a new antiretroviral drug, Crixivan. Today, at 59, Lee Chew looks healthy and appeared to have gotten over the worst. However, new worries come up as more people living with HIV+AIDS age. The doctors are not quite certain on how the aging body reacts to antiretroviral drugs. The doctors and researchers are only beginning to understand the implication of aging on HIV+ individuals.

Aside from the uncertainties facing senior PLWHA, the local health departments have to deal with the increasing number of PLWHA turning 50. The article reported that the number of people diagnosed with disease aged over 50 increased by 700 percent (Bennett). What physicians now know regarding the health impact of the disease is that PLWHA ages faster, not to mention the lack of immunity from diseases. Complications may be brought about by the combination of drugs taken to maintain their health.

Aside from the health issue, the article also mentioned the lack of adequate social support aging PLWHA. In the report, it mentioned that older PLWHA patients are twice more likely to live alone when compared to other older, straight individuals. The report recognizes the importance of social support. Charles Emlet, a social worker, indicated that “[p]eople with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer—outside of HIV disease.” (Cited in Bennett, 2008).

Psychological Concepts

The need for better psychosocial interventions to help senior PLWHA cope with their present situation is highlighted in the report. For example, the increase in older PLWHA is not exclusively the consequence of better medicines. Some men who are gay contracted the disease when they are older. This implies some high-risk sexual behavior among older gay men. In the clinical care setting, several approaches are proposed to reduce risky behavior. Schriebman and Friedland (2003) suggested behavioral counseling as a prevention strategy. The authors cited the study conducted by the National Institute of Mental Health’s (NIMH) Multisite HIV Prevention trial where they assessed the effectiveness of behavioral counseling to initiate change among high-risk, heterosexual, low-income patients (p.1172). The study noted the changes in behavior within the one-year study period, and risk behaviors were substantially reduced. The subjects reported fewer occasions of unprotected sex, the use of condoms and more likely to use condoms over an extended period (p.1172).

Social Cognitive Theory proposed the human behaviors are directed and encouraged by what was happening in the surroundings as well as events in the society. Bandura’s theory “emphasizes the roles of outcome expectancies, self-efficacy beliefs, and reinforcement value for instituting behavior changes.” (Kalichman, Rocha and Cage, 2005, p. 264) The theory further suggested that, “behavior change occurs as a direct result of observation and interpretation of behavioral performances.” (p.264) Moreover, this theory assumes that individual feelings and the interpretation of thoughts explain how one behaves. People always think about the possible outcomes, results, and future consequences of their behavior. The study of this theory can help identify where problems associated with risk behaviors were rooted. Since this theory was based on the individual’s use of the feelings and thoughts to influence behavior, behavioral change comes directly from the individual.

The fear of the unknown will continuously challenge both the patients and the medical practitioners. The circumstances of aging HIV+AIDS patients need to be explored. Physicians and researchers need to understand the impact of the disease on the aging body as well as the side effects or complications of medication. One must also acknowledge the psychology of an aging PLWHA may be quite different from that of normal individuals. Issues such as fear, loneliness, isolation, persistent social stigma and the uncertainties about the future add to the burden of having HIV+AIDS.

Research article on HIV+Aids

Emlet’s (2006) study revealed that the social patterns between the two groups (younger and older) were similar. However, the research also yielded that older people were more likely to live in isolation than their younger counterparts. Older and colored adults were more at risk of social isolation compared to other groups and ethnicity. The study found that the ethnic group most likely to suffer from stigma was older African-Americans. The group could suffer from rejection from family, friends, and religious institutions where most associate stigmatized behaviors with HIV transmission (Emlet, 2006, p.306).

The purpose of the study was to compare the social networks of younger patients with the older ones. The information gleaned from the study could help determine ways to prevent social isolation among older patients and other issues that may positively or negatively affect HIV-AIDS patients. The study was also conducted to “determine the potential role of social networks in mediating HIV stigma and evaluate the risk of social isolation among the study population.” (Emlet, 2006, p.305). Stigma, in some cases could be reinforced in “societies with strong bonds and allegiances to family, village, neighborhood and community.” (Chen et al, 2007,p.666)

The author conducted the research primarily for the improvement of social work practice in dealing with older HIV patients. Although the research was addressing social workers, in general, it is also applicable to other professionals tasked to care for aging HIV patients. Medical practitioner extending their help need not stop at providing pharmacological therapies. Previous research also revealed that “adequate emotional and social support…improve[d] compliance with HIV medications.” (Emlet, 2006, p.300).

To provide a framework for the study, the author used the concept of social networks and how they change over time. The convoy theory of social support lent credence to the research. The convoy could be “constructed from a variety of sources including family, friends and others” at a given situation or circumstances (Emlet, 2006, p.300). Other sources rendering support to the study include references to similar studies done previously. These researches showed how adequate or inadequate social support affects the patient. However, majority of the studies had been conducted on young HIV positive patients. This was where the author saw the gap. The author proposed that if practitioners dealing with older and ageing HIV positive patients had more knowledge concerning social networks, the social worker, medical practitioners or care providers can provide measures that could prevent isolationism and social stigma.

The author acknowledged some limitations and biases to the study. First, the respondents were selected purposively. Second, most of the respondents came from an AIDS service organization, so the results may not yield an accurate view of the perceived availability or lack of social support. Finally, all the respondents came from the same area, Pacific Northwest. The study may not be applicable to areas outside the region.

The strength of the study lies in the inclusion of older HIV-AIDS patients that had been long neglected. The author associated the increase in older HIV positive patients to the availability of better intervention strategies that extended the lives of the afflicted. The author recognized that pharmacological interventions were not enough to improve the chances of survival for those affected. Social support is important especially when the AIDS patient finds comfort in the social network he had formed.

The study is weak in the selection of respondents. A broader selection process could have given the practitioners a wider perspective. However, the study is replicable and could be repeated. Emlet’s (2006) is timely because of the increasing population of elderly HIV-AIDS patients and health practitioners need to consider strategies that would mitigate cost, fear, stigma, and isolation.

How the Study Relates to Real-World Issues

Solving the HIV-AIDS problem goes beyond the pharmacological interventions. In Emlet’s (2006) research, he considered the social aspects that affect the well-being of people living with HIV-AIDS (PLWHA). Pharmacological interventions like the highly active antiretroviral therapies (HAART) introduced in the 90’s had extended the life expectancy of the afflicted. Thus, increasing the number of older patients. With the increase in older HIV-AIDS patients, the author acknowledges the gaps concerning issues that may affect them. Practitioners are beginning to recognize the effects of HIV-AIDS on older adults. Previously, HIV-AIDS was considered a disease that primarily affects the youth. Social networks are important in alleviating the effects of the disease. Social support from family and friends are crucial to improve the lives of the people living with HIV-AIDS. Learning more about the gaps and circumstances of social networks, especially in older HIV patients would lessen the negative impacts of the disease like stigma, homophobia, discrimination, and isolation.

Jenkins and Guarnaccia (2003) found several patterns of patients seeking social support. “Gay/bisexual men were more likely to seek the HIV community than broader social-emotional support… Heterosexual men were least likely to seek either form of support, and the lesbians in the private clinic sample were most likely to seek both.” (p.420) These patterns would elevate the importance of social networks to improve the lives of people living with HIV-AIDS.

When risk behaviors associated with HIV+/AIDS infections are unbridled, they could become the reasons why the increase in HIV+/AIDS cases will continue unabated despite the many programs and interventions in place to reduce the incidence. Knowing that there are strategies to reduce the risk behaviors is important. Changing or reforming risky behavior associated with HIV+/AIDS could take several forms. Cognitive social and behavioral theories provide the framework to ensure change in HIV+/AIDS patient behavior.

The presence of other risk factors that have been overlooked, such as the possibility that sexual violence and high conflict areas could drive up the number of HIV+/AIDS infections globally. While numerous efforts are exerted to stop the violence and conflict in these places, it would also be a wise decision to include HIV+/AIDS prevention strategies. Women and children are the most affected segment of society in these situations.

Once a person gets infected with the HIV, some clinical signs may occur. An HIV infected person has several physical manifestations such as having headaches, fever, stomach ache, sore muscles and joints as well as skin rash. that can last for two weeks.

(What is Aids). Even if an infected person is tested to be negative, but found out to be positive later, he can already infect other people. This manifestation may take ten years or more depending on the ability of the antibodies to react or combat the virus before it becomes a full blown disease categorized as AIDS. An HIV infection becomes AIDS when the CD4 cells count is less than 200 or less than 14%. Proper treatment helps the CD4 cells maintain its number or lowers them down gradually. Oftentimes, the disease shows no symptoms at all. In most cases, an infected person never knows about his illness until the virus has already severely damaged his immune system (What is Aids).

AIDS is a lethal disease that causes everyone and all sectors of the society, particularly the government and civic-spirited groups to adopt a high degree of awareness on the effects it brings to the individual and the society in general. Once a person is infected with HIV, which eventually leads to AIDS, the following effects shall be evident.

The sickness is said to physically affect an infected person through the symptoms being manifested. An infected person feels ill because of the pains and difficulties brought by the infections and the response of the antibodies to the virus. The effects could be lessened if the infected person is tested immediately after the acquisition of the virus. Most appropriate, it is being advised that complete annual examinations and laboratory tests should be undergone by any individual who is exposed to the virus or in contact with infected persons.

AIDS is one of the most pressing social problems being addressed by government leaders and authorities. The US government, through the Public Health Service has been allocating annually a huge amount of public funds for the treatment and rehabilitation of HIV-infected persons and AIDS victims. In 1993, it is estimated that around $119,000 has been spent for the treatment of AIDS victims (Grolier Encyclopedia of Knowledge 190). With the increasing number of AIDS victims, the appropriation shall likewise increase, thereby sacrificing the funding of some basic services that should go to the whole constituents and the in-need.

A society with a large number of HIV positive and AIDS cases is considered unhealthy. It reflects the performance of leaders and legislators. It signifies that the efforts being done by authorities do not correspond to the demand for performance. This situation calls for more appropriate and responsive programs with financial requirements in order to minimize if not stop the growing number of AIDS cases. Side by side, these programs are the moral recovery orientations that should be conducted in order to reinforce the values of self-preservation, responsibility, and morality.

In closing, Emlet (2006) believed social networks are important in alleviating the effects of the disease. Social support from family and friends are crucial to improve the lives of the people living with HIV+AIDS. Learning more about the gaps and circumstances of social networks, especially in older HIV+AIDS patients would lessen the negative impacts of the disease. Intervention programs should fit the specific population. The intervention policies and programs of the government, for example, must now address the needs of this particular group, taking into consideration its linguistic and cultural values, social behavior, education, and economic circumstances. Without these considerations, the intervention and prevention programs might as well go to waste.

References

Bennett, J. (2008). ‘A Lot of Unknowns’ Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations. Web.

Chen, J. et al (2007). The effects of individual- and community-level knowledge, beliefs, and fear on stigmatization of people living with HIV/AIDS in China. AIDS Care, 19(5), 666-673.

Emlet, Charles (2006). An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health & Social Work,31(4), 299-308.

Jenkins, S.R. and Guarnaccia, C.A. (2003). Concerns and coping with HIV: Comparisons across groups. AIDS Care, 15 (3); 409-421.

Kalichman, S.C., Rocha, D. and Cage, M. (2005). Group intervention to reduce HIV transmission risk behavior among persons living with HIV/AIDS, Behavior Modification,29(2), 256-285.

Schreibman, T. and Friedman, G. (2003). Human immunodeficiency virus infection prevention: strategies for clinicians, Clinical Infectious Diseases, 36, 1171–1176.

‘A Lot of Unknowns’ Medical advances are helping many HIV patients live into old age. But that blessing presents its own unique set of tribulations. Jessica Bennett.

Newsweek Web Exclusive

There was a time when Lee Chew was so sick, he’d lost all feeling in his lower body—forcing him to wear diapers and get around by wheelchair. At 6 feet 2 inches, the once-robust actor was a skeletal 135 pounds, with severe pain in his hands that prevented him from even holding a fork. It was 1996, nearly 10 years after his diagnosis, and AIDS was all around him: friends, lovers, even his doctor, all died of the disease. Funerals were a monthly ritual. “In a way, living through the AIDS crisis of the 1980s was like living through our own version of the Holocaust,” he says. “It was a nightmare.”

Chew slowly began to wake from that nightmare with the approval of a new antiretroviral drug, Crixivan, that would help nurse him back to health. Slowly but surely, he went from wheelchair to walker, walker to cane, and finally, back to the gym. Today, Chew, a New Yorker, by way of Roanoke, Va., is happy and healthy, tan and fit. At 59, he looks about 40. “I can be pretty vain,” Chew jokes. “I like to make sure my pecs look good.”

In reality, Chew worries about a lot more. He is a social worker for aging HIV-positive gay men, so AIDS remains a constant character in his life. And though he’s healthy, Chew is getting older—which brings a whole new set of worries. His is the first generation to age with HIV. As he ages, there are changes in how his medications will interact. And doctors and researchers are only beginning to figure out what, exactly, that means.

What doctors do know is that despite infection rates that remain level, people over 50 now make up the fastest-growing segment of those living with HIV—part of the reason why the AIDS Institute this week announced Sept. 18 as national HIV/AIDS and Aging Awareness Day. It’s perfect timing: between 1990 and 2005, local Department of Health studies show that the number of AIDS cases in people over 50 shot up by more than 700 percent—today, 35 percent of people with HIV are aged 50 and older, and 70 percent are over 40, according to the AIDS Community Research Initiative of America (ACRIA). A large portion of those, say advocates, are gay men. Some of these older patients are newly infected, while most are long-term survivors.

Researchers know that HIV and age make for a complicated balancing act—a convoluted interplay of the disease itself, natural aging symptoms and the side effects of antiretroviral medication that may enhance those symptoms. Part of the aging process is already about a loss of immunity. So the fact that HIV is an immune disease may be one reason why its sufferers tend to age fast, in everything from body changes to cardiovascular disease, says Dr. Richard Havlik, an epidemiologist and former chief of the epidemiology, demography and biometry laboratory at the National Institute on Aging, in Bethesda, Md. But patients can also be plagued by ongoing side effects of drug cocktails, which range from high blood pressure to neuropathy—a painful nerve disorder that causes numbness in the hands and feet. And they must often fight fire with fire: a medication may heal one ailment, but in many cases, it only causes another. “All of those are bonuses—the side dishes—to the main course of HIV,” Chew says.

With multiple HIV drugs on the market, allowing for physicians to mix and match to limit side effects and resistance, the medical community can often only make educated guesses as to what causes a particular ailment: Is it the virus? The meds? Aging itself? “From a health care viewpoint, that’s one of the great black boxes,” says Stephen Karpiak, ACRIA’s associate director of research and the author of one of the only comprehensive studies on HIV and aging. “And the reality is we just don’t know.” Scientists didn’t begin using the drug cocktails that turned AIDS from death sentence to chronic illness until 1996; prior to that, it was still considered a young person’s disease, with everybody focused simply on survival.

Experts say that’s not enough history to grasp the drugs’ impact on the body, particularly in older patients. Clinical trials until now have been virtually nonexistent, and most big drug companies don’t use older patients in trials—because of the possibility that those already at high risk for disease would complicate the results. “It’s very much to me kind of a good news-bad news situation right now,” says Dr. Bill Stackhouse, director of the New York-based Gay Men’s Health Crisis, the world’s oldest AIDS service organization. “The good news is that the meds are great, and people are living longer. But now there’s a whole new set of issues to be faced.”

Chew and his patients know that reality all too well. On a recent Wednesday in New York, Chew led an HIV-support group for Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE). The group regularly vents about doctor’s visits, pill regiments and the laundry list of side effects that are becoming more complicated with age. For this session, Ernest Krysty, 61, has traveled from Connecticut; he says there isn’t a support group closer to him. He describes the painful lesions on his stomach from the acid in his drug cocktail—12 different pills each day: six for HIV, and the rest for heart problems and lipodystrophy, a degenerative tissue disorder that redistributes fat, which commonly occurs in those being treated for HIV.

Another member of the group, Bruce Miller, 59, takes up to 20 pills on some days—and recounts the painful hip-replacement surgery he had to have last year. Miller isn’t sure what caused the bone degeneration in the first place—as Havlik puts it, “there are a lot of unknowns”—but the procedure caused a hematoma that had to be surgically removed, resulting in nerve damage. During his rehabilitation, he was prescribed an antidepressant that he’s now struggling to wean himself from. And now he needs a replacement in his knee, too. “It’s sort of like a house of cards,” Miller says softly. “The more pills you take, the more possibility for interaction. And as you grow older, there’s more of a chance of that collision.”

Chew himself has diabetes, high cholesterol, and neuropathy—all ailments he never thought he’d be around to see. “Having been HIV-positive for so long, and lived through the earliest part of the epidemic, I think the notion was that it would kill us long before there was any question of any other physical ailments,” says 53-year-old Mark Stewart of Manhattan. “Part of what’s helpful about this group is that we share notes about … all those things you never thought you’d have to deal with, because you thought you’d be dead.”

Those issues, of course, extend far beyond the physical. Stigma related to disease and age—and, in many cases, sexual orientation, too—has been shown to cause depression and anxiety. (In a 2006 study, ACRIA found rates of depression in HIV survivors to be nearly 13 times higher than in the general population.) Many of those aging with HIV don’t have social networks they can count on, either: gay seniors, who make up a big chunk of this group, are twice as likely as their straight counterparts to live alone. “People with better social networks are more adherent to their meds, less likely to be depressed, and we know from the gerontological literature that those with better social networks live longer—outside of HIV disease,” says Charles Emlet, a social worker at the University of Washington who studies the virus and aging.

In many ways, HIV-positive people over 50 are like guinea pigs, says Chew: they are the first to age with HIV, and the first to experience that process truly out of the closet. “With each step along the road, from the ’80s to the ’90s to now, every step has been a step in the dark,” Chew says. “And there was always the thought that, well, this medication might result in heart disease, but if it keeps me alive now, then so be it.” Sometimes a step forward can feel very much like a step back.

On the choice of orphans in sub-Saharan Africa as the topic for this research, it aims at addressing the cause of overwhelming numbers of orphans in the region and how this impacts society. The research will also be carried out on the areas most affected by this epidemic. In the research, it will also be of significance to find out how orphans and poverty are related. It has always seemed like the poor societies are more affected by phenomena such as orphanhood than those higher in social status. There are millions of orphaned children in the world and the number is increasing rapidly day by day. Most of the world’s orphans are notably found in Africa and more so sub-Saharan Africa.

Research questions

1. What are the main causes of an orphanage in the world?
2. What are the effects of the orphanage on the victims?
3. Which are the main geographical regions with the highest number of orphans?
4. What is the impact of orphans on society?
5. Are there programs that cater to orphans?

Research methodology

The initial stages of the research will involve finding out the history of orphans in selected areas. This will give an insight into the reason for the existence of so many orphans. Having found a link between HIV/AIDS and orphans, the research will gravitate towards the history of AIDS and the search for statistics on AIDS orphans in different regions of sub-Saharan Africa.

The study will also involve digging into the impact that orphans have on the wider society, immediate and otherwise. In most of these setups, older children are left with the responsibility of taking care of their junior siblings and more often than not, their aging grandparents. The responsibility of the absent parents, therefore, falls stack on the shoulders of incapacitated young ones. The research will be focused on some of the most affected countries on the continent.

Introduction

Africa was oblivious to the HIV virus that is responsible for AIDS until the 80s. In countries such as Kenya and Botswana for instance, the first cases of AIDS were reported in 1985. Prior to that time, AIDS was associated with the homosexuals of the West and this influenced the initial attitude of society towards those who were found infected. They were looked at as immoral and to some extent, they still are, regardless of the means through which they got infected. Since then, the illness was set loose and has spread like fire through the dry bush. The rate at which the epidemic is claiming lives is alarming and there is no sign that it will abate unless drastic measures are taken. According to information on AIDS and HIV, world statistics show that there are estimates of more than 15million children of the age below 18 who have been orphaned because of AIDS. Out of this figure, sub-Saharan Africa is home to about 12million of these orphans. Some of the most affected countries include Zambia, Botswana, Swaziland, and Lesotho. In the most affected countries, a percentage of more than 20 of children below the age of seventeen in those countries have been orphaned. AIDS has claimed one or both of their parents (Poku & Whitesand, 2004).

Most of the orphans in some of the countries have been orphaned by AIDS more than by any other means. The statistics on orphans vary from one country to the other across all regions. This is dictated by the prevalence rate of AIDS and also differs from rural to urban areas. The age however stubbornly ranges from 0 to 14 years. The problem of the orphanage is sometimes covered by the difference in time between when the parents become infected and when they finally succumb to the illness. The crisis could be expected to escalate if more adults are infected over the next few years. Stephen Lewis, UN Special Envoy for AIDS in Africa, says “The increased spiral of adult deaths in so many countries means that the number of children orphaned each day is expanding exponentially and Africa is staggering under the load” (Newman, 2005).

Poverty and AIDS in sub-Saharan Africa

Research shows that approximately 95 percent of the children orphaned by AIDS in the world are found in sub-Saharan Africa. A report from United Nations Children’s Fund and Joint United Nations Program on HIV/AIDS shows there are around a 48million orphans in the region south of the Sahara. Out of these, 25percent are AIDS orphans. The infection of HIV/AIDS is prevalent in the groups that are socially and economically productive which is the age bracket between 15 and 45 years. Women seemed to be more affected than men. About 9million African lives have been claimed so far and the epidemic’s hunger appears to be insatiable. The disparity between HIV/AIDS prevalence in urban and rural areas is rapidly closing up. The world’s biggest epidemic disease has had and continues to have adverse implications of increasing poverty across generations. It is one of the hurdles that policy-makers have to contend with. We can not rightfully conclude that HIV/AIDS is confined to poor regions although they account for the larger percentage. The lifestyles led by many Africans expose them to infection and this is followed by social and economic effects. Poor social groups are however less able to cope with the implications of the growing epidemic (Poku & Whitesand, 2004).

Children from poor households eventually survive their poor deceased parents and the cycle goes. Poverty is viewed as the result of unequal distribution of resources across social circles. These are characterized by poor education, illiteracy and lack of skills, poor health, and low production of labor. Poor households suffer political and social marginalization. The result is difficulty in reaching the financially handicapped populations through emerging and existing programs aimed at improving their living standards. It is for this reason that these people adopt behaviors that expose them to infection. Poverty is the reason for labor mobility and the intensification of HIV/AIDS spread.

The HIV/AIDS orphans bear the greater stigma once their parents have passed on. They are left in isolation and cut off from access to social support. Orphans find themselves separated from the general community. In addition, these kids lack access to proper nutrition and the result is low production of labor and in the long term low income. Though this may not be immediate, the conditions to which orphans are exposed give them no room for social mobility and they become vehicles to generations of poverty. As the future for Africa and specifically their countries, the implication is that there is no hope for economic growth. The objectives for national development can not be tailored along these lines (Poku & Whitesand, 2004).

The research was mainly focused on two of the world’s most affected countries in sub-Saharan Africa. The two were Zambia and Botswana.

Botswana

HIV/AIDS History

Like in many other countries in the world, Botswana first heard of a reported case of AIDS in 1985. It embarked on an HIV/AIDS response where the first stages involved blood screening to curb the spread of the virus through blood transfusion. In the second stage, programs on information, communication, and education were introduced and the Botswana National Policy on AIDS was introduced. From then on, the response was expanded to include care as well as prevention. The National AIDS Coordinating Agency (NACA) formed in1999 was accorded the responsibility of mobilizing and coordinating the response to the epidemic. Among the adult population, the infection rate is estimated at 17%. A lack of human resources has been a setback to economic development in the country (IRIN Report, 2002).

Impact of HIV/AIDS

A vicious cycle could be formed by increased poverty in addition to low economic growth. This is where AIDS results in poverty for many families while at the same time poverty leads to a high prevalence rate of HIV/AIDS. To control this, the country will be forced to formulate plans to curb the spread of the virus and also come up with ways to alleviate poverty. Suffering caused by HIV/AIDS may not necessarily suppress economic growth and determining how much the epidemic has impacted the economy may be difficult since Gross and Domestic Product changes do not show a reflection of loss and consequential suffering caused by disease. The studies carried in Botswana show that the country’s poverty is likely to increase in the future. Botswana is rich in diamonds and a good base for economic growth but per capita income in poverty-stricken homes could well fall.

In Botswana, the impact of the HIV/AIDS scourge is especially seen in children orphaned by AIDS. In the case of the loss of both parents, the children are left in the care of elderly female relatives, in most cases grandmothers, who may not even be able to fend for themselves. Consequently, these children drop out of school for lack of maintenance money and their nutrition also changes in the negative. The kind of lifestyle they have could not in any way be comparable to that of children in families with both parents. Poor diet topped with lack of education automatically condemns the orphans to poverty and as a result a lot of stress socially and mentally. (UNAIDS/World Bank Report: “Aids Hindering Economic Growth, Worsening Poverty in Hard-hit Countries). Botswana’s economic input is also affected by the loss of workers as labor production goes down. HIV/AIDS is a major development challenge that threatens social and economic gains. This affects up to 47% of the population.

Measures to control poverty and AIDS

Programs have been set up to facilitate the control of AIDS and its implications. The United Nations Development Programme has for instance played a big role in providing advisory services on policy-making. Being incorporated are gender and governance issues. Among the program’s aims is the reduction of poverty, reversing HIV/AIDS spread, increasing per capita income, and maintaining a reasonable budgetary allocation of resources with emphasis on the poor societies (Newman, 2005).

Zambia

Zambia is one of the other countries with a high HIV/AIDS prevalence. It is known for its production of copper and relies on copper mines for 90% of export earnings Mining is, therefore, the main economic activity among its people. AIDS has however got integrated into all aspects of society so much that all discussions on issues pertaining to society have to include the mention of AIDS. A report by UNAIDS shows that in every seven adults, there is more than one person who is infected. The country is said to be weighed down by economic difficulties compounded by AIDS. Those living with AIDS face stigmatization from the rest of society (Geloo, 2004).

History of AIDS

The first case of infection in Zambia was reported in 1984 as shown by a World Health Organization (WHO) Report. Within a period of one year, the statistics on patients showed that 17.5% were AIDS patients. The problem escalated to a point where the National AIDS Surveillance Committee (NASC) and National AIDS Prevention and Control Programme (NAPCP) were set up to assist in the coordination of activities relating to HIV/AIDS. At first talk about the epidemic was hushed but in 2004, AIDS was declared a national emergency and a program for provision of ARVs was established.

Impact of HIV/AIDS

It has noted that infection rates among the Zambian society are higher among the well off than the poor. However, the poor are least able to deal with the effects of HIV/AIDS. The most vulnerable are young females. Prevalence rates also seem to be higher in Lusaka and Copperbelt, two urban areas of the country. A report on AIDS care shows that the rural regions are least affected. The kind of lifestyle adopted by women especially puts at a high risk of infection. Movement of people in search of work is also to a big extent responsible for the spread.

The AIDS epidemic has affected several sectors of the economy. Loss of employees and social workers stifles national development as production and harvests go down. Children are however the most affected. In 2007, there were reported to be at least 0.6million AIDS orphans in the country. These children face stigmatization and are abused and misused by the families in whose care they are left. These orphans have been found to run away into the streets where they beg pickpocket or do odd jobs to be able to look after their families. The number of children in the streets rises as AIDS continues to claim the lives of parents in Zambia. Statistics have it that about 94000 people die in Zambia as a result of AIDS. Consequently, more than 50% of children living in the streets are AIDS orphan.

Schooling has also become a problem among the orphans because of an unaffordable cost of education. Besides, they are faced with conditions of starvation as they scramble for the little they can find on the streets. With increased poverty, the possibility of a decent life is almost nonexistent. The girls find themselves in situations where they have to offer sex in exchange for a meal. With these conditions, it is almost inevitable to be infected with STIs and the population of the infected just keeps rising (Newman, 2005).

Crime has been another effect of orphanhood in the country. With little to sustain the growing population of street children, a society of thieves, rapists and terror gangs is emerging. This has also seen the rise of drug use as a source of escape from the hardships arising from orphanhood. Substances like cannabis sativa, cocaine and glue are in common use among them. The government lacks funds to support orphans and as Mendosa, a South American says, “The situation for street children is getting worse. The only thing to do is strengthen families so that they can look after their children.”(Zarina Geloo, 2004).

Strategies to control HIV/AIDS and poverty

The Copperbelt Health Education Project has employed music, groups, drama and role play to educate the masses on HIV/AIDS. The program mainly targets rural areas which is not entirely effective as the urban populations are more affected. In schools, the method has been used to educate roughly 25,000 students across the country. Education focused on peer groups has also employed youth services where peer educators work closely with health centers to reach out to sex workers, and street children.The media has also been a venue of influence in raising awareness but this has an advantage mostly on rural folk. Zambia established an Anti- AIDS Club in the 80s which reaches out to children at risk of infection and encourages safe living. The government has involved faith organizations and Non Government Organizations in the campaign against AIDS (Polak, 2005).

Problems Faced by AIDS Orphans in sub-Saharan Africa

Emotional Impact

From the onset, children who have been orphaned by AIDS suffer neglect even long before their parents have died. With the death of their parents, emotional trauma sets in. The difficult part is adjusting to a new life where there is nobody to look up to and no external support. The orphans may then have to fend for themselves and in the process there could be malicious people out to exploit and abuse them. The orphaned children are vulnerable to psychological distress and they bring it out in behaviors such as anger, anxiety and depression. There is a sense of hopelessness and some will even introduce thoughts of suicide to escape from the social implications of their situations (Polak, 2005).

Financial Impact

In most instances, upon the demise of the breadwinning parents, children are condemned to a life under the care of female relatives whose income can barely support them. (Monash & Ties, 2004) The orphans are therefore pressurized to step in and contribute to the financial needs of the household. This drives them out onto the streets where they have to do anything within their means to at least put food on the table. To a great extent, underage children find themselves in the predicaments where they are responsible for all the members of the household, young and old (Polak, 2005).

Social Impact

Homes affected by AIDS are often stigmatized by society. By extension, children of infected parents are associated with AIDS and are equally stigmatized. From this stigmatization, the children are not allowed to mix with others and access to social amenities is limited. Their future is at the mercies of society which is unwilling to accommodate them. Families consequently are threatened with disintegration (Polak, 2005).

Recommendations

The research proved that the world’s entire attitude towards AIDS ought to change if we are to make any headway in the eradication of a socially and economically crippling occurrence. This will not only enable for growth and development but could boost the morale of both the infected and affected towards productive living. It could give some start to the end of poverty by extension as all will be contributors to production of labor. If all people accepted AIDS victims into society and allowed them access to all social amenities, the social stigma they suffer could be eliminated and they would not be withdrawn. (Cohen, 1996).

Attitude may not however be of any use if other direct measures are not taken to face out the disease altogether. Policies that will govern the control of spread and care of infected and affected should be put in place to benefit not only the rich but also the poor of society who actually comprise the larger population. The policies could work well through programs such as the National AIDS Coordinating Agency of Botswana (Cohen &Trussell, 1996).

The programs could see to acquisition of skills that will enable the victims to fend for themselves financially and access medical care. Besides and more importantly, the programs would reach out to all regions and educate the populations on positive living and ways to avoid infection. AIDS orphans need to feel they are part of the society and like any other person demand love. Instead of delegating responsibility duties to old relatives, programs could be put in place which take orphans into social care centers and bring them up, preparing them for integration into society and promising futures (Monash & Boerma, 2004).

Conclusion

From this research it is evident that a great number of children who have been exposed to poverty all their lives will adopt the same manner of living that exposes them to infection by HIV. The effect will be a carry forward of infected communities into the next generation. The ultimate implication is that the epidemic, instead of taking a turn towards extinction, will grow. If the trend is not checked, the entire human race could slowly be faced with extinction (Monash & Boerma, 2004).

Bibliography

Caldwell J. “Rethinking the African AIDS Epidemic” (2008) Volume 34 Issue 3.

Cohen B. & Trussell J., (1996) Preventing and Mitigating AIDS in Sub-Saharan Africa. Washington DC: National Academic Press.

Cohen D. “HIV and Development Programme: Poverty and HIV/AIDS in sub-Saharan Africa.” Issues Paper No. 27.

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Abstract

The public health campaign addresses the issue of HIV prevention among young adults. The target group was selected due to its representatives’ high vulnerability to the identified health problem. The paper incorporates three significant components of the successful organization of the project. The first element is the use of systems thinking as a holistic approach to the health issue. The second component is the employment of research dedicated to the health problem. The third constituent is the use of interprofessional collaboration as an effective method of managing the HIV prevention process. Each of these elements is regarded by the public health professional. Pertinent data, examples, and evidence are offered to illustrate the selected problem better. The knowledge and skills necessary for public health professionals to address the health issue effectively are identified. Particular attention is paid to the arrangement of interprofessional collaboration, its drivers, and predictors. The aspects of teamwork that promote positive public health campaign outcomes are identified. The usefulness of research in the process of arranging a prevention project is analyzed. In the conclusion, the main points of the paper are summarized, and the skills necessary for productive work are reiterated.

Introduction

The purpose of the present paper is to offer an overview of the approaches a public health professional can use while implementing a public health campaign on HIV prevention in young adults. Because there are currently no successful treatment methods for this disease, prevention is the most effective way of saving youth from developing HIV. The selected target group is the most vulnerable to the health issue because of substance abuse and unsafe sexual behaviors. The paper will discuss how systems thinking, research and interprofessional collaboration can help the public health professional to create favorable conditions for preventing HIV in young adults.

The Use of Systems Thinking to Impact the Target Population’s Health

Given the severity of the effects that HIV can have on people’s health, public health professionals need to employ a variety of approaches in their preventive work. One of the most productive methods is including systems thinking in the process of work. This approach presupposes a holistic analysis of the issue by taking into consideration the interrelation of elements within some system (Battle-Fisher, 2015). With the help of systems thinking, one can reappraise policies “under a new critical eye” (Battle-Fisher, 2015, p. 5). Thus, this manner of analysis can benefit the public health professional’s work aimed at preventing HIV.

There is not much current evidence on the application of systems thinking in HIV prevention. According to Brown et al. (2015), some efforts have been made by Australian, British, and German specialists who introduced the approach in their interventions. What concerns the USA, systems thinking is viewed as a viable solution to reducing the growth of HIV infection rates (Meyerson, Ryder, van Hippel, & Coy, 2013). One of the aspects of current discussions is that the role of pharmacists in the process of preventing the spread of HIV is underestimated (Meyerson et al., 2013). While public health professionals advise individuals to test for HIV, they rarely consider the potential of the help one can get at the pharmacy. Consequently, it is crucial to revise the current methods and include a variety of aspects that can promote HIV prevention, such as the help of professionals at the drug store, the possibility of communicating with pharmacists and public health professionals, and the opportunity to manage the problem from different perspectives.

The Use of Research to Affect the Target Population’s Health

When planning preventive measures, the public health professional needs to recognize research as a vital component of any intervention’s success. According to pertinent data offered by the Centers for Disease Control and Prevention, many efforts are made to perform high-quality research on various aspects of HIV (CDC, 2017). In particular, the results of investigations on the development and assessment of HIV behavioral interventions aimed at preventing the disease’s transmission are available (CDC, 2017). Another useful piece of research evidence is offered by Mavedzenge, Baggaley, and Corbett (2013) who investigate self-testing for HIV as a means of prevention. Public health professionals could employ these data to collect evidence on the most successful prevention interventions and later use it to plan their activity.

The Use of Interprofessional Collaboration

The systems thinking approach is closely associated with interprofessional collaboration since both of these methods involve viewing health issues from different perspectives. Interprofessional collaboration is reported to have a positive impact on HIV prevention, to promote the spread of data, and to support the efforts of the public health professionals in the process of work with the target population (Peu et al., 2014). Collaboration in the course of preventive and care measures plays a crucial role due to assistance in planning, implementing, supervising, and assessing various strategies (Peu et al., 2014). Thus, the public health professional needs to carefully evaluate the possibilities of interprofessional collaboration and find ways of inviting other specialists to participate in the HIV prevention program.

A recent example of collaboration in the process of HIV prevention is the work of the interprofessional team in Eskenazi Infectious Disease Clinic in Indianapolis. In 2017, collaborative practice connected specialists from different departments, as well as students, to carry out the HIV prevention and care pilot project (“Interprofessional collaborative practice,” 2017). It is noted that to arrange such practice most practically, the efforts of public health professionals need to be reinforced by other healthcare workers. The project proved to be productive, and it is expected that other collaborative teams will engage in such a practice.

In research dedicated to interprofessional collaboration, much attention is paid to the identification of the elements that can promote this type of work. Franklin, Bernhardt, Lopez, Long-Middleton, and Davis (2015) outline the following aspects of teamwork that can lead to successful interprofessional collaboration: shared understanding, egalitarianism, cooperation, interdependence, and synergy. Mavronicolas, Laraque, Shankar, and Campbell (2017) note that the major drivers of collaboration are social exchange factors. What concerns the most crucial predictor of interprofessional collaboration, Mavronicolas et al. (2017) note that it is the relationship initiation. Therefore, the public health professional needs to take into consideration the variety of possible predictors and drivers of collaboration and select the most viable ones to arrange the successful collaboration aimed at HIV prevention.

Conclusion

The paper has focused on three approaches that can reinforce the efforts of public health professionals in their work on HIV prevention among young adults: the use of systems thinking, research, and interprofessional collaboration. The skills and knowledge expected of public health professionals to address the selected public health issues include the ability to initiate and arrange relationships, egalitarianism, synergy, and interdependence. The public health nurse should also be able to collect and analyze research evidence to approach the problem of HIV prevention most comprehensively. When all the mentioned aspects are taken into consideration, the results of the public health campaign are likely to be rather positive.

References

Battle-Fisher, M. (2015). Application of systems thinking to health policy & public health ethics: Public health and private illness. Cham, Switzerland: Springer.

Brown, G., Reeders, D., Dowsett, G. W., Ellard, J., Carman, M., Hendry, N., & Wallace, J. (2015). Investigating combination HIV prevention: Isolated interventions or complex system. Journal of the International AIDS Society, 18(1), 20499.

CDC. (2017). HIV/AIDS: Research. Web.

Franklin, C. M., Bernhardt, J. M., Lopez, R. P., Long-Middleton, E. R., & Davis, S. (2015). Interprofessional teamwork and collaboration between community health workers and healthcare teams: An integrative review. Health Services Research and Managerial Epidemiology, 2, 1-9.

Interprofessional collaborative practice in HIV prevention and care pilot project results. (2017). MATEC-Indiana. Web.

Mavedzenge, S. N., Baggaley, R., & Corbett, E. L. (2013). A review of self-testing for HIV: Research and policy priorities in a new era of HIV prevention. Clinical Infectious Diseases, 57(1), 126-138.

Mavronicolas, H. A., Laraque, F., Shankar, A., & Campbell, C. (2017). Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes. Journal of Interprofessional Care, 31(3), 368-375.

Meyerson, B., Ryder, P. T., van Hippel, C., & Coy, K. (2013). We can do more than just sell the test: Pharmacist perspectives about over-the-counter rapid HIV tests. AIDS and Behavior, 17(6), 2109-2113.

Peu, M. D., Mataboge, S., Chinouya, M., Jiyane, P., Rikhotso, R., Ngwenya, T., & Mulaudzi, F. M. (2014). Experiences and challenges of an interprofessional community of practice in HIV and AIDS in Tshwane district, South Africa. Journal of Interprofessional Care, 28(6), 547-552.

Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) cases are increasing per year. It does not only affect women but men and children as well. The disease is easily transmitted and is very fatal. Even though years of study have already been done, no treatments were still available to really cure the disease. According to UNAIDS, HIV/AIDS is affecting 33.2 Million people including 2.5 million children and around the year 2007 another 2.5 million people got newly infected with the disease. We could just see the fast pace of passing the infection from one person to another. About half of the total number of the people affected by the disease contacted the disease before they reach the age of 25 and unfortunately dies before they reach the age of 35 (World AIDS Day, n.d). The developing nations account for the 95% of the total number of HIV/AIDS victims. With this kind of trend in the society, what was the answer of the health sector all over the world? What was done to increase the awareness of the people about the disease? What purpose does World AIDS Day serve and what is the main goal of the founders why they started the observance of the said day? Why do we still mention it until today?

On December 1, 1988, the very first World AIDS Day was established. The concept of the celebration of World AIDS Day started at the 1998 World Summit of Ministers of Health on Programmes for AIDS Prevention joined by 140 countries (World AIDS Day 2006, n.d.). The campaign is not merely for raising funds but also for increasing the awareness, improving the education and fighting prejudice (World AIDS Day, n.d). Celebrated every first of December, this serves to strengthen global efforts to address the challenges that the pandemic of AIDS bring (World AIDS Day, n.d.). This day gave an opportunity for the non-governmental and local organizations, as well as individuals to show the importance of fighting AIDS and their dedication to this campaign.

Every year World AIDS Day has different themes. The very first celebration of the World AIDS Day was “Communication”, in 1989 “Youth”, in 1990 “Women and AIDS”, 1991 “Sharing the Challenge”, 1992 “Community and Commitment”, 1993 “Act”, 1194 “AIDS and the Family”, 1995 “Shared Rights, Shared Responsibilities”, 1996 “One World, One Hope”, 1997 “Children Living in a World with AIDS”, 1998 “Force for Change: World AIDS Campaign with Young People”, 1999 “Listen, Learn, Live: World AIDS Campaign with Children and Young People”, 2000 “ AIDS: Men Make a Difference”, 2001 “I care. Do You?” 2002 and 2003 “Stigma and Discrimination, 2004 “Women, Girls, HIV and AIDS”, 2005 “Stop AIDS: Keep the Promise”, 2006 “Stop AIDS: Keep the Promise-Accountability”, and in 2007 “Stop AIDS: Keep the Promise-Leadership”. Every year different themes were made and in connection with the themes organizations discuss information that the public needs to know. The themes are the basis of what would be included in the talks all over the world. This would give them idea on which topic to focus on thus increasing the awareness of the people about AIDS every year.

Each Year, from 1988-2004, it was the UNAIDS that spearheaded the World AIDS Day campaign; it was the organization that consulted the themes with other global health organizations. By the year 2005, the responsibility was then given to World AIDS Campaign (WAC) and this organization chose the main theme “Stop AIDS: Keep the Promise” for the World AIDS Day until the year 2010.

World AIDS Day is celebrated every year and a red ribbon is worn as an important symbol of AIDS awareness. This is worn all year round by some people and some just wear this every first of December just to remind everyone of the World AIDS Day thus remembering why this day is celebrated. Some may wear this to demonstrate their care and concern about HIV and AIDS and somehow affect others for their commitment and support.

Why the World AIDS Day is then celebrated all across the globe? The World AIDS Day is not just celebrated in the United States, Europe, or Asia, it is observed all over the world because the disease does not only affect this part of the globe, but the occurrence of the disease is worldwide. This affects men, women and children all over the globe. Considering the fast pace of the infection, people all over the world needs to be informed of the disease. The awareness must spread all over the world to educate the people about the disease so as to be careful and avoid activities that may expose them to the possibility of having the disease. Education about the disease should also include information about the kind of activities that may predispose one to the disease. Proper education and wide awareness may be a key to prevention and prevention is very essential because the disease has no known cure. All over the world, awareness raising activities are done and this is participated by a number of participants showing that they are concerned with importance of education about AIDS. The global awareness is very important to help decrease the number of infections per year. This does not affect only a certain locality but all people, with no exceptions, can be infected by the disease thus worldwide information dissemination is a must.

What’s the importance of celebrating the World AIDS Day? This very day is a constant reminder for us that there is a disease, a fatal one which is very contagious and affects millions of people around the world. This day is a reminder that HIV is here to stay until a cure is found. That every year we are reminded of our responsibility as an individual to help in our own little way in stopping the spread of the disease. Living by example may affect others and be responsible with themselves as well. This is where love and support is important among family members and between husband and wife. In this way, people would tend to look ahead and plan their lives rather than play around and have the disease.

Why is this day still mentioned until the present? HIV/AIDS has not yet gone away. It is still left with no treatment for cure. Studies are still done to find the treatment for the said disease. The World AIDS Day is a constant reminder for us that there are still a lot of people living with AIDS, many die from the disease. World AIDS Day would always remind us of the purpose it serves. It is to raise the communities’ awareness about the said disease. This also calls for support and understanding to those people living with the disease and the need to educate people on the about the disease and the prevention initiatives (World AIDS Day 2007 Stop AIDS Keep the Promise, n.d.)

In the present day, World AIDS Day has already influenced a lot of nations. The response of the people from different races and different cultures was positive that they even voluntarily participated in increasing the community’s awareness about the disease. This day is marked worldwide, and their purpose was met. Through the help of the government and the concerned people, this day is set to remain a primary vehicle for reinforcing the awareness about AIDS either nationally or internationally regardless of the theme or the participation of the UN (World AIDS Day, n.d.).

The World AIDS Day was created to serve a great purpose; it is to increase the awareness of the people. Increasing their awareness would include a plan for an improved education so to help the people better understand AIDS. AIDS may be a complicated disease to understand but it is not necessary for one to know the process that is going on with the disease. The most important thing that the people must know is its prevalence, its being contagious, how a person can have it, its effects and how is it prevented. These are the things that the World AIDS Day is primarily focusing into. Celebrating World AIDS Day every year constantly reminds us of the purpose, decrease the prevalence of the disease. By increasing awareness, chances it would be decreasing the HIV/AIDS cases every year. Proper information dissemination, especially with the activities done during World AIDS Day would help people reflect on its effects. New movements have been done. They wanted to transform the World AIDS Day not just a day for awareness but a day for transformation as well. The group came up with the activity entitled “6000 Reasons to Act” this is because 6000 children will lose a parent everyday because of AIDS (World AIDS Day, n.d.). This is an effect of the World AIDS Day information dissemination that was started almost 20 years ago.

World AIDS Day did not just awaken people to be careful with their very own selves but it also awakened the charity in them because many organizations were born to help people with AIDS through World AIDS Day.

Bibliography

NetGlimse Your window to the Internet N.d.. World AIDS Day. (2008). Web.

UMCOR United Methodist Committee on Relief. n.d. World AIDS Day 2007.

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WorldVision.n.d. World Aids Day. Web.

Introduction

HIV, which stands for Human immune deficiency virus, is the virus that leads to AIDS (Acquired Immune Deficiency Syndrome). It destroys the white blood cells that give the body protection from all forms of diseases and hence weakens the immune system of the body. This paves way for other opportunistic diseases such as tuberculosis. When the body defence system is weakened by the virus, it is unable to fight other diseases that attach it, hence when one is infected with HIV/AIDS; the possibility of having other illnesses is very high compared to someone who is not infected. Having no cure found, it has been declared to be a national disaster in many countries of the world. (Douglas 2006, 13)

Reports show that HIV/AIDS infection rate has greatly increased in most parts of the world in the recent past. In Europe in particular, the rate is growing very rapidly compared to many parts of the world. (Douglas 2006, 13)

Vulnerable Group

The society today has abandoned the rigid norms of a culture that forbids bad behaviour and advocates for morality. In UK, cultural values have faded away leaving people to live immorally in a submissive society, which encourages the will of the majority rather than moral living. (Gerald 2005,29)

In Europe, the most vulnerable groups to HIV/AIDS infection are commercial sex workers, drug users who use injection, men who engage in sex with other men, inmates who are usually locked up in prisons and migrants who leave their home area to look for jobs far away from home. Apart from being a health issue, HIV/AIDS is also a complex problem that affects the social life and the economy of a country. It is also a human rights problem. HIV/AIDS in Europe is seen to have its roots in such areas as poverty, discrimination, inequality, especially gender inequality and lack of proper information about the epidemic. For many years people have kept HIV/AIDS infection underground in fear of the discrimination and stigma associated with it. (Gerald J.Stine 2005,45)

HIV and AIDS infections in UK are high for all age groups ranging from the young generation to the old. It has been noted that, of late the HIV and AIDS infection for those aged fifty years and above has rapidly risen up greatly. The surveillance data from research on HIV infections in UK indicates that in 25,500 adults aged fifty years and above are HIV positive. 31% among these are not aware of their status. This figure recorded in 2006 reflects a double increase of the number recorded on a similar research in 1996. The high increase in the number of people living with HIV among this age group is attributed to continued changes in lifestyle and high increase in population in UK.

Homo/bisexual men in UK is estimated to at 7%, with estimate of a prevalence infection showing that 32,400 homo/bisexual men are HIV positive, of whom 10,500 were men above fifty years. Another reason of the high increase of HIV among the men aged 50 years and above is the high increase of men having unprotected sexual intercourse with young girls aged fifteen –twenty five years. Most of these girls are highly sexually active with multiple partners and hence highly vulnerable target. This happens mostly to the UK men that come to visit Africa. These old men who are loaded with money entice young African girls and boys with their money to have unprotected sex with them. On the other hand the Old UK women that visit Africa use their money to entice the young African men and boys to have sex with them. This increases their chances of HIV/AIDS infection since these young men are very sexually active with more than one sexual partner. Most of these young boys and girls do not insist on safe sex through the use of condoms since most of them do not have adequate education on sex.

Another vulnerable group are those old men and women that abuse drugs. A drug can be defined as any substance which when taken into a living organism may alter one or more of its functions. Drugs can be abused by taking an overdose that can lead to poisoning or prolonged use of a drug leading to tolerance. The mostly abused drugs include: alcohol, tobacco, cocaine and heroine. Drug abuse in UK especially among the old generation is high. This had made these individuals become careless and engage in promiscuous sex that increases their chances of contracting the HIV virus. The most abused drug for by these people is heroine. Heroine are taken through injections. This drug increase the chances of those old men and women that use them getting the virus, because most of these drug users share the un-satirized needles to inject heroine in their body.

The number of commercial sex workers in UK is very high. This is mostly comprised of immigrants who have come to UK to look for jobs. Many of them after failing to secure a job are forced to engage in commercial sex to earn their living. Most of these young men and women that engage in this business are end up being infected with HIV virus since they do not have the power to negotiate for safe sex and especially the women. Many UK old men and women who do not get sexual satisfaction from their partners seek it from the commercial sex workers therefore increasing their chances of contracting HIV/AIDS.

The other factor that has caused high increase of HIV/AIDS infection in UK for those above 50 years is the high increase in crime. This is because the poor UK prisons conditions have also been noted to contribute to the high rate of HIV infection. This is brought about by unsafe sex among inmates as well as sharing of injection needles for those who use injecting drugs. (Barry and George 2005,23)

Estimated Size of Core Population Groups at High Risk of HIV by Country

In UK many strategies have being put into place to address the high raise in HIV infections. These include both preventive and curative measures. In preventive measures people are educate about HIV/AIDS. This comprises its modes of transmissions, preventions and its associated opportunistic diseases. Its modes of transmissions include transmission through blood transfusion. This happen when a HIV/AIDS infected person donates blood to a HIV/AIDS uninfected person. The virus can also be passed from mother to child. The child can contract the HIV virus during birth if the mother is HIV infected. This is because during birth a lot of tissues are ruptured and this can make the mother’s blood come into contact with the blood of the born baby. Hence contracting the deadly disease. Other ways that one can acquire the HIV virus is by sharing of un-sterilized skin piecing instruments. The HIV/AIDS does not have a cure and hence when one contracts the virus they eventually have to die. This is because the HIV virus weakens the body immune system that facilitates the infected person to suffer from opportunistic infections such as tuberculosis, Pneumonia etc.

Currently HIV/AIDS victims are using antiretroviral drugs to boost their immune system. These drugs prevent multiplication of the virus and also prevent the entry of the HIV virus into the human cells. The HIV/AIDS victims are also advised to take drugs that treat opportunistic infections and immunity boosting drugs such as multivitamins.

Effects of HIV/AIDS

HIV/AIDS have greatly affected the social level of in UK: With the number of people infected with HIV/AIDS increasing, the societies have becomes weaker and many people have lost the strength desires to uphold it. There are many sickly people in the society and most of those who are not infected also become affected as their relatives and friends are infected. It has also increases the UK economy. This is because some of the people who are infected with HIV/AIDS are unable to continue with their work so as to seek medical attention. In some cases, when a person is identified infected with HIV/AIDS, he is discriminated at the workplace and opts to quit to avoid the discrimination.

In both cases, where one is too weak to work and where one quits due to discrimination at the workplace, the infected person depends on others for upkeep as well as for medical attention. They are unable to provide for their families and instead use up some of the family resources. When the infected persons die, they leave behind their orphaned children under the care of relatives. Many families discriminate against the HIV/AIDS orphans and even go to an extent of preventing them from playing with their children. They discourage the integration of AIDS orphans into the society with the fear that they could be infected just like their parents.

The negative treatments of HIV/AIDS victims affect them psychologically. The problems they suffer include: Shock, denial, anger, loneliness and fear. They experience these challenges due to the stigma and discrimination that is associated with HIV/AIDS victims. The UK government is responding well to this problem by educating and encouraging UK residents to give moral support to HIV/AIDS victims to enable them maintain a positive outlook in life. The hospitals in UK also give the HIV infected people proper counselling to enable them accept their HIV positive status. This enables these people to cope with their psychological problems and live a positive life.

Conclusion

Our data confirm the need for national and local prioritisation of sexual health and HIV prevention activities. Interventions such as those outlined in the English Sexual Health and HIV Strategy needs to be implemented urgently. For homo/bisexual men this includes HIV/AIDS education, promotion of safer sex and HIV testing. The strategy has also specifically identified even the old people as a priority group for action and the Department of Health is currently implementing a range of interventions including the National Chlamydia Screening Programme. In the meantime, key interventions for prioritisation include improving access to treatment and care services in hyper endemic areas; raising community HIV/STI awareness; and enhancing secondary prevention activities including partner notification. (Catherine and Campbell 2003,30)

Elsewhere in the United Kingdom, health promotion campaigns aimed at high risk subgroups are being implemented and will undoubtedly require scaling up in the near future. In Wales, for example, the “Come Clean” multimedia campaign has been run by BBC Wales and the Welsh Assembly and is targeted even among the old generation.

Effective secondary prevention activities are also needed to tackle the growing problem of STI re-infection and epidemiological synergy between STIs and HIV infection. Such initiatives need to be fully supported and sustained if further deterioration in the United Kingdom’s sexual health is to be prevented. Finally, although the impact of these initiatives can only be recognised over many years it is important that medium and long term targets are set and progress monitored to ensure the most appropriate, cost effective, and efficient use of scarce resources (Hammers and Downs 2003,112-119).

Many parts of Europe have taken several measures in responding to the HIV/AIDS pandemic. This involves best use of Orem’s model where the UK hospitals are admitting the very sick AIDS patient to give them specialized treatment and care. This comprises mostly the HIV infected who lives for a very long time unaware of their Status. The immune system of these HIV victims becomes very weak and subsequently suffers from opportunistic infections such as tuberculosis and pneumonia. Therefore these victims are given specialised attention when admitted and once they regain their health and strength they are discharged and introduced to retro-viral drugs. They are at the same time educated on the importance of observing cleanliness and eating balance diet with a lot of fruits and vegetables to boost their immunity. They are also advised to visit hospitals for check ups on regular intervals. These people are advised to stop involving themselves in sexual intercourse or when they do to use condoms to avoid enhancing multiplying the HIV viruses in their body. The UK government in collaboration with many other NGO’s are highly involved in HIV/AIDS education seminars for both the young and old generations to curb the high spread of this 21^st century pandemic. (Douglas& Julia 2006,15)

The UK residents are advised on accepting that the epidemic is a real problem to be dealt with. With this in mind, the government is able to take serious action and include strategic and well-coordinated plans to fight the disease and implement different approaches. People are also encouraged to share good experiences and practices in the war against HIV/AIDS. (Gerald 2005, 10)

In the fight against HIV/AIDS, The United Nations Development Programme has been able to achieve several successes that are both tangible and visible in UK. This has been possible through the leadership for results programme and its initiatives at the regional and the country level. It also works in its role in the global fund to fight AIDS, TB and malaria. In all this, UNDP aims at strengthening capacity mainly at the national level, addressing the challenges that face the government and developing leadership at all levels. The four key areas, which UNDP deals with, are: prevention of HIV/AIDS infection, Care for those infected with the virus, Support and finally Treatment. It forcefully works towards reduction of vulnerability. Through these measure HIV/AIDS infections in UK and especially among the old generations will reduce greatly. (Tony and Alan 2003, 105)

References

Barry S. and George M. (2005) Risk of AIDS injection drug users and Sexual partners, Greenwood Press: London pg 123.

Catherine Campbell (2003) Why HIV/AIDS Prevention Programmes Fail, Oxford University Press: London pgs 21-55.

Douglas A and Julia W. (2006) The AIDS Crisis, Greenwood Press: London pgs 13-17.

Gerald J.Stine (2005) AIDS Update. Prentice Hall New York pgs 9-12.

Hammers F and Downs A. HIV in central and Eastern Europe. /Lancet/ 2003 (in press). Published on line Feb 18, 2003 pgs 111-120.

Hood, S. [Ed.] (1999) Critical issues in social research: power and prejudice Buckingham: Open University Press pgs 31-54.

Hulder Reger C. (1993) The Cure for HIV/AIDS prentice Hall New York pgs 71-76.

Jared ed. Laurence (2004) Medication Adherence in HIV/AIDS, Oxford University Press: London pgs 45-67.

John P. Hutton (2001) Global Health, Oxford University Press: London Pg 28.

Tony B and Alan W. (2003) AIDS in the Twenty-First Century: Disease and Glamorization. Cambridge University: Press London pgs 98-109.

Abstract

Background

HIV drug resistance is becoming a major concern not only in developing nations but also in developed countries such as the United States, Canada, the United Kingdom, and Germany. The prevalence rate of the condition is high in Sub-Saharan Africa. The focus of this study was to investigate the possible causes of the resistance, its prevalence, and ways of dealing with the problem.

Methods

The review of literature focused on primary sources, especially peer-reviewed journals. The journals were obtained from online databases such as PubMed Central, the National Center for Biotechnology Information (NCBI), the Online Mendelian Inheritance in Man Database (OMIM), and WebMed. Other important sites used include Medscape, MedicineNet, EMedicine, EBSCO Information Services, and ProQuest

Results

The review revealed that enzyme mutation in the genetic structure of HIV is the primary reason that causes drug resistance. In cases where one is infected with both HIV-1 and HIV-2, it may pose challenges to the effective treatment of the virus. Factors such as poor adherence to medication, the inability of the body to absorb the drug, and varying pharmacokinetics were identified as some of the leading factors that cause drug resistance. When the condition of an HIV-positive individual continues to deteriorate even when they are under medication, it is recommended that such an individual should be taken through phenotypic and genotypic testing to establish if the virus has developed some form of resistance. The use of highly active antiretroviral therapy (HAART) would be appropriate in managing such unique conditions.

Conclusion

The findings of this study show that cases of HIV drug resistance are on the increase, especially in parts of Sub-Saharan Africa. To help overcome this problem, it is recommended that patients should avoid cases of reinfection. Patients who have developed resistance to the drug would need to use HAART, which is a more aggressive and effective form of managing the condition.

HIV

The use of antiretroviral (ARV) treatment has given hope to millions of HIV (human immunodeficiency virus) patients across the world. The medication helps to suppress the replication of the virus in the body and strengthens the immune system. Recent studies show a worrying trend of cases of drug resistance among HIV patients. According to research by Tang and Shafer (2012) among HIV patients in Africa shows that the virus sometimes mutates, making it difficult to manage the medication using conventional ARV therapy.

Factors such as lack of viral load monitoring, cases of interruption of the medication, and the inability of the body to absorb the drug are known to cause resistance to ARV medication (Jespersen et al., 2015). Patients who have both HIV-1 and HIV-2 viruses may not respond well to medication. Some studies suggest that Africans tend to develop the K103N NNRTI mutation, which is often caused by poor adherence to medication (Rhee et al., 2015). In this case, genetic polymorphism slows plasma MNRT clearance because of the interruption of the medication.

When a patient develops resistance to the ARV drugs, the consistent depletion of CD4+ T cells cannot be stopped, which means that the patient would have a severe immune system dysregulation (Onywera et al., 2017). The condition of the patient would progress rapidly into AIDS. When a patient fails to respond to cART regimens, they become susceptible to opportunistic diseases such as renal complications, cardiovascular diseases, liver problems, malaria, and diarrhea among others.

It is estimated that there are over 36 million HIV-positive patients around the world, most of who are in Sub-Saharan Africa. A significant number of these people are breadwinners in their families. The only hope that they have to lead a long normal life is when they get the right medication that would suppress the duplication of the virus and strengthen their immune system. As such, HIV drug resistance is a major concern that needs the attention of medical experts and other stakeholders in the field of healthcare. In this research paper, the focus is to understand the possible causes of HIV drug resistance among patients and steps that can be taken to address the problem.

Methods

When conducting this research, it was necessary to collect data from reliable sources. According to d’Ettorre et al. (2014), the primary essence of any research project is to address the existing knowledge gaps by providing new information or evidence. HIV is a controversial topic in the field of medicine. A report by Restrepo et al. (2019) shows that about 940,000 people died of AIDS around the world in 2018. Another 36.9 million people are living with the condition. It is necessary to find ways of managing this global pandemic. As such, it was necessary to find credible information that would guide the researcher to make a conclusion based on facts.

The problem is not unique to the United States but also in other parts of the world. It is a more serious problem in Sub-Saharan Africa than it is in the United States and other developed nations in Europe. When conducting this study, it was desirable to collect primary data from healthcare institutions and individuals who have been using antiretroviral therapy. However, geographic barriers and limited time available for the research made it impossible to collect data from these respondents. The researcher couldn’t travel to Africa and other worst affected areas to gather data because of the geographic barrier. As such, the researcher relied on publications made by other scholars.

Online medical databases were used to identify the resources needed for the study. PubMed Central and the National Center for Biotechnology Information (NCBI) provided important journal articles, which were instrumental in this investigation. The Online Mendelian Inheritance in Man Database (OMIM) and WebMed also proved crucial in providing the information needed in this project. Other important databases used include Medscape, MedicineNet, EMedicine, EBSCO Information Services, and ProQuest. The researcher used keywords such as HIV-1/2 dual infection, antiretroviral treatment, drug resistance, HIV prevalence, and CD4 cell. The information obtained from these sources was used to inform this project.

Discussion

According to Zoufaly et al. (2014), drug resistance refers to a condition where a disease-causing organism, which in this case is the HIV virus, to continue replication despite the administration of a drug that is known to destroy it. The body of such a patient would not respond to the ART treatment. One of the primary causes of HIV drug resistance is the mutation of the virus. The virus changes its genetic structure, especially enzymes in the virus, which enable it to replicate. Other than mutation, which is often caused by poor adherence to the medication, the presence of HIV-1 and HIV-2 in a patient may also cause resistance.

It is not common to have cases where one has to administer two types of ARV treatment to a patient. It means that when one is infected with both types, the medication will only focus on managing one of the types of the virus, which means that the other can easily mutate in response to the medication. In this section, it is necessary to look at socio-economic factors that would lead to mutation, investigate the scientific concept of HIV drug resistance, and factors that can be taken to address this medical problem.

Socio-Economic Factors Associated with the Spread of HIV

When analyzing HIV resistance to antiretroviral drugs, it is also important to look at factors that often lead to cases where an individual is infected with more than one type of the virus. According to Nakanjako et al. (2011), one of the leading factors that make it difficult to manage the viral load among some of the HIV-positive people is the existence of both type HIV-1 and HIV-2. Such cases are common when an individual who is already infected with one type is re-infected with a different type of the virus.

Managing the condition of such a patient may be very challenging. In this section, the researcher will look at socio-economic factors associated with the spread of HIV in Sub-Saharan Africa where the prevalence of this pandemic is highest in the world.

Poverty

According to Soria et al. (2011), poverty is one of the leading causes of the spread of the HIV virus in Africa. South Africa is one of the most populous African countries. However, unemployment among youths is a major problem that the government is struggling to address. Most of the poor youths end up in slums where they engage in irresponsible sexual practices as a means of earning income to sustain their basic needs.

In Kenya and other East African countries such as Tanzania, sex tourism is a booming business (Chan et al., 2016). One of the factors that have promoted this practice is the poor implementation of laws relating to prostitution. The biggest challenge associated with sex tourism is that it involves children, some as young as eleven years. At such a tender age, these young boys and girls do not know much about safe sex.

Both local and foreign visitors use these minors by giving them financial benefits in exchange for sex. They are constantly exposed to HIV infection every time they engage in such irresponsible practices. Lee, Wong, Wong, Wong, and Chan (2017) argue that the problem is that the extreme level of poverty in these regions leaves the affected group with no alternative other than to engage in prostitution. Some of them understand the dangers of unsafe sex but they know it is the only reliable source of income. It is the only way that they can avoid starvation.

Myths and misconceptions

Scholars have cited misinformed beliefs as some of the leading factors that increased the prevalence of HIV among sections of Africa and other developed nations. According to He et al. (2016), there is a widespread belief among various African communities that the only way of being cured of HIV is to have sexual intercourse with a virgin, most preferably a very young girl. As such, fathers, uncles, brothers, and close family friends are turning against young girls who trust them.

They rape these girls believing that doing so will cure them of their condition. It is important to note that the rapist knows well that he has the virus, and in so doing, he transfers it to the victim. The problem is compounded by fear among the victims who fail to report the crime as soon as possible so that they can get medication. Some of them would be subjected to repeated sexual abuse before they can be rescued. Most of them get to the hospital when it is too late to be given the Pre-exposure prophylaxis (PrEP) that can protect them from the virus.

Merci et al. (2017) explain that some women in the region are also embracing the belief that having unprotected sexual intercourse with young boys would help reduce their viral load. They entice these unsuspecting boys and young men with financial benefits.

Traditional practices

Some of the traditional African practices have also been cited as a major cause of HIV transmission. Wife/widow inheritance, a practice where a woman is required to get married to her late husband’s brother or cousin soon after the burial, is common in many African tribes. According to Mahajan et al. (2010), wife inheritance is common among the Luo of Kenya and Uganda, Dinka of South Sudan, various communities in Ghana and Nigeria, and parts of Malawi and South Africa.

The problem is that HIV prevalence in these regions is high, which means that some of these men die of the virus. Their infected women would then transmit the virus to the inheritor, who will then infect his wife. The vicious chain would continue, making it difficult to control the pandemic. Traditional circumcision is another common practice that may expose healthy youths to the virus. When the same knife is used to circumcise several boys or girls, then it is possible that the virus can be transferred from one of the initiates to another.

Social stigma

Social stigma is another major concern, in not only Sub-Saharan Africa but also other parts of the world. Philpott et al. (2004) argue that social stigma makes it difficult for a person to open up about being HIV-positive. There is a general perception that anyone with the virus is sexually immoral. Ponnan et al. (2019) explain that the society in the western world believe that when one has the virus, then he or she can die at any time.

There is also the fear that such a person can spread the virus to healthy people not only through unsafe sex but also through contact. Friends and some family members would shun such people. To avoid being in such a predicament, many people opt to remain silent about their condition. Others even fear being tested because they feel they cannot deal with the situation when they are informed they have the virus. Late diagnosis of the disease makes it difficult to manage the condition. Such an individual would also end up spreading the virus to others during the period when they are unaware that they have the virus.

In some extreme cases, HIV-positive people would deliberately spread the virus to many unsuspecting individuals either as retaliation or as a way of making the condition common to a large number of people to reduce the stigma. Ponnan et al. (2018) believe that such practices are common in institutions of higher learning and in populated slums where rates of absolute poverty are high.

Crime

Cape Town, Durban, and Nelson Mandela Bay are ranked top African metropolitans with the highest rates of crime (An et al., 2002). It is not surprising that they also rank relatively high in reported cases of those who are living with the HIV virus. In Mexico, Acapulco and Tijuana are known for the high prevalence of crime. In these territories, the prevalence of HIV infection is also high. Duwal, Seeler, Dickinson, Khoo, and von Kleist (2019) explains that the problem is that in crime-prone cities, cases of rape and other forms of sexual abuse are common. Sex is the primary way of transmitting the virus from an infected person to a healthy individual.

Drug abuse is also common in these regions. In the United States, the city of Miami in Florida has the highest prevalence of HIV infection (Lee et al., 1998). It is not surprising that the city is also grappling with the problem of drug abuse among teenagers and young adults. Some of the instruments they use to inject some of the drugs can easily spread the virus from one person to another. Boliar et al. (2018) also explain that once one is high on drugs, they can easily engage in irresponsible sexual practices. They can be easily manipulated into sexual practices, which then expose them to infection.

Antiretroviral Therapy

Antiretroviral therapy, commonly known as ARV treatment is the standard approach to managing HIV. The drug helps the body by strengthening the immune system, lowering the viral load, and reducing the risk of an HIV-positive person to transmit the disease to a healthy individual. Fusion inhibitors that block the virus from entering and attaching itself to specific cells within the body are some of the aspects of ART therapy.

CCR5 blockers work by blocking the host cell receptors, which effectively limit the ability of the virus to attach to specific cells (Trifone et al., 2018). The process causes interruption of the life cycle of HIV in the early stages of development. On the other hand, gp120 inhibitors functions by binding to the GP 120 proteins that the virus needs to enable it to attach to healthy cells (Liu et al., 2014). It means that this medication makes it impossible for the virus to attack healthy cells. Finally, gp41 inhibitors block the viral gp41 protein, making it impossible for the virus to fuse with healthy cells (Gutiérrez et al., 2019). The ARV therapy works by systematically creating an environment within the body that limits the ability of the virus to spread to human cells.

When HIV enters the human cell, an enzyme known as a reverse transcriptase would facilitate the copying of the viral RNA into DNA. The viral DNA copy would get integrated into the cell DNA of the host (Moir et al., 2008). Medical researchers have developed various ARV drugs, commonly known as reverse transcriptase inhibitors to block the reverse transcription that would interfere with the process of virus replication.

The non-nucleoside reverse transcriptase inhibitors (NNRTIs), often known as non-nucleosides, binds itself to the HIV enzyme known as a reverse transcriptase that is needed to facilitate the replication of the virus (Nikolova et al., 2016). It effectively blocks the virus from making copies, hence managing the viral load in the body. Nucleoside reverse transcriptase inhibitors (NRTIs) mimic nucleotides, which are the building blocks of the DNA of the virus (Siewe et al., 2014). Once incorporated into the DNA of the virus, they inhibit its growth by blocking the process of reverse transcription.

According to Chevalier and Weiss (2013), integrase inhibitors, which is another common form of ARV therapy, prevents the virus from inserting the genetic material into chromosomes of the host. It is widely used to block the reproduction of the virus within human cells. On the other hand, protease inhibitors limit the ability of HIV to construct protein components that it requires to assemble new viruses. The complex nature of HIV makes it necessary to use a combination of therapies that focus on eliminating the perfect environment that it needs to replicate and spread to various cells within the body. It is important to note that these different forms of medication only focus on inhibiting the duplication of the virus and its free movement from one cell to another.

Biological Basis of Drug Resistance

The ARV regimen is expected to work in different ways to limit the ability of the HIV virus to replicate and spread to other cells within the body, as discussed in the section above. However, medical experts have had to address cases where the patient develops resistance to conventional drugs used in managing the condition. According to Cagigi et al. (2009), drug resistance among HIV patients is primarily caused by the mutation in the genetic structure of the virus.

The change in structure alters enzymes, which help the virus to replicate. The standard medication would not work effectively on the virus once its enzymes are altered. The following are the main ways through which the body of a patient can develop resistance to HIV drugs:

Transmission of drug-resistant HIV

The golden rule in the management of HIV is for the infected person to maintain the intake of the ARVs. In the United States and many other parts of the world, when one is diagnosed with the virus, the standard practice is to put them on drugs. Continued intake of the drug over the years may result in instances where the virus develops resistance to some of the common drugs used in managing the condition.

If one is infected in any other way with a mutated virus from an HIV-positive person, the drug-resistant variant virus would be transmitted. The mutated strain of the virus cannot be managed using one or more conventionally used HIV regimens. Such patients would require highly active antiretroviral therapy (HAART) to help them manage their condition. It is estimated that about 5 to 20 percent of new infections in the United States involve the mutated HIV strain that is resistant to one or more HIV medication (Apostolova et al., 2015). The problem is more severe in Sub-Saharan desert, especially in South Africa where a large number of adults aged below 45 years are actively using ARV to manage their condition.

It is unfortunate that exact data about the number of those who are infected with drug-resistant HIV in these countries is not easily available because of limited research. However, Conway, Konrad, and Coombs (2013) believe that a significant number of those who are newly infected with the virus in these countries have a greater risk of acquiring drug-resistant HIV.

While using pre-exposure prophylaxis (PrEP)

The pre-exposure prophylaxis is a common drug used around the world by people who are HIV-negative but are at risk of being infected with the virus (Dellar, Dlamini, & Karim, 2015). One occupation may be a risk factor that makes it necessary to use the drug. Commercial sex workers and nurses who offer care to HIV-positive patients are at great risk of being infected with the virus.

In a discordant couple, the HIV-negative partner would risk being infected if they continue to have unprotected sex without proper measures being taken to lower the viral load and minimize the ability of the patient to transmit the virus. In the United States, the U.S. Food and Drug Administration approved Truvada as an appropriate PrEP for those who are at risk of being infected. As shown in figure 1 below, this drug forms a protective layer around T-cells, making it impossible for the HIV virus to penetrate. The virus would die after a short while if it is unable to penetrate the cell.

The protective layer can only be strong enough to prevent the entry of the virus if the patient adheres to the daily medication irrespective of whether they will be exposed to the virus or not. Duwal, Dickinson, Khoo, and von Kleist (2019) explain that the problem arises when some people fail to take PrEP as scheduled, only to resume a few days to the day they plan to engage in unprotected sex. In such instances, the strength of the protecting layer may be compromised, making it possible for the virus to penetrate the cell.

Such a patient would not realize that they are infected. When a patient continues to use PrEP when they are already infected, it causes resistance to HIV drugs, which use a similar approach to the PrEP to manage the condition. Duwal et al. (2018) argue that it is prudent for individuals who decide to use this form of protection to adhere to the instructions given to them to avoid cases of resistance. When one is aware that they were exposed to the virus, it is recommended that they should go for a medical check-up after three months just to ensure that they were not infected.

Factors That Affect the Effectiveness of HIV Regimen

The primary aim of ARV therapy is to lower the viral load within the body by inhibiting its reproduction and mutation (Dickinson et al., 2016). The regime also helps in delaying or preventing the mutation of the virus, making it easy to use conventional drugs to manage the condition. Unfortunately, there are cases where the medication fails to work as would be expected. The patient would be exposed to the adverse effect of HIV, which includes the progression to AIDS and the risk of death from various opportunistic diseases. The following are some of the factors that often affect the effectiveness of HIV drug medication:

Poor treatment adherence

When one is diagnosed with the HIV virus, one of the first steps that are often taken is to determine its type and the CD4 count. It helps in determining the type of medication that a patient should receive. When one is put on antiretroviral therapy, the primary goal is to inhibit the replication of the virus and the destruction of the white blood cells. The drug strengthens the immune system and ensures that the viral load is maintained at the lowest level possible. Skipping the ARV treatment allows the HIV virus to multiply within a short time. The virus will have the opportunity to destroy the immune system within the period when the patient fails to take the medication.

A weak immune system cannot effectively fight the virus, various other opportunistic diseases, and certain types of cancer (Duwal et al., 2016). Scientific research has also proven that poor adherence to HIV treatment increases the risk of drug resistance. The period within which the patient fails to take the medicine allows the virus to mutate in a way that makes it possible to fight ARV treatment. It means that when the patient resumes normal medication, the treatment may not work. The immune system will be too weak to fight the virus. The structure of the virus shall have changed in a way that makes it difficult to respond to the drug.

Poor absorption

The effectiveness of HIV drugs depends on the ability of the body to absorb it. Duwal and von Kleist (2016) explain that various factors may affect the process of absorption. Some people experience vomiting and diarrhea during the initial stages of taking the medication, which causes the drug to be expelled from the body before its absorption (Fletcher et al., 2014). Many patients are often not aware of what they need to do in case of intense vomiting and diarrhea. Excessive intake of alcohol may also impede the ability of the body to absorb the medication. Sometimes the body system may fail to absorb the medication because of genetic factors.

In such cases, the amount of HIV regimens in the body would be too low to fight the virus and manage its replication. Instead of having a positive effect suppressing the viral load, the medication will encourage drug resistance accumulation. If the problem of poor absorption is not addressed within a short period, the virus will mutate and that type of treatment will not work in future treatments. Grant et al. (2014) state that sometimes it is appropriate to take the medication with some supplement when it is established that the body is not absorbing the regimen as expected.

Varying pharmacokinetics

Once the drug has been absorbed into the system, it should be distributed, broken down, and removed from the body in the right quantity and at the right intervals. In some cases, the interaction between drugs may pose a serious challenge to a given patient. For instance, when NRTI is used alongside protease inhibitor Reyataz, Boliar et al. (2018) explain it is possible to have a case where that blood levels of Reyataz falls to very low levels, which may pose a serious challenge to the patient. Such a patient would require protease inhibitor Norvir to help in boosting the level of Reyataz in the bloodstream (Duwal et al., 2016). When the doctor fails to understand how to combine the right medication for the patient based on various factors discussed above, the drug may fail to function as expected.

Existence of different variants of the virus

Continuous use of antiretroviral drugs has also proven to contribute to cases of drug resistance among HIV patients. Restrepo et al. (2019) observe that a patient who adheres to the prescription of the ART can lead a normal life for several decades. However, the challenge that these patients face is that when they use a specific drug for a prolonged period, the virus would develop resistance towards it. It reaches a time when a given HIV regimen fails to manage the condition of the patient. In such a case, it becomes necessary to change the drug being used. It is necessary to ensure that the CD4 count of the patient is monitored closely to ensure that the medication is having the right impact. A consistent of a drastic drop in the CD4 count may indicate that the current drug is no longer having the right impact on the patient.

Managing Drug Resistance

The patient and the medical staff have the responsibility of managing the unique condition of a drug-resistant drug. It is necessary to look at two perspectives of managing the condition. On the one hand, it is necessary for those who are yet to have the drug-resistant variant to know how to manage their condition. On the other hand, those who have the variant resistant to medication should also know how to deal with the problem, as discussed below

How to avoid drug resistance

When one has an HIV variant that is resistant to drugs, their condition may become delicate. As such, it is important to take the necessary steps to avoid such a condition. Managing the condition requires a concerted effort by both the medical staff and the patient. One of the factors that an individual can take to avoid such a condition is to refrain from the misuse of PrEP (Duwal et al., 2016).

People who work or stay in environments where they are constantly exposed to the threat of being infected with the virus should know when and how to administer the drug. They should strictly adhere to the instructions given to them to ensure that they can realize the intended goals. Boliar et al. (2018) explain that responsible use of PrEP would require the relevant government department to promote awareness about the condition and effective ways of managing it.

Myths and misconceptions should be addressed in such campaigns to ensure that people are effectively empowered. Ponnan et al. (2019) argue that the use of PrEP should not be an excuse for an individual to engage in irresponsible and unprotected sexual practices with people known to have the virus. The society should also be reminded that HIV-positive individual risks being re-infected with other drug-resistant variants, which would complicate the treatment process. Some vengeful people often tend to engage in unprotected sex with other people as a way of spreading the virus, not knowing that they are exposing themselves to greater risks in the process.

When managing this medical condition, the HIV patient is encouraged to maintain a healthy lifestyle. They should engage in regular exercise, have a balanced diet, and avoid other viral and bacterial infections. A study by Restrepo et al. (2019) indicates that leading a healthy lifestyle is one of the best ways of managing the viral load in the body as low as possible. The CD4+ count will be at an optimal level and such an individual would lead a normal life. The benefit of effective management of HIV is that the virus will not mutate within a short period. It means that the same medication can be used for several years without having to change because of possible changes in the protein structure of the virus.

Understanding the HIV variant that one suffers from and administering the right medication is another important way of avoiding resistance. In some of the developing countries in Sub-Saharan Africa where the condition is prevalent, some non-governmental organizations are hiring semi-skilled individuals to help in administering drugs. Some of them are taken for 4-10 months of training before being posted to their workstations.

They do not understand how to determine the right medication for a patient based on the variant of the virus. They can make diagnostic mistakes or errors when dispensing drugs. The problem in these regions is that patients are either illiterate or semi-illiterate (Fletcher et al., 2014). As such, they would take the medication given to them without question. When the patient continues to get the wrong medication over a given period, the virus can develop resistance to drugs. Their health condition would continue to deteriorate even when they continue with their medication.

Dealing with drug resistance

When it has been established that an individual has an HIV variant that is resistant to drugs, it is appropriate to find ways of addressing the problem. According to Ponnan et al. (2019), one of the first steps that should be taken by the medical staff when the condition of the patient is not improving despite taking the medication is to conduct phenotypic and genotypic tests. These tests would help in determining the variant of the virus that is resistant to drugs.

Administration of highly active antiretroviral therapy is often recommended when addressing such a condition. When a given form of medication has proven effective, Restrepo et al. (2019) emphasize the need for the patient to adhere to the prescription to avoid further complications. They should be reminded of their delicate condition and the need for them to remain responsible for managing their condition. A healthy lifestyle is equally important for a person managing a condition where the virus is resistant to drugs.

Conclusion

Recent studies show that over 36 million people are suffering from the HIV virus around the world. One of the biggest challenges associated with this pandemic is that the virus can be transferred easily from one person to another through sex or the sharing of objects such as a syringe. Effective management of the condition minimizes the ability of an infected individual to transfer the virus to a healthy person. Antiretroviral treatment is often used to help in managing the condition.

The current concern that medical experts and stakeholders in the healthcare sector have to address is the emergence of an HIV variant that is resistant to commonly used ARV. Studies show that one can be infected with the drug-resistant drug. Continued use of the drug may also cause resistance within the body of an infected person. Irresponsible use of PrEP was identified as another factor that can cause resistance to some of the common HIV medications.

Social awareness is one of the best ways of dealing with the problem. People should be aware of the dangers associated with being infected with both HIV-1 and HIV-2. They should also understand the dangers of misusing PrEP when engaging in irresponsible sexual practices. When it is established that a given patient has developed resistance to some of the common HIV therapies, it may be appropriate to administer highly active antiretroviral therapy (HAART). Most importantly, it is necessary to find a lasting solution to this pandemic. Medical researchers should remain committed to finding a cure for this condition.

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