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.
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.
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.
Figure 1. HIV by Age: 20102015 (US) (Centers for Disease Control and Prevention, 2015)
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).
Figure 3. Most Popular Social Media (2017) (Statistic Portal, 2017)
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).
Figure 2. Facebook App for HIV-positive Single People (HIV-Single, 2017)
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.
Healthcare systems are designed to meet patients needs.
Medical professionals should be ready to identify at risk groups.
The selected population for this analysis is people with HIV/AIDS.
African Americans, Hispanics, transgender women, and intravenous drug users are affected the most.
This presentation examines the nature of this problem.
The available solutions and institutions for empowering members of this population are outlined.
Governments develop and implement health systems depending on the medical needs of their respective citizens. Medical professionals and public workers should collaborate and focus on the best ways to meet the demands of underserved populations. Persons with HIV/AIDS fall under the category of at risk groups. This presentation seeks to analyze the nature of problems this vulnerable population faces and offers a detailed analysis of the available programs and solutions to empower such patients.
Population Chosen
The selected vulnerable group is comprised of persons suffering from HIV/AIDS.
This disease is terminal in nature.
Affected patients are at risk of various medical complications.
The current health system does not meet all the demands of such patients.
A detailed analysis of this population can result in evidence-based solutions.
The ultimate aim should be to improve HIV/AIDS patients lives.
The chosen population for this discussion comprises of persons living with HIV/AIDS. Most of the affected individuals are unable to engage in economic activities and pursue their goals in life. Some of the procedures and measures put in place are incapable of providing the relevant support to most of these patients. Experts acknowledge that there is a need to analyze this health issue and consider the best ways to empower the affected individuals. The involvement of all key players could support the delivery of positive results.
Population Description
HIV/AIDS affects 1.1 million American citizens (Dingake, 2018).
Some groups appear to be more affected than others.
These include Latinos, African Americans, and drug users.
Transgender groups are also affected by this disease.
The current opioid epidemic is directly linked to increased cases of HIV/AIDS.
Affected persons continue to face stigma.
The latest statistics identify HIV/AIDS as a major medical problem affecting the health sector. The disease currently affects over one million citizens. African Americans, Latinos, and persons who use injection drugs tend to be affected the most. Opioid use is also directly linked to the increasing cases of HIV/AIDS transmissions. The government has also revealed that stigma remains a major challenge and it makes it impossible for more people to disclose their statuses. These facts indicate that the country will continue to record more deaths associated with this disease.
Population Demographics
HIV/AIDS affects various racial groups differently.
African Americans account for 13 percent of the total cases (Laurencin et al., 2018).
However, infection rate for such a group stands at 42 percent annually (Laurencin et al., 2018).
Infection rate for Latinos is around 27 percent (Dingake, 2018).
Drug users are also at risk of infection at 15 percent (HIV.gov, n.d.).
Of all races, bisexual and gay men were affected the most.
Native Americans account for 1.3 percent of the total HIV/AIDS population (HIV.gov, n.d.).
However, the rate of new infections remains low for this group.
Transgender individuals have increased rates of being infected.
Government initiatives have not focused on the needs of these groups.
Around 64 percent of the people with this disease receive the relevant medical care (Wansom et al., 2016).
Proper measures are needed to transform the situation.
The available data reveals that HIV/AIDS is a condition that affects different racial groups disproportionately. For instance, 13 percent of all HIV patients in the country are African Americans. However, the annual infection rate is around 42 percent. This is quite higher in comparison of that of Latinos at 27 percent (Dingake, 2018). Additionally, individuals who rely on injected drugs for recreation and bisexuals have increased chances of getting infected by this deadly disease.
HIV/AIDS continues to affect Native Americans since they account for around 1.3 percent of infections (HIV.gov, n.d.). Although the rate is quite low in comparison with that of the other groups, very little measures have been implemented to address the situation. Transgender groups are also affected by this condition. Government initiatives have also failed to focus on the medical experiences and outcomes of most of the affected individuals. Currently, only 64 percent of the HIV/AIDS population has access to the relevant medical services.
Background of the Problem
HIV/AIDS has reshaped the American public health.
The needs of patients compel the government to stretch its operations.
The disease requires continuous medical support.
The disease has economic, social, and cultural implications (Wansom et al., 2016).
Most of the initiatives put in place are still inefficient.
It forces the established public health systems to focus on the best medical outcomes.
The origin of HIV remains a controversial and highly debated subject in the world today. However, scientists agree that the condition cold have emerged in West Africa where hunters used to consume raw blood from wild animals. The causal agent for the disease is the human immunodeficiency virus. The virus is known to cause or trigger a status known as AIDS. The disease has become a global epidemic that affects individuals and results in a weakened immunity (Laurencin et al., 2018). It remains a leading cause of death in the world today.
Effects on Public Health
HIV/AIDS has reshaped the American public health.
The needs of patients compel the government to stretch its operations.
The disease requires continuous medical support.
The disease has economic, social, and cultural implications (Wansom et al., 2016).
Most of the initiatives put in place are still inefficient.
It forces the established public health systems to focus on the best medical outcomes.
HIV/AIDS is one of the conditions that have affected the nature and integrity of the public health system. The affected persons require additional support and medical care. Public health officers and community organizers have acquired new tasks to educate and encourage more people to avoid casual sex. These measures reveal why most of the existing agencies are unable to focus fully on other conditions. Such issues explain why the government should take this condition seriously and support vulnerable groups.
Cultural Background
The selected vulnerable population comprises of different races.
Most of the African Americans came to America as slaves.
They follow unique cultural practices, including herbal medicine and strong family ties.
Hispanics are economically disadvantages and have fewer opportunities.
Transgender groups have unique cultural practices.
These attributes explain why individuals from such cultures and those who have HIV experience numerous challenges.
The selected members of the American society encounter numerous challenges. They have a cultural history that explains their present conditions and experiences. African Americans and Latinos do not have access to numerous economic and social opportunities. Transgender groups encounter negative treatment in their respective settings (HIV.gov, n.d.). Some of the people engage in cultural practices and behaviors that affect their overall health experiences and outcomes. A detailed analysis of these issues can help the government consider new ways to provide proper support.
Psychosocial Concerns and Norms
Minority groups in the United States remain disempowered.
Some suffer from psychological problems, such as trauma and depression.
They engage in activities that expose them to HIV/AIDS.
Transgender groups and drug users encounter diverse challenges.
Drug sharing and absence of adequate information exposes members of such groups to HIV/AIDS (Laurencin et al., 2018).
Patients become mentally troubled and incapable of pursuing their goals.
HIV/AIDS patients from the selected vulnerable population experience various challenges and norms. For instance, majority of them lack social and economic opportunities, thus being unable to overcome the challenges of depression and trauma. Those who share drugs lack adequate information about the nature of this disease (Wansom et al., 2016). Transgender individuals have increased chances of engaging in causal or reckless sex to overcome the burden of discrimination and abuse. These norms are to blame for these health problems.
Similarly, Hispanics have lower opportunities in comparison with whites.
Majority of these people perform casual tasks and earn reduced income.
Transgender groups face discrimination when looking for job opportunities.
Those with HIV/AIDS are stereotyped and discriminated against (Laurencin et al., 2018).
The end result is a poor economic experience for most of the affected citizens.
Members of the vulnerable population under study do not have adequate education.
Over 40 percent lack college or university education.
This reality makes it impossible for them to get good jobs.
Majority of them have blue-collar jobs or part-time occupations.
These facts explain why they earn very little.
Proper mechanisms to address these issues are currently missing.
The selected population experiences numerous challenges and economic obstacles. For instance, African Americans do not get adequate job opportunities. This happens to be the same case for Hispanics and other minority groups. Transgender groups and persons suffering from addiction will be unable to get competitive opportunities. The situation is usually worse for individuals who have HIV/AIDS. Consequently, most of these individuals will encounter numerous problems and eventually record negative health outcomes.
Statistics reveal that almost half of citizens from minority groups do not have college education. This reality means that such individuals would find it hard to apply and get new jobs in the country. Consequently, the citizens are compelled to complete blue-collar jobs or focus on casual labor (Laurencin et al., 2018). Those who have HIV/AIDS would encounter additional problems since they face discrimination. Most of the patients will earn less competitive income and find it hard to pursue their social and economic goals. The government is yet to implement proper measures to mitigate most of these issues.
Health Concerns
The selected vulnerable population experiences negative health outcomes.
Patients have little or no access to timely medical services.
Individuals have weakened body immunity (Wansom et al., 2016).
Opportunistic conditions are common, such as diabetes, kidney disease, and cognitive disorders.
Poor economic position affects their ability to get medical services.
Existing health programs and facilities are inadequate.
Most of the people with HIV/AIDS encounter diverse medical challenges due to absence of proper programs and clinics. The disease exposes them to additional complications and illnesses. Some of the leading ones include kidney disease, dementia, diabetes, and cardiovascular diseases. Most of the affected patients are usually unable to meet their medical demands due to their economic situations. The relevant government agencies are, therefore, compelled to channel most of the available medical resources to meet the needs of this population.
Risk Factors
Minority groups lack adequate information and support systems.
Some engage in unprotected or casual sex.
Poor educational attainment is associated with higher HIV prevalence.
Unemployed and unmotivated persons start to abuse drugs.
Lack of proper medical support increases chances of developing additional complications.
These factors work synergistically to dictate the nature of this medical problem.
African Americans and Hispanics encounter more or less the same forces that dictate their overall health experiences and outcomes. For instance, those who have not acquired adequate education will tend to engage in unprotected sex and increase their chances of contracting this disease. Most of the patients will lack adequate information and resources to seek personalized or timely medical support (Gleton et al., 2020). The absence of adequate resources and makes it hard for members of this population to record positive health experiences or outcomes. The same risks are available for drug addicts and transgender individuals.
Prevention and Control
Several preventative measures are available to meet the demands of the selected population.
Primary prevention entails provision of timely information.
This approach could include guiding people to use protection during sex and avoid sharing needles.
Secondary prevention entails mass testing to identify infected persons and guide them to live positively.
Tertiary prevention is the provision of antiretroviral therapy (ART) drugs (Gleton et al., 2020).
Affected persons can be guided to attend clinics and avoid infecting others.
The outlined risk factors and health concerns explain why proper prevention measures for this condition are critical. For the selected vulnerable population, it would be possible to educate more members about the dangers of HIV/AIDS and how to avoid being infected. This will be followed by continuous testing to identify persons with and those without HIV. The next move will be to offer tertiary support whereby patients will get ART drugs. The sick will be required to attend clinics and get the relevant medical support.
Public Health Nurse
Public health nurses can play significant roles to help vulnerable populations.
The can begin by providing adequate knowledge to individuals at risk.
They will offer information for preventing infections and seeking medical support (Gleton et al., 2020).
They will complete evaluations to determine the effectiveness of implemented interventions.
They will go further to provide personalized care to individuals at their homes.
Their actions will help reduce the prevalence rate for this condition.
Public health nurses possess adequate competencies that resonate with their roles and responsibilities. Such professionals will identify individuals at risk and offer timely information. The beneficiaries will engage in actions that can reduce infections. They will launch new interventions and consider how primary, secondary, and tertiary approaches work to address the HIV/AIDS epidemic. They will offer personalized support and guidelines to support the delivery of positive results.
Public Health Core Functions
These are the three core functions of public health: assessment, assurance, and policy development.
Professionals will monitor the health demands of the at risk group.
This will be followed by policies aimed at educating and empowering the people.
Community actions and partnerships are capable of delivering positive results (Gleton et al., 2020).
Assurance revolves around the formulation and implementation of regulations.
Such measures are intended to deliver the best results.
The core functions of public heath include assessment of health conditions in a specific community, development of proper policies, and creation of laws and guidelines that will maximize assurance. These measures can work effectively to meet the demands of the selected vulnerable population. The involvement of all key partners and government agencies and the provision of adequate resources can help persons with HIV/AIDS lead longer lives and achieve their maximum potential.
Three Local Agencies
Several agencies and facilities exist to provide medical support to this vulnerable population.
First, the Ryan White HIV/AIDS program provides resources to end this epidemic.
Second, local regions have community-based health facilities, such as hospitals and clinics.
Third, the Office of HIV/AIDS offers leadership to support various organizations when responding to this disease.
The actions of these agencies help reduce the negative impacts of HIV/AIDS (Gleton et al., 2020).
Members of this population have benefited significantly from such agencies.
The United States have several facilities at the local level intended to meet the medical needs of persons with HIV/AIDS. This analysis has centered on some of the efforts targeting people from the selected minority groups. The identified ones include the Ryan White HIV/AIDS Program, medical hospitals and clinics, and the Office of HIV/AIDS. The efforts and missions of such agencies have made it possible for this country to achieve positive outcomes.
Accessibility and Services Rendered
Most of the patients are able to access the available services.
The Ryan White HIV/AIDS program is capable of providing community-based resources.
Hospitals in the country provide timely treatment to these patients.
The Office of HIV/AIDS is accessible to all willing patients (Laurencin et al., 2018).
This office presents guidelines and liaises with other agencies to tackle the challenges of HIV/AIDS.
However, some patients still find it hard to benefit from such programs or services.
The identified resources are designed in such a way that they help the U.S. address the burden of this epidemic. While most of the people have access to such programs, there are some gaps that continue to exist. Such agencies coordinate their operations with other facilities to support the delivery of positive results. Additional measures would be appropriate to ensure sustainable results are eventually recorded.
Additional Resources
The affected community could benefit from additional resources.
The first one is the launch of campaigns aimed at delivering primary and secondary prevention.
The second one could be drives aimed at encouraging people to get tested and seek the relevant medical support.
The third one could be facilities providing ART drugs to patients (Laurencin et al., 2018).
Learning institutions could also become part o f the strategy to tackle this disease.
The primary focus should be on members of the selected target population.
The United States is yet to address the challenge of HIV/AIDS and transform the lives of the affected patients. The consideration and inclusion of additional resources is an evidence-based approach for delivering timely results. The proposed ones could include HIV/AIDS campaigns, testing drives, and provision of ART drugs. Learning institutions could be instrumental towards supporting the delivery of timely results.
Conclusion
The completed presentation has identified a unique population facing the challenges of HIV/AIDS.
The U.S. continues to grapple with this deadly disease.
Some of the measures and facilities put in place are inadequate.
Social and cultural dynamics dictate the recorded gains and problems.
The consideration of evidence-based measures and resources will deliver positive results.
The ultimate goal is to empower and meet the needs of these underserved citizens.
The HIV/AIDS epidemic continues to affect many innocent Americans. Persons from minority groups, users of intravenous drugs, and transgender women are affecting the most. Proper measures and efforts would be needed to meet the demands of these individuals. The consideration of the proposed additional resources can make a difference and make it possible for more patients to lead better and healthier lives.
Gleton, B., Jahanfar, S., Inungu, J., & Latty, C. (2020). Factors associated with condom use among African American and Hispanic/Latino youth. European Journal of Environment and Public Health, 4(1), em0033. Web.
The title of the article Adherence to antiretroviral therapy among people living with HIV by Madi et al. is clear because it gives the reader an idea of the research content and pinpoints the key variables and the sample population. In this case, the variable is Antiretroviral Therapy (ART) compliance, while the population sample is persons living with Human Immunodeficiency Virus (HIV). The abstract provides a concise summary of the background of the research, aims, methodology, results, and conclusions to help the audience understand the without reading the entire report.
The problem statement is straightforward and indicates the studys aim to determine the adherence levels and the factors affecting ART compliance at a healthcare facility in Southern India. The research problem is significant for nursing because healthcare professionals provide critical patient education that promotes ART compliance among persons living with HIV. The problem statement is persuasive because it seeks to identify the degree of ART compliance and what may hinder ART adherence among HIV patients in India. A quantitative approach is suitable for this research problem because the measurements of ART compliance can only be analyzed statistically.
The lack of hypothesis or research questions is justifiable because the study is descriptive, and a reader can easily understand the research process without a hypothesis. Additionally, the absence of a literature review segment makes it difficult for the audience to understand existing studies and connect them to this report. The lack of a theoretical framework is unjustifiable because it hinders the readers from connecting the research variables and finding the studys basis.
The protection of human rights is guaranteed through approval from the Ethics committee at the Kasturba healthcare facility and obtaining patients consent. The investigation utilized a cross-sectional design to gather patient data; nevertheless, the researchers should have used a longitudinal design to increase the credibility. The population sample involved persons living with HIV who had used ART for over a year, which was suitable for the topic. A sample size of 116 individuals was ideal for this quantitative study to generate reliable results. The research used interviews based on semi-structured questionnaires to gather patient information (Madi et al., 2013, p.221). This improved the authenticity of the results because the research was based on primary data collection methods. The authors also provided a formula to calculate the measurements and outlined the procedures used to conduct the study.
The researchers failed to provide a step-by-step process on how they evaluated the data. The analysis shows that the collected information was examined through SPSS version 11.5 and a Chi-square assessment, where the value of P was estimated at < 0.05 (Madi et al., 2013, p. 221). Instead, the researchers should have indicated how the data was edited and coded before being exported to the SPSS and how the Chi-square assessment was completed. The findings are clearly outlined; for example, out of the 116 patients, only 54.3% had 100% adherence while approximately 33% had low ART compliance (Madi et al., 2013, p.222). Increased compliance was associated with self-motivation and free ART, while forgetfulness, depression, social stigma, and financial constraints were linked to reduced adherence.
The research provides a discussion section where authors explain how various aspects, such as depression, financial challenges, stigma, family care, and substance abuse, may reduce ART compliance. They also use other research studies from India to support their findings. These interpretations are compelling because they are based on factors affecting the sample population. There are no recommendations in the report, which would have been critical to guide other researchers who may want to further the study.
The report has a good presentation; it uses paragraphs and subtitles to break the text, making it easier for the audience to follow and understand the content. The study is credible because the authors provide their source of data, sample size, data collection methods, analysis, and how the findings were achieved. The research lacks a summary assessment which would have been vital in reviewing the research process and identifying which areas to improve on when conducting another research.
This study shall investigate nursing students attitude and perception on their educational programs. The perception of students on their training significantly correlated to the nursing care that they will offer to HIV patients during their nursing practice. In Saudi Arabia, little research studies have been demonstrated to establish the attitudes of student nurses on the kind of education and training offered. In collection of data for analysis will be through demographic and student form questionnaires. The study will involve 500 nursing students from the Saudi Nursing colleges from all study levels. The research findings shall offer insight to improve training of nurses in Saudi Arabia by determining the overall perception and attitudes on the course content in respect of HIV/AIDS.
Introduction
Throughout her history, Saudi Arabia has recorded significant advancements in the field of nursing research with an aim of improving the theory and practice of nursing. Through training of nurses has received much attention, studies indicate that perceptions of practicing nursing professionals towards HIV/AIDS patients were still at its low rate (Akala, Jenkins, & World Bank, 2005). Research conducted both in Saudi and outside revealed that nurses were still not well knowledgeable about the pandemic and as such, their provision of nursing care to HIV patients was impaired. Despite that Saudi is the largest Gulf country in the Middle East, its nursing sector remains a young and fragile profession.
Perceptions of nursing students correlated strongly with their willingness to accept caring for HIV patients ( Baumann & Blythe, 2008). Therefore, it is important to structure programs to enable nursing student to develop desired perceptions to facilitate better care for HIV/AIDS patients. According to Barbe (2005), there has been a controversy and discrepancy in the nature and level of correlation between attitude and knowledge about AIDS among nursing students and the relationship between the two over their four-year program.
Literature Review
In this research, the review will explore the current knowledge and literature regarding the level of comfort of nursing students on educational program preparation for the care of people living with HIV/AIDS in Saudi Arabia. In this study, students overall understanding of the concept of HIV will be factored in. additionally; perceptions on AIDS, factors that influence their attitude about course content, and the effects of the scourge in the society shall be discussed (Abu-Raddad, 2010). To gain understanding of nursing education, the study will consider a number of items. They shall include their comfort with people suffering from HIV, their future preparation for nursing care for HIV patients, and significance of their knowledge in nursing care.
In a study conducted by Aydin et al. (2007), 61.3% of practicing nurses expressed anxiety about HIV patients, and approximately 63 % feared socializing with HIV (+) persons. Extensive studies indicate that nurses working and with experience anxiety while administering care to people living with HIV/AIDS. This revelation may be because of lack of sufficient knowledge by nurses about transmission of HIV/AIDS. In a separate study conducted by Aydin (2007), 73% of the nurses expressed their right to refuse to deal with AIDS patients before they underwent educational training. The findings of this study indicated that uneducated health care nurses had negative attitude towards care for people living with HIV/AIDS (Oxford Business Group, 2009) and (ALJabri & AlAbri, 2004).
Interesting to note is that training in some nursing workers had no significant impact on change of attitude even long after the training (ALJabri & AlAbri, 2004). In assessing levels of comfort of students about the educational and course trainings are imperative in ensuring that they are competent enough to deal with the patients ailing from HIV/AIDS. Though discomfort may be a difficult item to measure, attitude submission will serve as a tool to establish the level of their comfort. In a report released by WHO, student nurses were very knowledgeable about transmission of HIV/AIDS (International Council of Nurses/World Health Organization, 2005)
A study by Miller-Rosser (2006) established that nursing students had little knowledge on virology as well as immunology. This study results compared nursing student, medical students, and general undergraduate about their confidence regarding knowledge in HIV/AIDS. Their findings suggested that 81% of the students were less or under-confident. The research attributed these eminent results to the fact that the knowledge related to a subject causing anxiety hence making them exercise caution on being over-confident about an issue perceived to be potentially risky (Miller-Rosser (2006)
A similar but separate study conducted by Al shehri (2009) revealed that nursing students generally had low scores on knowledge on HIV/AIDS. Students knowledge about HIV was high except in symptoms disease and immunopathology (Al shehri, 2009). Current studies still reveal that there are gaps in nursing student knowledge levels concerning the mode of HIV transmission; for example, student still expressed their thoughts that transmission of HIV was possible through contact with fishing hooks and mosquitoes (UNAIDS/ WHO, 2004).
Nursing students attitudes on Caring for People Living with HIV
The nursing Code of Ethics gives a guideline that practicing nurses must provide their nursing care to people living with HIV with great respect (ALJabri & AlAbri, 2004). This code acknowledges any patient as a person, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust, and the dignity of all members of society. The International Code of Ethics for Midwives states that a nurse must above all put compassion and respect for the patients life, must be constantly ready to provide competent care to patients regardless of their age or sex, nature of the disease or other differences (Ellis &Hartley, 2001). Arrogance, neglect or degrading treatment of a patient is not allowed. A nurse is not entitled to impose their moral patient, religious and political beliefs. Failure to comply with this statement of the Code of Ethics substantially hampers the realization of the inalienable right of every individual on the confidentiality, obtaining quality health care and social support. To maximize patient care the nurse should be somewhat away from the meticulous execution of his/her direct responsibilities under the internal regulations of the hospital or other medical institution, and strive to establish long-term professional relationship with the patient and his or her milieu. Though this clarity has been made to nurses, some of the nurses still believed that they had the right to refuse to care for patients with HIV (UNAIDS/ WHO, 2004). In an older study by UNAIDS, students recognized that though patients with HIV were deserving of care, 49% of the students would rather not provide care to HIV/AIDS patients. Of these students, only approximately 24% would be willing to administer mouth-to-mouth resuscitation if there were no protective devices (UNAIDS/ WHO, 2004).
In a separate research conducted the same year, (Roupa et al, 2004) noted that 54% of the students suggested that nurses should be allowed to reject providing care to AIDS patients while 36% would out rightly be unwilling to provide health care to AIDS patients. In a study conducted in three large teaching Australian hospitals by UNAIDS & WHO (2004), nurses were refusing to provide care due to the underlying perceived risks and lifestyles of HIV/AIDS patients. The results of the surveys show that prejudice against HIV patients among nursing students is sufficiently high, though their awareness about HIV transmission. Infected are often denied treatment based on their HIV status, violate privacy, unreasonably impose quarantine, compulsory internment and / or segregation. Stigma and discrimination are major obstacles to effective treatment and care of HIV / AIDS patients. Stigma is a social stereotype that reflects the bias of medical officers as well as other people to HIV-positive. It leads to feelings of shame, guilt and isolation among people living with HIV infection, and negative attitudes of others (discrimination) are pushing these people to inaction or action that may cause harm to others. But the negative attitude of nurses to such patients can and should be changed by examining the needs and motives of fears. The determination of the causes and motives of fear of contamination among nurses makes possible to eliminate them in individual work with each individual or a group. This kind of work is to be carried out by professional psychologists and co-operation of HIV-infected persons.
The relationship between Prevalence of HIV/ AIDS in the Students Study Area and students perception and knowledge
The level of AIDS prevalence in the students environment is a fundamental aspect that affects their level of knowledge and attitude. This factor has far-reaching influence on the level of confidence that nursing students on the educational program preparing them for HIV care. Research reveals suggests that students whose origin is of an area characterized by low HIV prevalence have higher tendency to develop positive attitudes on patients with HIV/AIDS. On the other hand, students from areas with high-prevalence rates showed higher knowledge about HIV/AIDS pandemic (Aydin et al, 2007)
According to studies by Al-shehri (2009), results about high knowledge of students from high prevalent regions was due to the widespread community awareness about HIV, increases in infection rates, and mandatory educational programs. This study approach was to establish the students attitude and knowledge about HIV in high prevalence regions.
Maswanya et al. (2008) conducted a study on knowledge and attitudes about HIV/AIDS among nursing students in Nagasaki, Japan. The study involved a survey on 383 female nursing students. In their study, they found that students accessed knowledge about HIV/AIDS mainly through the media, and not from their teachers. Although students exhibited a high level of understanding about HIV/AIDS, a significant number of them had reserved attitudes about patients living with AIDS. The study concluded that an appropriate nursing training was required to reduce that gap between students knowledge and perception with respect to HIV/AIDS (Maswanya et al., 2008).
Qualitative study revealed absence of an effective training for nursing students in Japan especially on AIDS pandemic. In Japan, limited literature is available about education, attitude and perception of nursing interns on HIV/ AIDS. The study hence informs other researchers that absence of proper knowledge programs results in misconceptions about issues in dealing with HIV/AIDS. It is therefore imperative to note that cases where such reports are unavailable, students tend to develop negative perceptions during their preparation for HIV/AIDS nursing care.
Kermode, Holmes, & Langkham (2005) took a study on the influence of knowledge on musing professionals attitude towards patients living with HIV in rural India. The study administered questionnaires to 266 female nurses from rural areas. The study indicates that most of the nurses had developed a positive attitude towards caring for patients living with AIDS. However, the analysis showed a misconception of the knowledge about infection and risks. Furthermore, the results from findings indicated that willingness to offer nursing care for HIV/AIDS patients significantly correlated with their experience in dealing with such patients. In the same study, qualitative analysis gave an inference that no correlation between knowledge of transmission and attitudes towards risk. This study reveals that nursing professionals and students needed first-hand experience with HIIV/AIDS patients during their training to reinforce their positive perceptions (Kermode, Holmes, & Langkham, 2005).
A separate study conducted by Miller-Rosser (2006) established that students who accessed frequent nursing experience in caring for people living with HIV demonstrated high positive attitude towards the nursing curriculum that prepared them for HIV/AIDS care. A similar study by Miller-Rosser to determine the level of perception of nursing students on HIV/AIDS care in Riyadh Military hospital involved 100 nursing intern students from Jeddah, Saudi Arabia. The studys main objective was to find out how nursing students knowledge influenced their ability and perception to care for HIV/AIDS patients. The study used a qualitative methodology to explain how knowledge and attitude, and how they influenced nursing students ability to care for HIV/AIDS patients. Student nurses who were comfortable with handling HIV patients had wide knowledge coverage on the concept of HIV/AIDS in relation to transmission and perceived risk.
According to Al-Mazrou, Y et al. (2005), the government of the Kingdom has established many strategies to battle with the increasing prevalence of HIV/AIDS through the National Aids Control Program. However, challenges that face the implementation of the strategic plan include the inability to access perceived high-risk areas and limited reporting. Although the Saudi Ministry of Health has gathered data on HIV/AIDS pandemic, continuous surveillances do not offer specific absolute information. Al-Mazrou et al. (2005) noted that little studies have explored the subject of HIV/AIDS and as such, little literature is available to equip nursing students about the pandemic.
To understand the influence of perception on nursing education on the kind of nursing care offered by practicing professional, we examine a study conducted by Kermode, Holmes & Langkham (2005) in India. The study is a descriptive analysis of the impact of knowledge and attitude of nursing students on their training in preparation for nursing care for HIV/AIDS patients. The study employed a self-administered questionnaire whose objective was to explain the impact of nursing education on perception of nursing students while in their actual care for patients living with HIV/AIDS. In their findings, they concluded that the ability of students to incorporate and internalize their nursing education and training had a positive correlation with the ability to offer high quality nursing care for people living with HIV/AIDS.
Significance of Study
The concept of nurses perception on the educational knowledge in preparation for HIV patient is imperative since it is critical in determining the perception of the would be nurses on HIV patients during their nursing practice. Studies on perception of nursing students discussed in the literature review indicate that the topic of study is significant in establishing of a more inclusive, sufficient and relevant knowledge that can influence the underlying attitudes of nursing students and even practicing ones (Polit, & Tatano, 2004). Although numerous studies have explored the topic, the Saudi Arabian student nurses have gained little attention in improving their training programs. Nursing colleges need information that would help in creating a curriculum capable of improving the level of student knowledge and attitude towards the content and the AIDS pandemic. This study is hence imperative in contributing its findings to the research literature already available and more so, the findings will be beneficial to the education sector, nursing health care of the Saudi Ministry of Health.
Research Aim
The research aims at determining the level of Saudi Student nurses Perception on their educational preparation for HIV/AIDS patient care.
Research Questions
The research questions designed are to prompt the research response from students studying nursing in Saudi Arabia about their level of comfort with the educational and training program that prepares them for the duty of caring for HIV/AIDS patients.
Does the knowledge level about the HIV disease increase with year of study?
Does change in attitude about HIV/AIDS correlate with the level of study?
What is the relationship between nursing knowledge offered and the perception of students on HIVAIDS?
Research Design
The research shall employ a quantitative approach in which self-administered questionnaires will gather data on nursing students in Saudi Arabia. It will involve collection, organizing and analyzing of numerical data to derive theory to answering the research questions. It will adopt a cross-sectional descriptive design aimed at investigating the level of attitude of nursing students in Saudi on their educational program in preparation for duty to care for HIV/AIDS patients (Zafar et al., 2005).
To facilitate the process of data collection, a questionnaire will be designed for utilization by the nursing students in Saudi Arabia.
Research Setting
This research will narrow its setting to Saudi hospitals in Riyadh region. The study will utilize three hospitals within the city and they will include Riyadh Medical Complex (RMC), a four-hundred-bed capacity Sultan Bin Abdul-Aziz Humanitarian City (SBAHC), and Riyadh Military Hospital (RMH) that has a bed capacity of 1,192. The researchs selection of these hospitals is because of high number of nursing student interns who take their internship programs within the city and more especially in these hospitals.
Study Sample
The sample chosen will utilize 500 nursing students from different levels of study. The study anticipates that this will be the most convenient sample capable of producing reliable and efficacious results that will serve to achieve the study objective. At the same time, the sample is most appropriate and convenient since students are most readily available and as such, it will be an inexpensive process (Watson, 2008).
The following will be the criteria for selection of the research samples and respondents who will volunteer to participate in the study.
The sample will include Saudi nursing students who are in all levels of study
Both male and female students who shall be Saudi citizens
Participants who do not meet the requirements of the study criteria shall be excluded from being respondents; for example, non-Saudi nursing studying in Saudi.
Data Collection
Instrumentation
A demographic questionnaire consisting of seven items shall designed to gather information about respondents actual age, nationality, course study level, gender, marital status, how many cases HIV they knew, and number of patients they have previously taken care of. This information will be imperative in describing the research sample. Respondents will fill in or correctly mark in the boxes in response to the study prompts.
Knowledge- Impact questionnaire to assess HIV/AIDS knowledge will benefit the research in gaining validity and reliability. A practicing nurse with extensive experience in HIV/AIDS will review the questionnaire. To achieve content validity, two independent nursing professionals will rate the questionnaire on the scale of 1 to 5on the basis of appropriateness for a sample of nursing students (Taylor & Kermode, 2006).
HIV-impact questionnaire will benefit from student form designed to measure the nursing students attitudes and use of precautions while dealing with patients with HIV (AlMazrou et al., 2005). The questionnaire will entail four responses from which respondents will choose. They include; agree, strongly agree, disagree and strongly disagree. Agree and agree will be combined into a cumulative percentage of agree.
Procedure
The study will seek approval from the three host hospitals together with the primary nursing colleges from which the students learn. Participants who meet the research criteria will be included in the study where the researcher will conduct a meeting geared towards informing them of the study objective and their participation (Munhall, 2010). Participants shall access questionnaires from their respective nursing departments in colleges and hospitals. Respective authorities shall collect dully-filled questionnaires from respondents and deliver them via secured post delivery system.
Research Timeline
Date
Plan
Oct 2011
Nov 2011
December 2011
January 2012
February 2012
March 2012
April 2012
May 2012
Design of Proposal
Presentation for Approval
Review of and final submission
Funding
Data collection
Data analysis
Final draft
Presentation
Data Analysis
Data collected will be analyzed using the Statistical Package for Social Sciences (SPSS) software. The demographic data will be analyzed using descriptive statistics. Analysis of the data could be carried out by using one-way Analysis of Variance (ANOVA). Year of study would be selected as an independent variable; knowledge and attitude shall be two dependent variables set at 95% level of significance (Houser, 2007).
Project Ethical Considerations
Professional ethics is a fundamental factor in any given scientific or social research and as such, the project has given this item due consideration to ensure accurate and fair representation. Initially, the project will seek legal authority from parties deemed relevant in giving project mandate. They will include the Saudi Ministry of Health (SMOH), RHC, RNH and SBAHC ethics committees. The research will ensure its response to the laid down research guidelines by the ministry and the research Ethics Committee (REC). In this study, the research ethical considerations that will be addressed shall include; confidentiality, informed consent, concept of no harm, and participant withdrawal. The following ethical considerations shall be important in the process of study.
Confidentiality and privacy policy
The research project will endeavor to assure research participants of their confidentiality and that of the information. Since the research shall depend on individual responses from persons volunteering information regarding the host topic, participants privacy shall be fundamental to ensure accurate and honest responses. According to Taylor and Kermode (2006), maintaining of confidentiality includes protecting data from persons unauthorized to access it or by coding data to create anonymity of the source or contributor. To ensure this, the research will design a confidentiality mechanism informed by research design to achieve objectivity of its findings.
No identification of personal details will come from participants to avoid either direct or perceived embarrassment that is likely to impair on the final research results. The research data obtained from field surveys, interviews and questionnaires will be confidential with no access to unauthorized persons. However, the initial design will ensure data coding to avoid mistaken reporting of some perceived personal details (Taylor & Kermode, 2006). In seeking objectivity and validity of participant response, the researcher will request participants to go through the privacy policy and inspect the information so gathered to maintain participants confidence (Polit & Beck, 2004). The data collected shall remain under lock and key in data stores and web portals accessible by researchers via security passwords (Taylor & Kermode, 2006).
Participant withdrawal
In this research, participation of respondents shall be free and voluntary. The participants in the research will have the right for informed participation, and of withdrawal without undue penalty. The research will endeavor to facilitate the participation of the respondents through practice of ethics and conduct necessary for respondent confidence in the researcher as well as the research subject.
The researcher shall communicate the study aims and objectives of the research in advance before commencement of data gathering from participants to prevent premature withdrawal of participants from the research study (Latimer, 2005).
No harm
There is a correlation between participant withdrawal and subsequent harm or punishment. As noted, no participant withdrawing from their involvement will suffer any disadvantage due to their action or omission in the research (Watson, 2008). This means that participation may be partial or complete in the sense that participants refusing to volunteer particular information express their partial withdrawal from the research exercise while those who resign from any form of engagement shall have completely withdrawn from their participation. As such, any of the actions taken by the respondents based on their perceived reasons shall not pose a liability on their side (Holloway & Freshwater, 2007).
Informed Consent
Before commencement of study, potential participant nurses will attend study briefings aimed at providing adequate information regarding the host topic. As prospective respondents, the researcher will request the student-nurses to ensure that all study requirements are clear to ensure that they do not compromise their consent. During the conference, nurses will receive study materials such as leaflets and brochures to ascertain their conceptualization about the study topic and participant requirements. To assure the researcher of their participation and consent, nurses will sign and return questionnaire to demonstrate their consent.
Dissemination of Findings
The research project aims at using the findings as a tool for mutual sharing to create value to stakeholders both directly and indirectly involved in the project. Dissemination of research findings will take place through guided sharing after the study as follows:
Findings will be used by the Saudi Nursing for purposes of symposium aimed at improving its operations
The research findings will be used by the Saudi Ministry of Health (MOH) as an instrument for future improvements in the nursing section
The research report will be made available to research participants
Research findings will be used in publishing of nursing journals
Presentations of these findings will be useful to both local and international conferences.
Project Funding
The project shall rely on the funding and facilitation from the Saudi Ministry of Health (SMOH). MOH is the main financier to this project since it is the primary party involved in researches conducted in nursing to improve the theory and practice of its nursing care. An overview of the funding needs of the project is as follows:
Table: Project Cost Estimates
Expense Item
Description
Cost (USD)
Transportation
Shall be all transport and movement costs involved in the facilitation of the project. This will be the major research cost due to extensive study area intended for coverage.
$3200
Stationery
These include all materials and equipments such as questionnaire printouts, pens, note books etc
$2400
Assistant in data collection
Since the process is intensive, assistance will be sought from persons to facilitate data collection
$400
Assistant in data analysis
Data analysis will be conducted by the researcher together with assistance from qualified professionals in data analysis. Their services will be outsourced at a fee to accomplish this task.
$500
Internet connection
Research costs from online searches for related literature on the study topic.
$100
Miscellaneous costs
This will include those other costs arising out of unplanned tasks not initially anticipated by the project. They will take care of the emergency and contingency cost items
$400
Total cost
$7,100
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HIV/AIDS is currently one of the greatest impediments to Africas development. Of more than 40 million people estimated to be HIV-infected worldwide, 95 percent live in middle- or low-income countries. (Biehl & Eskerod, 2007:4) Society is exposed to the risk of contracting the disease either due to ignorance or because of risky cultural practices. The situation is aggravated by the fact that it is extremely difficult to fight the spreading of this disease for no one knows where to start with AIDs. (Monette, 1988: 2) In this paper, therefore, I will concentrate on two culturally rich nations, one in India and the other in Africa: Sri Lanka and Kenya.
A crucial issue to examine with regard to HIV transmission is male circumcision. While modernization, with its negative implications such as mushrooming of prostitution, has been significantly responsible for facilitating the spread of HIV, modern techniques of education and community mobilization have been active in fighting the spread of HIV through condoms and other preventative measures. However, despite such milestones in understanding the infection, the battle is far from being over. Lorber and Moore suppose that circumcision is one of the main reasons for HIV spreading in Africa.
For the past decade, there have been reports in epidemiological and medical journals about the possible link between circumcision and HIV transmission. When the AIDs epidemic burgeoned in Africa, researchers noted that there was a lower incidence in areas where male ritual genital surgeries were common than where men were not circumcised. (Lorber and Moore 2002: 97)
Across the Indian Ocean to India, for instance, a similar situation prevails. HIV is spread because of the circumcision which is obligatory due to religious convictions. Religion as the basis of social culture in India has been a facilitator of the spread of the AIDS pandemic. In India, religion and culture have been identified as impediments to the fight and prevention of HIV-AIDS (Pisani 2008:83). Nevertheless, it is to be noted that religion and culture do not necessarily oppose prevention measures, but that some beliefs and practices found in these societies can facilitate HIV transmission.
Male circumcision, as a cultural practice among some traditional societies in Kenya, has contributed to HIV transmission of HIV, while the lack of circumcision in Sri Lanka has also led to high prevalence. In this paper, therefore, I set to prove that circumcision is an impediment in the fight against HIV and related infections.
The World Health Organization has estimated that 34% of men 15 and above worldwide were circumcised as of 2006 (CITATION). This translates to 665 million males. The larger uncircumcised percentage is largely due to religion, culture, and lifestyle. Religion as the main basis of culture has resulted in the entrenchment of the ban on circumcision to the culture itself. In the case of Kenya, we have seen that the Luos in Nyanza do not recognize circumcision as a rite of passage into adulthood, but just an unnecessary interference with human genitalia (Juma, 2005, p. 21). Pizer and Meyer (2008, p.136) say that 0.3 million HIV-related deaths and 2 million new infections over ten years can be averted through circumcision assuming an efficacy of 60% as has been observed in studies. According to the BBC, trials in Kenya found a 53% reduction in new HIV infections in heterosexual men who were circumcised while the Ugandan study reported a drop of 48%. Results last year from a study in 3,280 heterosexual men in South Africa, which was also stopped early, showed a 60% drop in the incidence of new infections in men who had been circumcised.
Circumcision
Circumcision is simply the surgical removal of the foreskin or the prepuce on the penis covering the glans. Conventional circumcision was done with the purpose of affecting hygiene and rite of passage into adulthood in Kenya and more so among the famous Maasai Tribe (Juma 2005:9). Circumcision in Sri Lanka is done purely for religious reasons. Some research has shown that the practice lowers the risk of contraction and transmission of the disease from another infected person during sexual contact. According to the Centers for Disease Control and Prevention (2008), there are four main reasons why the uncircumcised foreskin increases the risk of HIV transmission. These factors include:
The foreskin is more prone to keratinization, whereby the deposited cells are very likely targets for the HIV virus unlike the inner skin or any other penile tissue.
The foreskin is more susceptible to traumatic epithelial disruptions (which in other words may be explained as damage to the skin integrity due to the influence from the outside).
The microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival. (which means that the foreskin may serve as a place for bacteria accumulation).
The higher rates of sexually transmitted genital ulcerative disease, such as syphilis, observed in uncircumcised men may also increase susceptibility to HIV infection.
Other reports have indicated that Jewish women rarely get cervical cancer, a fact that Pizer and Meyer (2008: 142) partly attribute to male circumcision among Jewish men.
In Sri Lanka, the prevalence rate is less than 0.1%, based on the fact that approximately 3,800 Sri Lankans were found to be living with HIV as of the end of 2007. 60% of the total amount of HIV-positive people (280 cases) were male. As far as Kenia is concerned, 1.4 million people were registered as HIV-positive in 2007 (three out of five people were women).
Attitude to Circumcision in Kenya and Sri Lanka
Traditionally, circumcision is viewed skeptically in Sri Lanka. In Sri Lanka, there are no exact figures on circumcised males but given that the population is mainly Hindu, who religiously abhor circumcision, then it would be expected that a majority of men are not circumcised. In fact, according to Narvan (2008, p. 212), a circumcised man cannot be converted into a Hindu as his body is mutilated.
In Kenya, circumcision is very diverse given that over forty ethnic communities are found in the country. Several communities, such as the Luo and Teso in the western region of the country around Lake Victoria, do not practice male circumcision. As LA Times informs, other communities which embrace circumcision in the country as a rite of passage into adulthood have been accused of forcing their uncircumcised neighbors to undergo the cut.
HIV infection rates in Kenya have been declining at a steady rate prior to a surprising increase in 2008. In 2006, it stood at 5.9%, down from a high of 6.1% in 2005 and 6.7% as of 2004. In 2007, however, the rate increased to 7.8%. Women constitute the higher percentage among the infected at 65% thus being higher than the Sub-Saharan regional estimate of 57% according to a Kaiser family foundation report.
The Nyanza region, a province of Kenya situated on Lake Victoria, is largely occupied by the uncircumcised Luos has a relatively higher infection rate than other areas. However, this is not directly related to the fact that they are uncircumcised, but due to a lack of information about HIV. Circumcision rules are a bit different for the Maasai community. Among the Maasai community, circumcision is a must and performed for both boys and girls. Unfortunately, the communitys circumcision techniques can encourage HIV transmission. This is because the circumciser will often use one knife with no anesthetic to circumcise a single age group that could number over 50 boys at the same time. The practice has more often than not been extended to girls despite medical and religious opposition to the practice. As a result, the rate and chances of HIV transmission remain relatively high among communities practicing circumcision (Juma 2005:12).
In Kenya, circumcision is a sign of adulthood among majority communities. When performed as a part of an initiation ritual, the boys are expected to receive the surgery without flinching, lest they disgrace their families. It is preceded by a cold dip in a river to deaden the senses. Circumcision is such a public symbol, it is not unusual to hear a man say I have been to the river, to mean I know what I am talking about. Because of its social significance, youths who do not undergo initiation, either because the family lives away from the tribal area or they are in school, will arrange for private circumcision from a doctor or clinician. After his teens, an uncircumcised male is on the butt of ridicule and is at a considerable disadvantage in finding sex partners. A youth who cries out during the surgery is disgraced for life and will be able to find a wife only among the handicapped, elderly, or those with illegitimate children.
Many communities that do not practice circumcision avoid it for cultural reasons. 70% of Sri Lankans are Buddhist. Buddhism openly discourages circumcision by teaching that anyone who chooses to be a Buddha in following the eight paths to enlightenment must have a fully retractable penis (Nirvan, 2008, p. 188). The author goes ahead and says that Buddhism prohibits one from harming himself or another person. As a result, many Buddhist women will not condone a circumcised man. Therefore, the fear of rejection from women has also played a vital role in discouraging circumcision even as the world moves into encouraging circumcision in the fight against HIV.
In Kenya, the Kikuyu tribe believes that a circumcised man is wiser than an uncircumcised one. Though this might be viewed to have been directly picked from the Bible, Juma (2005, p. 13) notes that the community practiced this rite before the coming of missionaries; hence, it is engraved in their culture. The debate of circumcision has even been a source of tribal hostilities taking the form of forced circumcision. The Kenyan government together with NGOs has campaigned against circumcision in the cultural setting citing medical reasons. As such, some of the communities are having circumcision done on their young male members of society at hospitals. However, the project is facing resistance due to the relatively high levies charged. In the case of Kenya, hospitals charges range from $15 USD to $150 USD. Charges depend on the level of services offered, such as daily cleaning of the wound. With a majority of Kenyans surviving on less than two dollars a day, circumcision in hospitals is way out of reach for many of them; thus, they stick with the relatively cheaper traditional way (Juma, 2005, p.15).
Churches in Kenya have stepped in the rescue of the poor locals by offering subsidized services. Unfortunately, the locals are skeptical in a way as they still insist that the young circumcised boys miss an opportunity of getting some informal education about life and their culture. Pizer and Meyer (2008, p.136) note that demand for circumcision among the locals and Africa in general, would present a novel public health challenge for the financially challenged governments.
In Sri Lanka, however, there has been slow but encouraging progress in the number of persons embracing circumcision. Nirvan (2005, p. 218) attributes this to cultural interaction. He says that a majority of Sri Lankans living out of the country have undergone circumcision and, on their return home, recommended others to undergo the procedure. Similarly, women have realized medical and sexual benefits of circumcise and started slowly and carefully encouraging their men to be circumcised. Applying circumcision to the caste system would mean violation of culture. This is because circumcision would tend to bring about equality in the castes, which would not customarily be preferred.
Education in Fight Against HIV
Formal education has a large role to play in the fight against HIV. The fact that literacy levels in Africa in general remain low has led to the high prevalence rates in the sub Saharan region. As of 2004, literacy level in Kenya was 80.8%. This has presented a great challenge in the fight against the HIV pandemic. The government has, however, made substantial effort in the fight. For instance, it has been providing free condoms in public hospitals and other public social facilities (Juma, 2005, p. 11).
In the recent past, the government has also conducted campaigns for encouraging circumcision for men and banning circumcision for women. However, the progress in this direction is facing resistance from cultural taboos and perceptions. For instance, the Luo community has, in one way or another, felt that they are losing their cultural identity by undergoing circumcision. Information on the medical benefits of the procedure is not flowing fast enough amongst the folks in the rural areas due to low literacy levels (Juma, 2005, p. 11, 9).
In the global war against HIV, Sub Saharan Africa has largely been the recipient of billions of dollars in terms of aid from the US and other international parties. Much of this aid is utilized in informing and educating the public. The government has also introduced free anti-retroviral medication for all HIV victims. In part, this has encouraged the population to embrace HIV victims who are commonly associated with sin . The social stigma has, in many occasions, been blamed for the spread of the disease. According to the local dailies, the harsh treatment form the society has resulted into some of the victims hitting back by intentionally infecting other members of the society (Juma, 2005, p. 19).
Sri Lanka, as a relatively rich country, has been receiving little help in fighting with AIDs. This is because prevalence rates remain relatively low. The problem with African countries is that lack of information, such as on the dangers of unprotected sex, has been the main cause of high prevalence rates. For instance, among the Luo, wife inheritance is a common practice. This has been one of the major ways of HIV transmission (Juma, 2005 p. 21). In the case with Sri Lanka, prostitution is the number one method of transmission (Nirvan, 2007, p. 218).
Womens Views on Male Circumcision
Women in Kenya have been known to reject uncircumcised men. The men who refused to undergo circumcision are viewed as cowards as in the traditional setting, the practice is done with no anesthesia with the rest of the community watching. In Sri Lanka, uncircumcised male cannot be heir to his fathers wealth, cannot marry or officiate in tribal rituals Jones, 2006:92) In fact, he is considered to be not a man but a boy, and he is unlikely to attract any womans attention.
Some women believe that circumcision can be of great benefit for wives whose husbands are having sex with other women, since these women are often powerless to insist on the use of condoms. Other women were wary of an initiative that could give men an extra excuse not to use condoms. Most could assume that women from third world countries are shy when it comes to matters concerning sex. They consider that men know more about sex, so it is their right to decide when there will be sexual intercourse and what kind of protection will be used. Whatever he says goes. Some women may see this as the opportunity for men to suppress women even more.
Kenyas and Sri Lankas Government Fighting with HIV
In Africa, specifically Kenya, steps are already being taken to promote circumcision in a non-direct and forceful way. As circumcision is still considered culturally taboo, the Kenyan government is setting an example to show its people that it is okay to go through such a procedure. In other words, the government is sending a message that the Kenyan population will be safe, irrespective of the other cultures attitude towards their traditions.
The Kenyan government has a target of circumcising two million people, particularly in the Luo province, as this province abhors the idea of circumcision and needs more support in presenting the issue to the public. Top politicians from the area announced they had been circumcised to increase awareness about circumcision as a means of HIV prevention. In front of a wide audience in Kisumu, key figures such as Prime Minister Raila Odinga, three government ministers, and an MP said they had secretly undergone the operation.
Medical researchers are spreading the knowledge that most others in Africa cannot or will not acquire. They contend that circumcision reduces the risk of HIV infection among men. However, they will not mislead the public and assure them that circumcision is the only prevention. To maintain and promote basic safety, they have assured the public that using condoms is still far more effective and circumcision is just another step in fighting the infection and the spread.
The prevalence of HIV is high in the Luo community and the government has recently introduced a programme to promote the practice to curb the spread of AIDS. Unlike the nearby Luhya community, who last month turned out in large numbers to undergo circumcision in an annual festival, removing the foreskin is not performed as rite of passage amongst the Luo. Hundreds of young men have begun to turn up for circumcision at public and private hospitals. At the Lumumba Health Centre in Kisumu, more than 80 medical practitioners have already received training. We are teaching young men and older people about circumcision. They usually come for circumcision of their own free will, says Wycliffe Omondi, one of the doctors providing training at the centre.
Nearly 1,000 men have been circumcised since March and medical workers receive two days of training, claims Omondi. However, the Luo Council of Elders is not convinced that circumcision lowers the risk of infection. I dont think it will be a solution to fight the spread of Aids, said Joe Asila, a pastor and Luo elder. Other communities practise circumcision, but there is still a high prevalence of HIV.
The support of the local people in Luo has spread the idea that circumcision is indeed a safe approach to fighting the infection socially and medically. The forecoming success in Luo is bringing commotion in other parts of Africa as well. For example, in Malawai, hundreds of men are reported queuing at medical centres to be circumcised.
Unfortunately, after much research, there is hardly any evidence regarding the solutions for Sri Lanka either from the government, the people, or doctors. It seems as though the cultural and religious views of male circumcision are much more stricter and enforced in Sri Lanka than in Kenya or other parts of the world.
WHO and other international bodies have embarked on providing circumcision funding to governments and informing the public about the benefits of circumcision. Also, Family Health International (FHI), the Bill & Melinda Gates Foundation, and the Government of Kenya have come together to address this challenge. FHI has received a five-year, US$18.5 million grant from the Gates Foundation to establish the Male Circumcision Consortium (MCC). The Consortium, in consultation with the Government of Kenya, will conduct a range of research and training activities to determine the safest and most effective ways to provide voluntary male circumcision services. It will also help Kenya provide comprehensive and accessible HIV prevention in areas with the lowest levels of male circumcision and the highest prevalence of HIV.
Conclusion
Research has been directed at increasing the efficacy rate by combining it with other preventive measures. Unfortunately, the realization that circumcision lowers the chances of HIV transmission has encouraged more irresponsible sexual behavior. The sudden increase in HIV prevalence in Kenya, though not explicitly stated, can be attributed to this. Also, it is important to note that support is greatly needed from key figures in society. The idea to use persons of high caliber as an example for the public is a strong strategy to promote and encourage healthy lifestyles and to show to the public that looking after ones health plays a vital role in saving other peoples lives.
Despite current efforts to bring prevention and treatment to an ever increasing number of HIV-positive people, many hope for the availability of new approaches, including male circumcision. Not to be confused that this is a cure for the spread of HIV or AIDS, this promising prevention strategy must be counterbalanced with caution about the potential downfalls that could be encountered.
Health services in many developing countries are weak and there is a shortage of skilled health professionals. There is a need, therefore, to ensure that male circumcision services for HIV prevention do not unduly disrupt other health care programs, including other HIV or AIDS interventions. In order to both maximize the opportunity afforded by male circumcision and ensure longer-term sustainability of services, male circumcision should, wherever possible, be integrated with other services. Modeling studies suggest that male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.
Since male circumcision has been found to decrease risk of HIV infection among men, it is important to determine its acceptability as a potential HIV prevention strategy in Kenya and Sri Lanka. This reality and knowledge can finally bring us closer to bringing down the statistics of such a horrid pandemic.
References
Biehl, Joao & Eskerod, Torben. (2007). Will to Live: AIDS Therapies and the Politics of Survival. New Jersey: Princeton University Press.
Jones, A. (2006). Men of the global south: a reader. Zed Books.
Juma, M. (2005). Coping with HIV/AIDS in Education: Case Studies of Kenya and Tanzania, London: Commonwealth Publishing.
Lorber, J. and Moore, L.J (2002). Gender and the Social Construction of Illness, Rowman Altamira.
Monette, P. (1988). Borrowed Time: An AIDS Memoir. Harcourt Brace & Company.
Nirvan T. (2007). Religion and culture in Asia. Mumbai: Visionary.
Pisani, E. (2008). The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. New York: WW & Norton.
Pizer, H. and Meyer, K. (YEAR MISSING) HIV prevention London: Academic Press.
Steinbrook, Robert. HIV in India A Downsized Epidemic. NEJM, (2008).
The silent partner: HIV in marriage is a documentary filmed and produced in Kenya by Population Action International (PAI). It takes twelve minutes. To educate people on the realities of married women, the film was developed early in 2008 to expose the challenges of preventing HIV among them. It includes a broader approach to fighting HIV, like breaking social norms that tell people at risk. In a region whose fight against HIV is slowed by a lack of awareness, the film shows how traditional ways of fighting the pandemic fail to serve the needs of married women.
Purpose of the film
This documentary aims at giving other approaches to be considered in fighting HIV (Golon (2009, para.4). It advocates for the free flow of information, general discussions, and political and monetary support in the fight. Issues of reproductive health and human rights a part form HIV emerge as strengths of a cohesive society.
More robust policies, better preventive measures, and abandonment of harmful social customs can help achieve a better society. The film shows that educating men and women on the impact of reproductive health, improving counseling, and ensuring protection for all community members through a better legal structure is essential.
Services for HIV need to be integrated with reproductive health services to reach more married couples. We need to develop programs that encourage people to safe sex practices. Political structures need to be rectified to accommodate these policies that support the protection of women from inheritance problems even when they are infected. Domestic violence and other vices like rape and lack of schooling among girls need to be entirely outlawed.
Events in the film
The film begins by showing a group of women dancing while singing a local encouragement song. Next, the narrator introduces the topic in a brief background. Then, a local church leader, Pastor Mugambi, is brought on to issue his opinion on how gender discrimination frustrates the efforts in fighting HIV. Finally, a comparison is given between Zambia and Rwanda, where most HIV infections occur among cohabiting couples.
Marita Tabu Barrasso is a widowed HIV-positive woman shown doing some chores in her house. She has been previously involved in counseling others against HIV and can even display a certificate she received. The cause of the infection was not her fault, but people began to shun her as an outcast. Her family disintegrated immediately after her husband died, and now she has to struggle to feed her family.
We are shown everyday life on a street in Nairobi, but many people do not know their status. Women perform their chores, but they usually have no time to check their position because they are home caregivers. Men generally reject the proposal to know their condition. Women have been fighting for their rights, but the political system filled with male dominion only passed the sexual offenses Act in 2006. That was after a clause illegalizing rape in marriage was expunged. However, the male still doesnt want women to have a chance. Even at a soccer match, spectators say women must always obey what a man wants, and no woman can force her husband to use condoms.
As the documentary progresses, the strength of men is determined by the number of women you lay, one actuality says. Judy Atieno is a member of Women Fighting Aids in Kenya. She is HIV positive and has two young children. She represents many women in this region whose lives are shattered when husbands die. Too much dependency on men as breadwinners leads them to poverty. Even as the film ends with shots of people walking, the appearance of men and females are different. A couple is waiting for a bus on the sidewalks of a road; the man is more well-dressed than the woman. Perhaps she is just escorting him, after which she will return home. The reprieve is shown in a shot of a man and woman at a social function, and a close-up is shown of a man listening to a whispering woman. Perhaps to show that people have begun to listen to each other.
Positive Reactions to the Film
Both men and women must cooperate to end the HIV pandemic. In the documentary, through the Aids Control Council of Kenya (Whose head is male), the government gives facilities to those affected to continue awareness. In addition, many women groups have been allowed to help in counseling.
Most of those infected are now being accepted in the society that rejected them. Some, like Marita, are even counselors. Only through better communication can we bond with those affected by the pandemic.
The film involves the opinion of both men and women. To help resolve the customs problem, both males and females must be involved in the discussions.
There is hope in the documentary that the problem will end someday one day. This hope is what encourages everyone to contribute to the fight.
Adverse Reactions to the film
Some shots in the film were not ethical. Sometimes, the cameraperson focused on the behinds of women walking on the street.
This film shows many actions in an urban setting, while an introduction talks about sub-Saharan Africa in general; one expects to see both the urban and rural to know the extent of the pandemic.
In conclusion, this documentary was timely. A lot of the problems affecting social settings in the region can be alleviated through communication.
Reference List
Golon, N. (2009). The silent partner: HIV in Marriage Documentary Summary. Web.
Oyando, M (Producer), Golon, N (Director). (2008). the silent Partner: HIV in Marriage.
Nineteen-year-old So-Young stands at less than five feet tall after being chronically malnourished in North Korea. A refugee, she crossed illegally into China with hopes of a better life, but found instead a nightmare of sexual exploitation. An employer offered her approximately $1.40 per day in exchange for workmoney that So- Young planned on sending back to her family. Deceived by this empty promise, So-Young spent the next several months being passed between handlers. Just days before she was to be purchased by a forty-year-old Chinese man, So-Young managed to escape with the help of a local pastor. Three years later, she was forcibly repatriated to North Korea where she was imprisoned for six months before escaping once more to China. Traffickers kidnapped her once again, repeatedly raping her prior to her sale. Her new husband also raped her multiple times before she was able to escape. So-Young remains in hiding today: There are many people coming out of North Korea, but they dont have anywhere to go and no other choice but to go that route [into China]. (US Department of Labor)
I entered or, the first time I was prostituted I was eleven, when I entered the trade. So, very young. Younger than most. I was working the kiddie corner strip. (Vancouver Rape Relief and Womens Shelter)
Main body
Two separate incidents but same destiny. Caught in the racket of sex traffickers both the girls end up as sex slaves. This brings us only to face with an increasing truth of trafficking of women globally. Thousands of women and girls are trafficked across borders to a country they hardly know to work not as prostitutes but as sex slaves. US Department of Labor estimates each year, more than 2 million women of different age groups are exploited in the global commercial sex trade.
Sex trafficking has been identified by US Department of State as (a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age; or (b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. With increasing and prevalent demand for sex workers in the global market, there has been a boom in the commercial sex industry but has brought additional woes such as morality, criminality, and health threats of the victims. Presently the global commercial sex trade is an organized sector on which the economic successes of many countries like Thailand, Malaysia, Philippines, etc are depended on. The industrys huge turnover is an indication of the industrys commercial success but at the cost of lives of millions of women and children. This article discusses the success of the sex trafficking industry with globalization and impending health issues pertaining to HIV/AIDS.
With globalization of the world, economic order and business one of the oldest trades of the world are gaining international ventures. Sex trade in South East Asian countries like Indonesia, Malaysia, the Philippines and Thailand, Easterner European countries growing there are increased number of women and children being trafficked from these countries to the United States or Canada. Peter Landesman identified in his article in The New York Times magazine called The Girls Next Door recounts that these girls trafficked from Asia, Eastern Europe, Russia, all come with a dream and are shattered when they are forced into prostitution at very early age. The report also reveals the horrifying journey of the young girls and their plight. These girls are abducted, or bought, or shown the American Dream and transported through the porous borders of Mexico. The perpetrators of the crime are members of organized underworld crime racket who push young girls in this deplorable trade.
With the world becoming a global entity and increasing boons of globalization, there has evolved globalization of sex trade too. As globalization has reduced distances and the flow of information across borders, and allows its movement at high speed through impervious boundaries, sex trade too has evolved with technoscape and mediascape as identified by Elina Penttinen in her book Globalization, Prostitution, and Sex-trafficking. Elina believes that Technoscape &enables the overcoming of distances meets its shadow in the global sex industry . Like other trades that have benefitted from globalization, so has sex trade. Sex workers are treated as human cargos that have to pay their way through the trafficking process, and then earning revenue for her traffickers through sex enslavement. Similar fate is restored for sex slaves in Thailand. They are bought from poor farming villages in Thailand, as told by Kevin Bales, and are brought to cities as bonded labors, who are in debt for the amount they were sold:
Siris debt was 50000 bath rapidly escalated. Taken south by the broker, Siri was sold for 100,000 bath to the brothel where she now works. After her rape and beating Siri was informed that the debt she must repay, now to the brothel, equaled 200,000 baht. In addition, Siri learned of the other payments she would be required to make, including rent for her room at 30,000 baht per month as well as charges for food and drink, fees for medicine, and fines if she did not work hard enough or displeased a customer. The total debt is virtually impossible to repay, even at Siris higher rate of 400 baht. About 100 baht from each client is supposed to be credited to reduce her debt and pay her rent and other expenses; 200 goes to the pimp and the remaining 100 to the brothel. By this reckoning, Siri must have sex with 300 men a month just to pay her rent (Bales 41)
Sex trade thus has become extremely profitable, as has been identified by Elina too, who further identified sex trade similar to drug trade, with lesser risk associated. The financial benefits of sex trade have been accentuated with the utilization of information technology.
Another catalyst of trade through the globalization process is information technology. The possibilities produced through information technology, namely the Internet, are enormous. The Internet acts as the medium through which information regarding commercial sex is passed on and also serves as the venue for much of the sex business. It provides opportunities for accessing mail-order-bride catalogues, buy escorted tours in sex tourist destinations, and also acquire information regarding prices of sex workers all across the globe. The sale of international prostitutes or brides and live strip shows on the internet, as Elina points out, decreases the cost of the business also makes these services more easily accessible for clients worldwide. (46)Clearly there are no need to print expensive model portfolios, color pictured catalogues can be uploaded which can be viewed by all or live strip shows or pornographic videos can be transmitted to customers with minimum cost. This increased scope and accessibility of global sex industry and its developments, thus, can be associated with globalization.
The increase in globalization of sex trade and the deteriorating social and mental health of the world has evolved as a major concern. There is increased concern of AIDS problem among sex workers which is making their life even more miserable and ending their lives as social pariahs. Kevin Bales narrates the story of a fifteen year old girl:
Siri is very frightened that she will get AIDS. Long before she understood prostitution, she knew about HIV, as many girls from her village returned home to die from AIDS after being sold into brothels. (Bales 36)
The occurrence of AIDS among sex workers have increased considerably over the last few years. The UN Report on the Global Aids Epidemic, 2008 estimates that in virtually all regions outside sub-Saharan Africa, HIV disproportionately affects sex workers ( among other causes like injecting drugs, etc.) the most. The report points out that sex work is one of the major causes of the HIV/AIDS epidemic with an estimated amount of 20 percent of the sex workers being infected by the virus. The report also identifies that in many countries like Cambodia, Thailand, India the adoption of condoms during commercial sex there has been a marked decline in infection rate. In Cambodia, the adoption of condoms during commercial sex increased from 53 percent in 1997 to 96 percent in 2003 and there has been a subsequent reduction in HIV prevalence among sex workers from 44 percent in 1998 to 8 percent in 2003. But the scene is not very optimistic with only 14 percent of men who buy sex have reported to use condom. Clearly, the plight of sex workers remains to be exploited for the two or four years of their enslaved lives and then die with the fatal virus.
Even though the International covenants and protocols obligate criminalization of the commercial sexual exploitation, official data shows that sex trafficking amounts to a significant piece of overall trafficking and the in the end forms the basis of transnational modern-day slavery. Sex trafficking would not exist without the demand for commercial sex flourishing around the world. The U.S. Government adopted a strong position against prostitution in a December 2002 policy decision, which notes that prostitution is inherently harmful and dehumanizing, and fuels trafficking in persons. Turning people into dehumanized commodities creates an enabling environment for human trafficking.
Conclusion
The lives of girls who get entrapped in the vicious circle of sex trafficking seldom find respite. They are always haunted by their past, their present, and their future. Very few girls can escape the life of abuse, exploitation, and degradation. Even if they do, they have nowhere to go they do not have a family to go back for many will not take them in, or for the fear of being killed or getting their families killed, law enforcement authorities are the last place to go as legal system in many countries (even in the US) view them as anti-socials and trespassers in their country. These girls, still young, are broken. They resign their fate to destiny and live their life in brothels.
References
Bales, Kevin. Disposable People. London: University of California Press, 2000.
Landsman, Peter. The Girls Next Door. The New York Times 2004.
Penttinen, Elina. Globalization, Prostitution and Sex-trafficking. New York: Routledge, 2008.
United Nation. Report on the global AIDS epidemic. XVII International AIDS Conference. Mexico City: UNAIDS, 2008.
US Department of Labor. Human Trafficking Reprot. 2008. US Department of Labor.
