Category: AIDS

Description of the Community

The HIV/AIDS epidemic was first identified in Kenya in the early 1980s among commercial social worker population (US Census Bureau 2). Since then, the epidemic has spread to other parts of Kenya, including remote, marginalized areas. The Kenyan government had declared AIDS a national disaster in the year 1999. It is noteworthy that HIV/AIDS control and campaign programs have been relatively successful because of declines in prevalence rates have been noted across the country in both low and high-risk individuals, as well as in urban and remote parts of the country. In addition, population-targeted HIV testing has also shown the decline in the rates of new infections among the public (US Census Bureau 2).

Latest data provided by the Population Reference Bureau & UNAIDS (United Nations Program on HIV/AIDS) in 2012 have noted that 1.6 million Kenyans are living with HIV/AIDS. Kenya currently has 44 million people in which 820,000 women aged 15 years old and over have tested HIV/AIDS positive while nearly 200,000 children live with HIV/AIDS based on figures obtained in the year 2012. The HIV/AIDS prevalence rate in the country is 6.1 percent while deaths related to HIV/AIDS were 57,000 in the year 2012 (Regents of the University of California 1).

Although marginal declines in the prevalence rate have been noted over the years, further studies have revealed that new, increased cases of infections have been identified among married couples who were initially not targeted in the health promotion campaigns. This, in turn, affects progresses made and could explain why the prevalence rate has remained the same (6%) since the year 2008 to 2012.

A summary of the mini-needs assessment conducted to determine a priority HIV/AIDS in Kenya

Studies have established that married couples and other people in more stable relationships have contributed to the highest number (more than 44%) of new HIV/AIDS infection in Kenya (Omanje, Bosire and Mwenda 73). Nevertheless, the UNAIDS report of 2010 had demonstrated that a decline in the rate of new HIV infections in the last decade was generally attributed to behavior changes, changes in social norms and enhanced knowledge on HIV/AIDS.

It is estimated that for every ten couple, a partner is most likely to be living with HIV/AIDS. In these marriages and relationships, some couples are not infected. Nevertheless, knowledge of HIV/AIDS among couples in relationships has been a significant source of concern. In addition, most of these couples have multiple sexual partners in marriage. While some couples are aware of their partners HIV status, not all couples have this knowledge (Omanje et al. 73). Moreover, a consistent use of condom is not common among married couples whose status remain unknown to their partners. Thus, most HIV transmission cases among married couples and those in stable, long-term relationships have resulted from ignorance of partners or self HIV/AIDS status (Omanje et al. 73).

Discordant, married or cohabitating couples remain at significantly higher risk for new HIV infections in the country. Moreover, couples who are in acute phase of new infection are also critical source of risk for subsequent spread of the virus to their partners within or outside marriage (Omanje et al. 73).

Therefore, without appropriate interventions, a large percentage of HIV infected individuals will infect their partners with HIV.

Until recently, the current prevention efforts have largely failed to account for couples (married, discordant or coexisting). Rather, most prevention strategies and campaigns have focused on casual relationships and youth. Thus, lack of knowledge has been a factor contributing to new HIV infections among couples in stable, long-term relationships. In this case, one can observe that lack of knowledge also implies a lack of awareness about risks of contracting the virus in such relationships. In addition, failure to use condom or low usages could be responsible for the widespread HIV/AIDS and other sexually transmitted diseases among population at risk.

A description of the primary socio-ecological factors related to HIV/AIDs in Kenya

Several major socio-ecological factors have been attributed to HIV/AIDS in Kenya. First, individual factors such as multiple sexual partners are responsible for several cases of new infections. These factors are influenced by community practices, beliefs and policies among others (University of Ottawa and Ontario Ministry of Health 1). Second, societal factors, including systemic discrimination and stigma affect the spread of the disease. People living with HIV/AIDS may fail to pursue interventions because of stigma. Third, socioeconomic and political factors show that HIV/AIDS is now common among marginalized, poor sections of Kenya.

Inequalities and gender influence risks of contracting HIV/AIDS. Fourth, cultural practices in Kenya could also be responsible for the spread of HIV. Practices such as wife inheritance and attributing HIV/AIDS to curse or witchcraft have affected any intervention efforts in such communities. Fifth, gender factors also influence the spread of HIV. In Kenya, for instance, it has been noted that women are more vulnerable to infections relative to men. In addition, coercive sexual practices and violence against women have exposed many women to HIV/AIDS. Sixth, generally, Kenya lacks robust healthcare infrastructures to cater for many people living with HIV/AIDS or implementing any effective health promotion programs. HIV/AIDS can only be controlled when healthcare infrastructures are working effectively.

Finally, government policies also influence HIV/AIDS outcomes. For instance, countries that have recorded success in fighting HIV/AIDS have favorable political environments and well-formulated policies. Policies should ensure that all stakeholders, including patients, political leaders, religious leaders, not-for-profit organizations and civil societies take active role in the fight against HIV/AIDS.

Types of resources and community stakeholders

Resources required for the target population, specifically married and cohabitating couples. They should aim to provide information on risks associated with HIV/AIDS in marriage or long-term relationships. Mass and local media should be used to offer consistent messages about HIV/AIDS and are the best channels for most Kenyans in rural areas.

Posters, leaflets, public announcements, printed articles and messages on radio and televisions have proved to be effective in Kenya. In addition, interpersonal communication conducted by leaders, physicians and other individuals of authority should reinforce the message.

All messages must be accurate, fact based, easy to comprehend and consistent among the target population.

HIV/AIDS programs in Kenya involve a wide range of diverse stakeholders, including people living with HIV/AIDS, policymakers, cultural leaders, religious leaders, civil societies, funders, regulatory agencies, care providers and international partners. In Kenya, only prominent stakeholders such as Ministry of Health, Kenya; National AIDS Control Council, Kenya; National AIDS/STD Control Program, Kenya; not-for-profit making organizations; and international organizations are recognized as useful. Thus, other stakeholders largely remain unaccounted for during stakeholder identification.

These stakeholders should participate in all processes involving HIV/AIDS intervention programs, including program implementation and outcomes. This approach normally enhances the relationship among stakeholders, evaluates their levels of engagement and focuses on HIV/AIDS concerns in a community.

A description of the stakeholder collaboration strategy and its appropriateness

A stakeholder collaboration strategy for the health promotion should be shared ownership for community health. Generally, as identified above, there are diverse stakeholders with different expectations from health promotion campaigns. It should be asserted that public health should be a priority for every member of the community, and not just healthcare providers or governments. A consultation process would bring together all representatives of all stakeholders in HIV/AIDS issues. It is expected that stakeholders would have divergent views but would share common concerns about HIV/AIDS infection in Kenya (Desclaux, Kouanda and Obermeyer S79).

Through consultation processes rooted in shared ownership for community health, all stakeholders would ensure that they create population health capacity over time. For instance, experts would provide knowledge for best practices on HIV/AIDS control and management. The process will ensure that stakeholders with diverse views develop a shared agenda, evaluation metrics, structured procedures and jointly funded health promotional campaigns to achieve one goal of reducing rates of new infections (Barnett 1).

Stakeholders must be represented across all phases of the HIV/AIDS programs. However, it is observed that not all stakeholders can play similar roles in the process. Therefore, experts in various fields may take multiple roles based on their professional skills in HIV/AIDS management in Kenya and other parts of the world. All members involved in the implementation of the campaign must address any issues that may hinder progress through effective consultation and collaboration processes.

Program goal and objective

Health promotion goal is to use comprehensive strategies to create awareness about new increasing rates of HIV infections among married, cohabitating couples and other people in long-term sexual relationships in Kenya. Thus, the promotion will engage married, cohabitating and discordant couples and the public across various continua of stages to ensure acquisition of knowledge and behavior change about HIV/AIDS spread among identified population at risk. This would strive at reducing the rates of new infections among sexual partners. It would also be imperative to collaborate with various stakeholders, including local, national and international agencies to identify and obtain external resources that could assist in HIV/AIDS health promotion campaigns.

The objective of the promotion on HIV/AIDS is to inform, educate and empower married, cohabitating and discordant couples and the public about new cases of infection among the target population. Thus, it is expected that by the end of the health promotion, at least 80 percent of the couples will have acquired knowledge on HIV/AIDS transmission among couples and demonstrate behavior change through changes in sexual behavior practices, use of condom and knowing partners HIV status among others. The target population may be contacted within three months to determine outcomes of the health promotion.

The theory used to guide development of the intervention

The Theory of Planned Behavior (TPB) has been effective for interventions (Foy et al. 207) because of the following reasons. TPB predicts behaviors with regard to factors considered for change such as belief systems, sexual behavior practices and potential external difficulties. TPB has been evaluated and found to be effective in various settings, and it recognizes that violations may occur because people to do not have absolute control over their actions (Foy et al. 207).Based on TPB, attitudes toward behavior is imperative, and a persons view could be a subjective norm while perceived social pressure or views of others and alleged behavioral factors that include belief systems and self-efficacy (confidence in performing and achieving a given goal) and a wide range of environmental factors have profound effects on promoting or inhibiting performance. The theory also focuses on attitudes that show perceived outcomes and emotional attitudes. That is, TPB considers whether couples will benefit, be harmed after disclosing their status or healthcare professionals would feel discomfort while evaluating the disclosed behaviors. Thus, the theory will make it possible to predict changes related to sexual practices and acquisition of knowledge about HIV infections in marriage and long-term sexual relationships.

An appropriate intervention strategy that targets one of the socio-ecological factors associated with HIV/AIDS condition and target population

Behavioral intervention would be adopted in health promotion campaigns to change behaviors and sexual practices of married and cohabitating couples. It is imperative to recognize that most of these couples are now more informed about HIV/AIDS with the exception of few couples in marginalized, remote areas of the country. Education and behavioral skills to reduce exposure risk for infection and a focus on individual factors that hinder change would be appropriate intervention for Kenyan married couples.

Behavioral interventions accompanied by counseling and testing would be effective for many married couples who are at high risks of contracting HIV.

Specific Program Activity

Behavioral change will focus on couples HIV counseling and testing so that couples can know HIV status of their partners and change their sexual practices. Couples HIV counseling and testing would be effective because studies have shown that knowledge of HIV/AIDS alone does not necessarily lead to behavior change (Kanekar 10).

Couples HIV counseling and testing activity in this population at risk will aim at enhancing benefits of engaging in safe sex among couples. They must however undergo counseling and testing to change poor behaviors and reinforce their knowledge. Health promotion must ensure that counselors understand the relevance of interpersonal skills when engaging participants. In addition, they must demonstrate other practices such as constant use of male condoms during sexual intercourse. Counselors should also stress the risk of pleasure seeking by engaging in sexual intercourse with multiple partners outside marriage or stable relationships.

Counseling and testing for couples should also address individual factors related to unsafe sex such as low knowledge or poor perception of risks, abuse and inequalities in marriages and relationships.

It is believed that couple counseling will enhance risk perception through social interactions in which couples are encouraged to engage in meaningful conversation related to HIV/AIDS risks. This is most likely to lead to behavior change by ensuring regular and correct use of condoms and remaining faithful to only one partner.

A Logic Model for the Health Promotion Program for Couples

Works Cited

Barnett, Kevin. Best Practices for Community Health Needs Assessment and Implementation Strategy Development: A Review of Scientific Methods, Current Practices, and Future Potential. 2012. Web.

Desclaux, Alice, Seni Kouanda and Carla Makhlouf Obermeyer. Stakeholders participation in operational research on HIV care: insights from Burkina Faso. AIDS 24 (2010): S79S85. Print.

Foy, Robbie, Jillian Francis J, Marie Johnston, Martin Eccles, Jan Lecouturier, Claire Bamford and Jeremy Grimshaw. The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia. BMC Health Services Research 7 (2007): 207. Print.

Kanekar, Amar Shireesh. HIV/AIDS Counseling Skills and Strategies: Can Testing and Counseling Curb the Epidemic? International Journal of Preventive Medicine 2.1 (2011): 1014. Print.

Omanje, Thadeus S, Sheillah Bosire and Samwel Mwenda. Knowledge and Perceptions of HIV/AIDS among Married Couples in Kenya. Public Health Research 5.3 (2015): 73-78. Print.

Regents of the University of California. HIV/AIDS in Kenya. 2014. Web.

University of Ottawa and Ontario Ministry of Health. Socio-ecological assessment: HIV/AIDS in Kenya project. 2009. Web.

US Census Bureau. HIV/AIDS Profile: Kenya. 2008. Web.

Breakthrough of the Year: HIV Treatment as Prevention

Until 2011, the prevention of HIV/AIDS transmission using anti-retroviral drugs (ARVs) was considered to be a myth. Government and health organizations, including the WHO, stresses that the use of barrier contraception methods, such as condoms, was the essential component in preventing HIV transmission. The main reason for such misconception was that there were no conclusive and reliable studies showing the effectiveness of ARVs in preventing HIV transmission. However, in 2011, researchers presented results of a clinical trial that confirmed the 96% reduction in transmission following the use of ART. Thus, the research became the breakthrough of the year as it shifted the previous misconceptions about HIV/AIDS prevention by proving the effectiveness of ARVs in reducing transmission.

Consequently, the breakthrough also affected the global fight against AIDS in at least two aspects. First of all, it offered sound evidence for the use of ARVs in HIV/AIDS prevention. Reducing the rates of HIV transmission on a global level, in turn, could lead to the reduction of HIV/AIDS prevalence, thus helping to eliminate AIDS. Secondly, the discovery helped to reduce the stigmatization of HIV and AIDS in society by showing that transmission can be controlled with adequate treatment. The reduced stigma associated with HIV and AIDS can help to improve testing rates among the general population, thus contributing to the effect of prevention and treatment efforts.

The WHO guidelines on the use of ARVs have changed since the breakthrough in response to the evidence in favor of the earlier initiation of ART. Until 2011, the guidelines stipulated that the start of therapy should be based on CD4 cell count and the clinical stage; today, however, the WHO recommends ART for all HIV-positive adults, regardless of their clinical stage and CD4 cell count. The change in recommendations was largely due to the proven effectiveness of ART in reducing transmission rates among homosexual and heterosexual couples.

The Definition of the Health Fraud

• Health fraud is a product that is described and advertised as preventing and treating different diseases and health conditions.
• However, the safety and effectiveness of these products are unproven by the Food and Drug Administration and by any medical association.
• Many health fraud scams are designed only to gain profits, and the use of the intentionally advertised products can lead to unexpected negative outcomes such as serious disease consequences and the problems with stating the right diagnosis.

Health Fraud and Quackery

• The form and the result of using health fraud scams is the quackery as a process of treating the disease and different health conditions with the focus on unproven remedies and strategies.
• Bloodletting and breast enhancement with the help of popularly advertised simulators are the famous examples of the quackery.
• Thus, different types of sexual enhancement products are the quackeries in their nature.

The Characteristic Features of Health Frauds

Health frauds are designed to draw the customers attention and to stimulate their buying behavior. To determine health frauds among the other advertisements, it is necessary to pay attention to such features as:

• The absence of the producer or providers contact information.
• Advertisements are presented as real cases and histories of real persons who used the products to improve their health.
• Advertised products are expected to treat a wide range of symptoms.
• The use of vague language, attention grabbers (innovation, exclusive, secret, natural), and jargon.

HIV/AIDS Fraud

The main goal of the HIV/AIDS fraud providers is to receive the profit and to convince the buyer.

Thus, only approved drugs can be used in the therapies proposed by physicians, and these drugs are widely known and discussed by

• HIV/AIDS frauds are professionals. developed to persuade the public that the medicine for the disease exists, and even though it is limited, it is available only for the customers of the concrete producer.
• The immediate recovery mentioned in scams is impossible in the case of HIV/AIDS.
• The use of personal stories and references to the tests and surveys conducted in countries is health fraud.
• The cure is not foreign developed yet. People can typically for relying only on supportive therapies.

Sexual Enhancement Scams

• Sexual Enhancement Scams developed to enhance the breast or penis size do not work, as it is stated by sex therapists and other physicians.
• Health fraud producers manipulate peoples emotions and fears to receive revenue.
• Any statement about the quick and observable breast or penis enhancement is not and cannot be supported with the facts.
• Size enhancers for men can work only as erection enhancers if any effect is observable.
• Moreover, different proposed dietary supplements and devices can be harmful to peoples health.

The use of drugs sold without prescription can be dangerous for peoples health.

The Preventive Measures

To avoid contributing to the multi-million industry of creating health frauds, it is necessary to:

• Contact a physician or a pharmacist to receive a professional commentary on the product.
• Search the information available about the product while referring to the United States medical associations.
• Check the information about the product with references to the Food and Drug Administration.

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 peoples 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 programs 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.

Introduction

The prevalence rates of HIV/AIDS vary from on ethnic group to another in the United States. The epidemiology of this global menace has evolved with time since it started by affecting the white people and is now affecting the black people. Epidemiological data indicates that in the modern society, black people have high prevalence rates of HIV/AIDS.

One of the many ethnic groups experiencing worst cases of this disease is the African Americans because they have high prevalence rates when compared to other ethnic groups. For example, this disease is more prevalent among African Americans than among Asian Americans and Hispanic Americans.

Stone, Ojikutu, Rawlings, and Smith (2009) record that within a period of 20 years, viz.1985  2005, the rate of infection of HIV/AIDS doubled from 25 per cent to 50 per cent among African Americans.

This change means that more African Americans are contracting the disease, living with it, or are under treatment than ever before. Additionally, statistics indicate that HIV/AIDS infections have gender orientation, as rates of infections are higher among women than among men (National Alliance of State & Territorial AIDS Directors, 2008).

Overall, a number of reasons might explain this scenario; for instance, drug abuse, sexual behaviors, and socioeconomic factors. The American government has come up with a number of programs to combat this problem. Therefore, this paper explores the potential causes of the disparity in HIV/AIDS and examines the efficacy of the programs that have been established to help in combating this menace.

Overview of HIV/AIDS in the US

Beyond 1980s, the white people had a higher number of people living with HIV/AIDS when compared to the blacks. Drug abusers and homosexuals defined the group of people among the whites who had a high prevalence of the disease. However, as cases of HIV/AIDS infections increased among the Americans, Africans Americans started to experience higher rates of infections than other ethnicities.

Between 1985 and 2005, the infection rates doubled among African Americans from about 25 per cent to approximately 50 per cent (Stone, Ojikutu, Rawlings, & Smith, 2009). In 1985, the population of African Americans formed about 12 per cent and during 2005, their population comprised 13 per cent.

The increase in population by 1 per cent does not justify the doubling of the disease cases. The increase was quite shocking because infection rates among other ethnic groups remained considerably low. Currently, the cases of infections among African Americans are still increasing exponentially. The disproportionate impact of the disease on the Americans indicates that many factors, which mediate infection, exist among varied ethnicities and communities.

In the United States, the population of people living with the disease has been increasing exponential in the last three decades. The people at risk of getting HIV/AIDS infections belong to the ages of 13 and 34 years because they are sexually active. Stone, Ojikutu, Rawlings, and Smith (2009) indicate, At the end of 2008, 322, 796 persons were living with AIDS, nearly twice the number of those at the end of 1994 (p. 2).

The exponential increase of the people living with the disease occurs due to change of lifestyles in the society coupled with other factors related to sexual behaviors. The government thus supported the introduction of treatment regimes and increased the number of prevention strategies.

Although the treatment regimes and prevention strategies enabled stemming of HIV/AIDS amongst the whites, cases of the infections continued to increase among African Americans. As the cases of the disease continued to increase unabated among African Americans, the government and health care system had to revise their preventive strategies to help in combating the epidemic. From 1980s, it gradually became evident that African Americans had numerous predisposing factors that cause high rates of infections.

Surveillance studies indicate that HIV/AIDS infections have both geographical and gender orientations. Stone, Ojikutu, Rawlings, and Smith (2009) note that surveillance data provided an interesting epidemiological aspect of HIV/AIDS epidemic, viz. It was concentrated in specific geographical areas: the Northeast, the South, the Mid-Atlantic and the West coast (p.3).

The geographical aspect of the disease distribution indicates that there are social, economic, and cultural factors that contribute to the dominance of the disease in one region than other regions.

Moreover, the occurrence of HIV/AIDS among African Americans has gender orientation. African American women have higher cases of infections than their men counterparts do. African American women comprise only 12 per cent of the female population in the United States, yet they accounted for 64 per cent of women living with HIV/AIDS at the end of 2006 (National Alliance of State & Territorial AIDS Directors, 2008, p. 1).

This observation means that gender-based factors predispose African American women to the disease. In this view, the presence of many predisposing factors to the disease is responsible for the disproportionate distribution of HIV/AIDS cases amongst American ethnic groups.

Potential Causes

Drug Abuse

The prevalence of HIV/AIDS infections among African Americans is higher when compared to the general population of the United States because they form a significant population of drug abusers. Given that African Americans have low socioeconomic status, they tend to abuse drugs as a way of dealing with stress and other life challenges.

Laurencin, Christensen, and Taylor (2008) posit, Illicit drug use is an important primary risk factor for HIV/AIDS infection among African Americans, which is also noted as the second leading cause of HIV infection for both black men and black women (p.38). Drug abuse predisposes African Americans to the disease because they share needles that they use when injecting drugs into their bodies.

Since drugs that people abuse are illegal, they abuse them in secret places where they cannot access extra needles in the event that they attempt to avoid sharing. Lack of extra needles and the addictive nature of the drugs compel the drugs users to share needles, thus predisposing them to the disease. Hence, if one of the drug users has HIV/AIDS, the entire group of drug users would contract it.

Moreover, drug abuse predisposes African Americans to unprotected sexual intercourse because drugs influence ones rational judgment. Usually, sober individuals are unlikely to participate in unprotected sexual activities because they still have the rational capacity of protecting themselves during sexual intercourse.

In contrast, drug users are unable to protect themselves either during consented sexual intercourse or from rape. When a drug user is under intoxication, the chance that he/she can consent to perform sexual intercourse with protection is minimal. Hence, most sexual intercourse activities that occur among intoxicated drug users are unprotected.

McCree, Jones, and OLeary (2010) assert that drug abuse is responsible for high cases of HIV/AIDS among drug users because they are vulnerable to sexual abuses. Drugs users are vulnerable to abuses such as rape, sodomy, and gang rape because they do not have the capacity to protect themselves from such abuses. Eventually, victims contract the disease and continue to transmit to other people whom they abuse drugs together.

Drug abuse also influences adherence to antiretroviral medication and other related medications. When infected people abuse drugs, they forget to take their medication, thus increasing viral load in their bodies.

Increased viral load increases the chances of HIV/AIDS transmission during unprotected sexual intercourse. A study of female cocaine users, predominantly African American women, showed that substance users were less likely than nonusers to take their antiretroviral therapies exactly as prescribed (Laurencin, Christensen, & Taylor, 2008, p. 38).

Thus, drug abuse among African Americans contributes to poor adherence to prescribed medication and increases transmission of HIV/AIDS within population. Additionally, some illegal drugs impede efficacy of antiretroviral drugs for the normal dose of medication does not have the intended impact on the viral load. Reduced efficacy of the antiretroviral drugs implies that the medication does not help in management of the disease. Therefore, among drug abusers, antiretroviral drugs are not significantly helpful.

Sexual Behaviors

The nature and type of sexual behaviors that Africa Americans practice put them at risk of contracting HIV/AIDS. Significant cases of infections occur through heterosexual contacts. African Americans nurture the social behavior of trusting each other while mistrusting other ethnic groups.

The National Alliance of State and Territorial AIDS Directors (2008) posit, African American women are less likely than other women to date men outside their racial/ethnic group (p.1). Essentially, African American women tend to have sexual intercourse with African American men, thus restricting transmission of HIV/AIDS within their ethnic circle. Hence, heterosexual contact within the community explains why African Americans have a high prevalence of the disease when compared to other ethnic groups.

Lower marriage rates among African Americans contribute to the increase in the cases of HIV/AIDS transmission. Owing to low rates of marriage, African Americans prefer having multiple sexual partners. Given that most young people are single, they indulge in heterosexual intercourse with many partners, thus increasing the rate of transmission of HIV/AIDS. Moreover, sex-ratio imbalance has given men the advantage of having many sexual partners because women seem to be desperate in competing for the few available men.

The sex-ratio imbalance in African American communities can give rise to womens difficulties in discussing and negotiating condom use with male sexual partners (National Alliance of State & Territorial AIDS Directors, 2008, p. 4). Thus, African American women succumb to demands of their partners, hence increasing their vulnerability to the disease. Ultimately, since men have multiple sexual partners, they increase the rate of transmission of HIV/AIDS among African Americans.

Homosexual behaviors among African American men also contribute to the disproportionate occurrence of the disease. Among African American men, male-to-male sexual contact is responsible for the occurrence of high incidences of HIV/AIDS. Studies have shown that homosexuals have increased in the past decade due to recognition of their rights in the society. Hence, homosexuals have contributed to the increase in the prevalent rates of the disease among African Americans.

According to Laurencin, Christensen, and Taylor (2008), survey conducted across the United States indicated that clubs, cafes, bars, parks, gyms, gay pride events, and social organizations are places where homosexuals interact and propagate their sexual activities. Since most African American men are dominant in such places, they are vulnerable to HIV/AIDs because they interact with people from various backgrounds.

Sexually transmitted diseases predispose people to HIV/AIDS. The disproportionate occurrence of the disease among African Americans is due to the high incidences of sexually transmitted diseases. In 2005, African Americans were 18 times as likely as whites to have gonorrhea and approximately five times as likely to have syphilis (Laurencin, Christensen, & Taylor, 2008, p. 38).

Gonorrhea cases formed about 58 per cent of the total cases while cases of syphilis comprised 41 per cent. Sexually transmitted diseases such as gonorrhea cause inflammation on genital areas and increases susceptibility to the disease.

Susceptibility to HIV/AIDS increases because white blood cells concentrate on an inflamed genital tract thus causing the viral load to increase (Friedman, Cooper, & Osborne, 2009). Syphilis is an ulcerative sexually transmitted disease, which enhances entry of viruses through mucosal ulcerations. Therefore, high prevalence of sexually transmitted diseases among African Americans has contributed to the disproportionate occurrence of the disease.

Socio-economic status

Socio-economic status is a factor that determines the susceptibility of people to HIV/AIDS. The low socio-economic status amongst African Americans has contributed to high incidences of the disease. Women under low socioeconomic status are prone to sexual abuse because they are unable to defend themselves.

Therefore, they become subjects of sexual abuse, thus predisposed to HIV/AIDS. Friedman, Cooper, and Osborne (2009, p.1003) argue, Infections are not simple product of behavior alone, but a complex of social and economic factors that affect the lives of African Americans. Hence, differences in socio-economic status between the whites and blacks have contributed to the high incidences of the disease among African Americans.

Additionally, low socio-economic status determines access to healthcare, and thus relates to the incidences of HIV/AIDS cases among the African Americans. Limited access to high-quality healthcare, housing, and HIV/AIDS prevention and education programs both directly and indirectly increase the risk factors for HIV infection (Laurencin, Christensen, & Taylor, 2008, p. 38).

In the year 2000, approximately 25 per cent of African Americans lived in poverty, which means that they could not access essential healthcare services. Historically, African Americans faced social and economic marginalization, which increased their vulnerability to drug abuse, homelessness, incarceration, and risky sexual behaviors. Hence, poverty and social alienation prevent African Americans from accessing critical healthcare services, which translates to increased HIV/AIDS prevalence.

Government Programs

Community mobilization to increase awareness about HIV/AIDS is one of the strategies that the United States has applied in reversing trends of the epidemic among African Americans. Issues to deal with increased awareness of the disease and its associated risk factors such as drugs and sexual behaviors have significantly reduced the rate of infections among African Americans and the general population. Mobilization of communities to enhance awareness of the disease has changed perceptions and norms about the disease.

Through awareness, stigma has reduced, people have diagnosed HIV/AIDS early, patients have adhered to treatment plans, and the entire population has transformed their lifestyles for healthy behaviors (Stone, Ojikutu, Rawlings, & Smith, 2009). Hence, community mobilization has made tremendous reductions in the rate of HIV/AIDS infection among African Americans for they have avoided drug abuse and risky sexual behaviors.

Adherence to medication is a major problem that influences management of HIV/AIDS. The government employs an educational program where healthcare providers offer patients with essential information to enhance adherence to antiretroviral drugs.

The United Nations Educational, Scientific, and Cultural Organization (2007) indicate, Preparing patients through treatment education and providing ongoing need-based education help persons with HIV to manage their treatment and HIV-related diseases (p.1). Treatment education enables patients to manage their condition by adhering to medication and improving their CD4 counts.

Treatment education at the community level aims at encouraging people to check their HIV status and take the appropriate healthcare measures. Eventually, the community becomes responsive to the needs of patients and thus reduces the stigma associated with the disease. Hence, treatment education is an effective program that is helpful in promoting adherence to medication.

Enhancement of socio-economic status of the African Americans is a strategy that the government has employed in combating the high incidences of HIV/AIDS. Enhancement of socio-economic status of African Americans enables them to access healthcare services they could not afford before.

The government has made significant progress in enhancing accessibility of healthcare services. It has collaborated with various stakeholders such as Medicaid and Medicare in providing affordable healthcare to the poor people, who are mainly African Americans.

The government has also used comprehensive approach in empowering African Americans to reverse trends of HIV/AIDS infections. One strategy to create such a vast change involves merging HIV/AIDS prevention with efforts against racism, homophobia, joblessness, sexual violence, homelessness, substance abuse, mental illness, and poverty (Laurencin, Christensen, & Taylor, 2008, p.41). Hence, comprehensive approach is appropriate in combating HIV/AIDS among African Americans.

Conclusion

The disproportionate occurrence of HIV/AIDS among African Americans indicates social, economic, and health disparities that exist in the United States. Though African Americans represent about 13 per cent of the population, they have about 50 per cent cases of HIV/AIDS.

The major causes for the disproportionate occurrence of the disease among African Americans include drug abuse, sexual behaviors, and low socio-economic status. Hence, the government has set up programs such as community mobilization, treatment education, and enhancement of socio-economic status via comprehensive approach to combat HIV/AIDS among African Americans.

References

Friedman, S., Cooper, H., & Osborne, A. (2009). Interventions strategies for HIV/AIDS Prevention among African Americans: Structural and social contexts of HIV risk among African Americans. American Journal of Public Health, 99(6), 1002-1008.

Laurencin, C., Christensen, D., & Taylor, E. (2008). HIV/AIDS and the African-American Community: A state of Emergency. Journal of the National Medical Association, 100(1), 35-43.

McCree, D., Jones, K., & OLeary, A. (2010). African Americans and HIV/AIDS: Understanding and addressing the epidemic. New York, NY: Springer.

National Alliance of State & Territorial AIDS Directors. (2008). The landscape of HIV/AIDS among African American: Women in the United States. Web.

Stone, V., Ojikutu, B., Rawlings, M., & Smith, K. (2009). HIV/AIDS in U.S. communities Of color. New York, NY: Springer.

United Nations Educational, Scientific, and Cultural Organization. (2007). Current Research and good practice in HIV and AIDS treatment education. Retrieved from https://unesdoc.unesco.org/ark:/48223/pf0000149722

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 bodys 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. Australias 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 Africas 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 Africas 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).

Australias 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 persons 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 patients 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 Africas 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), 20912104. 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.

In the present article, the way female patients with HIV follow the doctors instructions is addressed. The research question is to examine the relationships between antiretroviral medication adherence and a set of indexes, namely context, environment, and psychological factors, in order to help professionals, provide better care for HIV-positive women (TyerViola, Corless, Webel, Reid, Sullivan, & Nichols, 2014).

As the authors state, the research incorporates three groups of independent variables. Context variables include income, education, race, age, and so on; depression symptoms, stigma, a health care provider, and engagement form the environmental factors; psychological factors are constituted by sense-coherence, self-esteem, adherence self-efficacy, and self-compassion (TyerViola et al., 2014). There is only one dependent variable, the level of medication adherence.

While some of the variables are categorical (for instance, race), the majority of them are ordinal: the attributes may be ranked (for example, depression symptoms vary from the least to the most intense). As the medication adherence, context, and environmental variables can be characterized by the limited number of values. Although psychological issues are individual, they are assessed by means of the standardized measures. Consequently, all variables are discrete.

As for the statistical tests, the authors emphasize that descriptive and multivariate statistics were used, for instance, self-compassion scales and Berger stigma scale are mentioned among other measures, and t test was utilized.

The researchers arrive at the conclusion that adherence self-efficacy and depression symptoms determine the antiretroviral medication adherence in female patients living with HIV (TyerViola et al., 2014). In this context, the nurses task is to evaluate these factors. It is underlined that future research concerning adherence self-efficacy and depression is necessary.

Article Review

The article under consideration pertains to the topic of lung cancer stigma. The author presents the results of the study concerning barriers to medical help-seeking behavior objectively and proves that the results are reliable.

First and foremost, the rationale for the significance of the topic is given: it is properly explained that nurses should address this patient outcome issue because timely actions are of paramount importance. Further, the researcher describes the method: she not only provides the information about the design and setting but also includes the theoretical foundation (CarterHarris, 2015). This approach seems advantageous since the ground for the choice is present.

The section concentrating on the procedures is also accurate. As it is demonstrated, the study is appropriate: the Institutional Review Board approval and patients consent were obtained. Sampling, data collection, analysis, and protection are thoroughly described. Further, the author concisely presents the results of the study. She draws readers attention to the correlations, means, and standard deviations on subscale values and sheds light on the connections between the stigma and treatment delay.

One should also mention that the discussion section provides the valuable information: the author professionally analyzes the collected data and interprets the facts. Finally, the limitations and implications are remarkable. The fact that the researcher does not hide the truth and gives her perspective on how the study may be useful in future is also profitable.

While the contents of the article are good, the structure is a little confusing. The author places the conclusions before the discussion, limitations, and implications sections. This organization is not typical, and it may puzzle a reader.

Overall, the article is notable for the approach, the authors accuracy, and the essential research results. Simultaneously, the article structure differs from that of similar papers, and it may be perplexing for readers.

References

CarterHarris, L. (2015). Lung cancer stigma as a barrier to medical helpseeking behavior: Practice implications. Journal of the American Association of Nurse Practitioners, 27(5), 240-245.

TyerViola, L. A., Corless, I. B., Webel, A., Reid, P., Sullivan, K. M., & Nichols, P. (2014). Predictors of medication adherence among HIVpositive women in North America. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43(2), 168-178.

The OraQuick Home HIV Test gadget uses saliva in detecting the presence of antibodies that indicate the presence of HIV in the human body (Best inventions of the year 2012, 2013). It helps individuals avoid visits to the doctor. It captured my attention because I never associated HIV with saliva. This invention will contribute to reducing the number of HIV-related deaths since individuals will know about their status early enough to start medication (Oraquick, 2014). It does not affect me personally, but I believe it can help my close friends and relatives or me in the future. I think this invention has the potential for improvement because the 20-minute wait for the results is too long. The inventors or other technologists can work on reducing the time people have to wait for the results.

Advantages

• It reduces the time people spend visiting the doctor.
• It is suitable for people who fear showing their HIV status to others.

Disadvantages

• People who cannot contain positive results can even commit suicide.
• This invention does not require any new skills.

References

Best inventions of the year 2012. (2013). Time. Web.

Oraquick (2014). Web.

Disease Process, Introduction, and Spread

• The Human Immunodeficiency Virus (HIV) is a contagious that causes a condition known as the Acquired Immune Deficiency Syndrome (AIDS).
• This virus is passed to another person through vaginal fluids, breast milk, blood, and semen.
• Unprotected sex is the leading mode of infection.
• Physical contact cannot result in infection.
• Tears, sweat, and saliva cannot transmit the virus.
• Despite the initiatives and measures implemented to deal with this communicable disease, new cases continue to be recorded every year.
• The World Health Organization (WHO) indicates that over 3.4 million people in Nigeria are living with this condition (Ajuwon, Komolafe-Opadeji, & Ikhizama, 2014).
• Statistics also reveal that over 1 million patients are unaware of their medical statuses.
• This tool can empower and guide more people to protect themselves from the dangers associated with this disease.

Self-Management Tips

• HIV/AIDS is a leading cause of death in the developing world.
• Primary and secondary prevention measures have the potential to deal with this epidemic (Ajuwon et al., 2014).
• Individuals should engage in a number of self-management practices. Some of these tips include:
  • Frequent testing and counseling.
  • Engaging in protected sex.
  • Using condoms.
  • Infected persons should use ARVs.
  • Mothers infected by HIV should not breastfeed.
  • Balanced diets and healthy food materials.

Diet and Nutritional Directions

• HIV/AIDS patients should be keen to monitor their nutritional statuses and diets.
• These insights will serve every person with this communicable condition positively:
  • Avoid soft drinks and sweets.
  • Eat dies high in legumes, whole grains, and vegetables/fruits.
  • Meals should have small quantities of good fats.
  • Proteins and carbohydrates are essential.

Potential Treatment Options

• Secondary preventative measures are essential because they guide patients to contain or manage HIV/AIDS.
• The chances of infecting others with the virus reduce significantly whenever positive treatment methods are put into consideration (Ajuwon et al., 2014).
• These options are essential for patients who have been diagnosed with this disease:
  • HIV drugs and medicines can be taken daily.
  • The combination of such drugs is known as antiretroviral therapy (ART).
  • Engaging in exercises.
  • Taking appropriate medicines to treat side effects.
• HIV medicines are known to result in drug-drug interactions.
• This means that doctors should advice their patients accordingly in order to deliver positive results.
• Specific issues such as drug resistance should be monitored frequently.
• This practice will guide physicians to identify the right combinations depending on the unique needs of the targeted individual.

Potential Resources

• Many people in Nigeria can learn a lot about the issues associated with HIV/AIDS from a wide range of resources.
• Patients can focus on different agencies such as the World Health Organization (WHO) and the Aids Alliance Organization (AAO). These bodies have websites that offer evidence-based ideas and information that can be embraced by individuals who want to protect themselves from the condition (Mbachu, Okoli, Onwujekwe, & Enabulele, 2017).
• Additionally, patients can identify new drugs and therapies that can improve their lifestyles and health outcomes.
• Individuals can also focus on a number of publications and campaigns implemented by the Government of Nigeria in order to know more about the emerging issues associated with this condition.

Risk Reduction

• Maartens, Celum, and Lewin (2014) indicate that individuals aged between 15 and 65 are at risk of contracting this condition.
• The problem of this disease is worsened by the fact that many people are unaware of their HIV statuses.
• The absence of adequate educational resources is something that makes it impossible for many people to protect themselves from HIV/AIDS.
• The identification and knowledge of appropriate practices can result in risk reduction, thereby supporting the health needs of many people in this developing country.
• These measures/practices have the potential to reduce the risk of contracting this communicable disease:
  • Being tested for HIV at least once every year;
  • Parents should educate their children about the issues associated with HIV/AIDS;
  • Church elders and community leaders should inform more people about this disease;
  • Counseling should be available to persons with HIV/AIDS;
  • Individuals should engage in protected sex;
  • Pregnant women should be tested in order to engage in evidence-based practices.

Concluding Remarks

• Patients should not infect others with the virus.
• They should be on the lookout for any information about the disease.
• Patients should embrace the use of ARVs.
• Cases of rape should be reported immediately.
• Balanced diets should be taken seriously.

References

Ajuwon, G. A., Komolafe-Opadeji, H. O., & Ikhizama, B. (2014). Librarian-initiated HIV/AIDS prevention intervention program outcome in rural communities in Oyo State, Nigeria. International Quarterly of Community Health Education, 34(4), 367-390. Web.

Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: Epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271. Web.

Mbachu, C., Okoli, C., Onwujekwe, O., & Enabulele, F. (2017). Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south-east Nigeria. Health Expectations, 21, 270-278. Web.

Definition

Even with new threats to global health having emerged over the past few years, HIV remains the issue that puts peoples lives in jeopardy. The Centers for Disease Control and Prevention (CDC) report that, in 2015, the percentage of HIV patients remained relatively the same across all age groups (see Figure 1) (Centers for Disease Control and Prevention, 2015). Particularly, adolescents and young adults are affected. According to the data provided by CDC in 2017, STDs take a particularly heavy toll on young people (Centers for Disease Control and Prevention, 2017). Thus, it is crucial to focus on preventing the instances of HIV/STI contraction among young people, as well as manage the needs of the patients with HIV/STI.

The significance of addressing HIV/STI as a public health issue is obvious. Despite the fact that medications have been discovered to address STIs, as well as antiretroviral medicine to prevent the further development of AIDS in HIV patients (e.g., Abacavir, Didanosine, etc. (U.S. Food and Drug Association, 2016)), the said diseases still have detrimental effects on peoples health. They affect the quality and length of peoples lives, trigger numerous health complications, damage the reproductive system, and may lead to fatal outcomes unless attended to accordingly (UNICEF, 2015). Furthermore, people with HIV/STIs suffer extensively from the social stigma with which the diseases are associated. Therefore, there is a pressing need to develop a comprehensive program that will help build awareness about the threats of HIV/STIs and promote active knowledge acquisition among young people. Furthermore, the program must encourage the rest of the community to learn more about HIV/STI patients and realize that they need support from their community members.

Specific Audience: Description and Key Characteristics

The project in question, which is about to be launched by the New York City STD/HIV Prevention Training Center and, therefore, is known under the title of NYC STD/HIV PTC targets at at least two specific audiences. Particularly, the vulnerable population (i.e., the young people that have developed or are under a threat of developing HIV/STI) and the community members (i.e., the healthy population that may have prejudices against HIV/STI patients and, thus, contribute to them being ostracized) are viewed as the primary audiences (World Health Organization, 2016).

The group containing the members of the vulnerable population is represented by infants, children, teenagers, and adolescents who may contract or have contracted HIV/STI. The group includes all ethnicities and people from all socioeconomic backgrounds. It is suggested, though, that the results of the intervention should be classified based on the participants background so that specific factors affecting the aggravation of the issue could be isolated.

The second group includes adults that may provide support to the first group. These include adult family and community members. It is also expected that the project may attract the attention of organizations that may become potentially helpful for HIV/STI patients, as well as for any person willing to find out more about the subject matter and contribute to the improvement of the healthcare service and support quality. However, targeting large entities is not the primary objective of the project at present. A follow-up initiative, in its turn, may be focused on the identified issue.

Purpose: Reducing HIV/STI Levels, Building Awareness, and Improving Connectivity as Specific Aims

NYC STD/HIV PTC aims at managing several crucial issues that remain persistent in the global healthcare realm. Particularly, the participants of the program seek to reduce the number of instances of HIV/STI contraction among young U.S. citizens and bring down the negative effects of prejudices that surround the diseases in question. Thus, the environment for managing the problems related to HIV/STI can be created.

In light of the fact that the HIV/STI development levels remain rather high among the target population, the necessity to educate young people about the threats of HIV/STI, as well as the methods of avoiding and managing them, is evident. The program, therefore, also focuses on improving information management in the contemporary healthcare environment so that a better connection between the vulnerable population and healthcare professionals (HPs) could be established. Thus, the foundation for significant improvements can be built.

Furthermore, the program seeks to reduce the deplorable effects of social prejudices on the lives of HIV/STI patients. It is imperative that the people with the specified health issues should not be ostracized and, instead, should be provided with extensive support from the community members. For this purpose, community members will be invited to participate in the program and acquire the relevant knowledge about HIV/STIs. Thus, the harmful effects of social prejudices can be reduced, and the patients will be able to receive the support that they need.

Specific Strategy: Engaging the Target Audience

In order to engage the target audience, one should consider using a social media promotion campaign. Facebook and Twitter will have to be utilized as the platform for carrying out the campaign. Particularly, the advertisements and posts in the identified types of social media will be used as the means of attracting the attention of the target population. The advertisements and posts will serve as the attention grabbers that will compel the target population to explore the opportunities that the program has to offer. Thus, both the vulnerable population and the rest of the community will be embraced.

Furthermore, it will be necessary to use blog posts as the means of attracting the attention of the target population and inviting them to join the program. Each post will be devoted to a particular prejudice associated with HIV/STIs and debunk the myth, thus, enlightening the audience and increasing their engagement levels. Furthermore, each post will end on a cliffhanger so that the targeted population could have the impetus to return for more information. As a result, a rapid increase in the number of followers, subscribers, and participants is expected (see Figure 3).

Choosing the Right Technology: Two Tools That Will Make a Difference

As stressed above, it will be imperative to incorporate the use of social networks into the program. Specifically, one will have to consider using Facebook and Twitter as the primary means of attracting the attention of the target population. Facebook posts will shed light on some of the most topical concerns associated with HIV/STI among the American youth. Furthermore, Facebook can be used as the means of spreading the word about the events that the program in question will include so that the number of participants could increase. Moreover, Facebook applications such as the dating/supportive tool for HIV-positive single people can be utilized as essential means of providing extensive support to HIV/STI patients (see Figure 2).

Twitter, in its turn, can also be used as the tool for providing essential information about the upcoming events, recent issues, current threats, etc. Thus, the participants will be updated on the latest news and remain aware of the existing opportunities and threats. Furthermore, information about the recent studies about HIV/STI and the relevant statistical data can be provided on Twitter.

Blogger.com and similar services should be used as the platform for the participants to discuss the issues associated with HIV/STI. Apart from providing essential information about the subject matter and debunking the existing myths about HIV/STI, blog posts will prompt discussions among the readers, thus, contributing to a rapid increase in engagement levels. Consequently, a rapid rise in awareness rates can be expected among not only patients but also the rest of the community members. As a result, the threat of being ostracized due to the social stigma will be reduced significantly among HIV/STI patients, and extensive support from the community members, as well as the patients families, can be provided.

Advantages and Disadvantages of the Chosen Tools: Analysis

One must admit that the chosen media has both its benefits and problems, while the advantages are very numerous, some of the negative aspects of the said media may become serious impediments to the success of the campaign. Therefore, an elaborate strategy for enhancing the effects of advantages and preventing the problems from impacting the campaign must be devised.

The speed of data dissemination clearly is the most obvious advantage of the tools mentioned above. With a huge number of people being online, and the opportunity for keeping each other updated about the changes in ones online activities, the relevant information will be spread very quickly with the help of likes, retweets, etc. As a result, a significant number of participants can be recruited for participating in the campaign within a relatively short amount of time. Similarly, the use of blogs allows for a range of opportunities, the chance for inviting people to discuss specific issues being the key one. By starting a conversation in the online environment, one will invite others to contribute to the analysis of the problem and, therefore, attract the attention of a range of users.

However, the suggested media tools also have their problems, the lack of control over the actions of the participants being the key one. For instance, it will be barely possible to make sure that the subscribers should visit the Facebook, Twitter, and Blogger.com official pages of the NYC STD/HIV PTC campaign on a regular basis, participating in the events and discussions organized to support the HIV/STI patients. Furthermore, the discussions can hardly be controlled. While moderators will be able to prevent the instances of online bullying and flaming, making sure that the communication process could be steered the required way may be problematic. Therefore, thorough moderation and a set of rigid rules for discussion threads must be viewed as a necessity.

Plan for Using the Social Media: Communicating the Message

Goals Identification

It will be necessary to promote active participation among the people that will join the campaign. Particularly, the issues associated with HIV/STI, as well as the prejudices that people with the said diseases have to face on a regular basis in the modern community, will have to be scrutinized. The increase in the engagement levels among patients and community members can be viewed as the expected and desirable outcome.

Moreover, the promotion of the required behaviors and attitudes among the target population should be deemed as an essential goal. While shedding light on the threats to which the target population is exposed important, it is also necessary to show why the current behaviors are inappropriate and offer an alternative. As a result, young people will be able to avoid a range of threats by following simple rules such as using protection, refusing from promiscuous sex, etc.

The identified goals are expected to be achieved by compelling young people to participate in online discussions of HIV/STI-related issues. Furthermore, information about the subject matter will be disseminated among the identified audiences with the help of modern media. Finally, the people involved in the program will be provided with consultations from health experts, as well as free contraceptives.

Intended Audiences

The key message must be communicated to two primary groups. First, the vulnerable population, i.e., children, teenagers, and adolescents, especially the ones that come from a poor socioeconomic background, as well as young people with HIV/STI, must be viewed as the target audience. Afterward, the rest of the community, particularly, the target participants family members, local authorities, healthcare organizations, etc., will have to be invited to take part in the program to reduce the pressure of social prejudices and relieve HIV/STI patients of their social stigma.

Messages

The following message should be considered the focus of the campaign: HIV/STI remains a consistent threat, and prejudices and myths about it stigmatize patients, making their experience even more difficult. Learn how to help or get help yourself  take part in the NYC STD/HIV PTC Campaign! It is important to incorporate both the idea about raising awareness and providing the target population with the necessary resources. The messages will be presented via Facebook and Twitter on an HIV awareness day.

Pretesting Messages and Materials

The materials will include two Blogger.com posts, a Facebook post, and a message on Twitter. The selected population (5-8 young people that are deemed as the vulnerable population and 2-3 community members) will be invited to read the information and respond to the ideas that they will consider interesting, if any. The objectives of the pretest include checking whether the messages invoke any emotional response among the participants.

Revising the Messages

One must bear in mind that several problems may be revealed in the course of pretesting. For instance, the current message might lack urgency and, therefore, discarded by the target audiences. Thus, an impetus for action must be incorporated in a new and revised message so that it could attract the attention of the target population faster.

Plan Implementation: What It Might Look Like

The implementation of the plan will involve writing an exciting blog post about myths regarding HIV/STI and debunking some of the prejudices that have been present in the target community for years. The links to the post will be provided on Facebook and Twitter, with corresponding announcements about the important and peculiar information that the blog provides. Furthermore, the information about the new blog will be spread via word of mouth among the community members. Thus, the target audience will be able to learn about the campaign and consider enrolling for participation. In case the number of people that the identified approach will attract will be lower than expected (less than 30% of the target population), using direct advertisement via e-mails should be viewed as an option.

After the participants start visiting the site, it will be necessary to make sure that they should take part in the discussion. Thus, it might be necessary to provide the opening message that will help the target population engage in a conversation faster. By breaking the ice in the conversation process, one is likely to trigger an active discussion of the issues raised in the post. At the same time, important links and contact information must be provided to the participants at the end of the article. Thus, further consultations and assistance will be offered to the patients, whereas the rest of the community members will be able to register for the further participation in the program to assist HIV/STI victims.

Ostensible Effects and Their Assessment: What Needs Improvements

It is assumed that the program will contribute to a rapid increase in the engagement levels among the target population. Particularly, young people are bound to consider the issue of HIV/STI as a tangible threat and acquire the habits, skills, and knowledge that will help them avoid the threat of developing the disease. Furthermore, it is assumed that family members will learn to provide sufficient support to the patients.

Expecting that the campaign will help eliminate the prejudices against people with HIV/STI fast and completely, therefore, affecting the quality of patients life in the community, would be too optimistic, though. Changing peoples mindset is a long and difficult process, especially as far as the delicate issue of HIV/STI is concerned. Seeing that the diseases in question are often linked to promiscuity and other types of sexual behavior that is deemed as blameworthy in the contemporary society, it will be very complicated to convince people to reconsider their opinions.

The problem mentioned above can be addressed once a sufficient number of community members enroll in the program and learn more about the needs of HIV/STI patients, their vulnerability, and the harm that social prejudice cause. However, time will be an essential resource. It is important to make sure that the message sinks in among the target population; thus, conscious and efficient support can be provided to the HIV/STI patients.

Changes for Future Plans and Implications for Public Health

Seeing that the process of engaging the community members and contributing to a drop in the effects of social prejudices may take a significant amount of time, it will be required to boost the campaign. The levels of engagement among the target audiences may be increased by showing them that HIV/STI patients are not any different from them as far as their needs, lives, and emotions are concerned. The identified effect can be achieved by encouraging HIV/STI patients to share their stories and experiences as blog posts. Taking interviews and posting them with the permission of the interviewees, therefore, should be considered one of the methods of enhancing the efficacy of the campaign. As soon as a strong connection between the vulnerable population and the community is established, significant improvements in the quality of patients lives, as well as an increase in engagement levels among the young and vulnerable population, can be expected.

References

Centers for Disease Control and Prevention. (2015).HIV/AIDS. Statistics center. Statistics overview. Web.

Centers for Disease Control and Prevention. (2017). Sexually transmitted diseases. Life stages and populations. Adolescents and young adults. Web.

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UNICEF. (2015). Turning the tide against AIDS will require more concentrated focus on adolescents and young people. Web.

World Health Organization. (2016). Sexually transmitted infections (STIs). Web.