Category: HIV

Introduction

The Russian HIV crisis is getting worse, found to have the greatest number of people living with HIV (PLWH) in Europe and the fastest increasing number of new cases by 10-15% each year (UNAIDS, 2016), Russia’s epidemic is not improving. The consequence of this is HIV/AIDS now rising to the top ten causes of mortality in Russia (IHME, 2017). In this essay, it will be discussed why this high-income country is far more affected by the virus than many other countries of the same resources and what are the impacts of this on the individual.

Availability of drugs

The cost of the ARV’s available are very high in Russia compared to the generic cost of treatment most other countries pay per person per year (ppy). For first-line treatment, the average generic price is $115 ppy while the Russian pays more than $1000. (Frontline AIDS, 2019). The cause of this is the government sourcing the drugs from originator companies when part or all of the treatment regimen is under patent. As a result, many people cannot access these drugs because they are too expensive for health centres to purchase on government budgets.

An example of the lack of access to ARVs in Russia is Dolutegravir (DTG) recommended by the World Health Organisation in July 2019. However, ViiV healthcare was granted patents on DTG, meaning exclusive rights on the drug until 2026. However, major donors put forward a price deal of $75 ppy for DTG for many. Yet Russia, who chose not to be involved in the license are still required to pay $1871 (Frontline AIDS, 2019). It is precisely patents like these combined with the lack of involvement of the Russian government that leaves Russian citizens with no treatment, resulting in a growing population of PLWH.

Social mechanisms that contribute to health

The life of someone living with HIV in Russia, looking through the social perspective, is greatly affected by wider society, which sets up multiple social barriers that affect their equality. A study (Amirkhanian Y, et al., 2003) revealed 48% of participants were forced by doctors or police to sign conformation of their HIV positive status, which then may be used for criminal charges. Through the abuse of power by authoritative figures in society, the judgment they display ripples into the general population. The effect of this is individuals face challenges in their life, shown by a follow up 2011 study (Amirkhanian Y, et al.,2011), showing nearly 25% of persons refused health care, 11% refused employment and 6% made to move out of a family home because of their HIV-positive status. It must be taken into account however both the studies by Amirkhanian were only done is St. Petersburg meaning a small sample size in comparison to the whole of Russia but also different experiences in more rural places are not present.

A clear example of the neglectful response by the government is the 2016 budget of $325 million, which is a fifth of what is estimated to improve the epidemic (AVERT,2019). Following this, in January 2017, the Ministry of Health’s request of $1.2 billion to implement the 2017-2020 National HIV/AIDS Strategy was rejected by the government (AIDSpan.org, 3 April 2017). The failings of the government to adequately respond to the epidemic contributes to the increased prevalence of HIV and the general feeling of neglect of PLWH. This lack of funding has led to a lack of specialists in Russia’s healthcare, with only 100 HIV/AIDS centres in the country, which is no longer sufficient for the estimated one million PLWH (AVERT, 2019). This lack of funding also means no change in policy of discrimination in health care and the workplace or campaigns to tackle the stigma that resides in HIV.

Two major groups that are of the highest risk of contracting the virus but also the most targeted by social attitudes and repressive government policy are people who inject drugs (PWID) and men who have sex with men (MSM). PWID are shown to be the most at risk for HIV in Russia due to the culture of sharing needles (UNAIDS, 2016). An example of the damaging Russian government policy is banning opioid substitution therapy (OST), although recommended by UNAIDS and the World Health Organisation. The therapy has been found to reduce drug use and vulnerability to HIV and tuberculosis (UNAIDS, Do No Harm 2016). Without this therapy patients admitted to the hospital, who inject drugs, are unlikely to remain in hospital due to severe withdrawal effects resulting in them returning to the high-risk environment of sharing needles. The power imbalance between the police and PWID also contributes to social inequality, with 60.5% arrests of PWID due to police planting syringes or drugs (Lunze, et al., 2014). This supports the assertion that punitive drug laws contribute to the HIV risk environment of PWID because the more repressed drug users are the more it reinforces the hazardous use of needles. Furthermore, planting drugs on PWID as a pretext for arrest violates their rights. Furthermore, due to Russia reaching a high-income country status, the global fund has been removed and without reinvestment, by the government, the needle exchange programs (NSP’s) have been shut down despite the increasing HIV levels. As of 2018, a very small number of twenty NSP’s are offered in all of Russia (AVERT, 2019).

MSM also have an oppressive environment created by negative social attitudes and unhelpful laws such as the gay propaganda law which has made it difficult to reduce stigma and transmission. Since 2013 the policy has made it illegal to post information about being gay, even if It is strictly informative. The result is a lack of education on safe sex and therefore failure of reduction in transmission or risky behaviour. Akin to this is the code 103 required by all clinics to follow, where if HIV is diagnosed for a male, the patient must disclose how the virus was contracted. If from gay relations it is recorded and can be used by the police for evidence for prosecution. The two major effects of this are the actual number of people with HIV in Russia is unknown as many refuse to go to a clinic out of fear and these people that do not go cannot get the ARV drugs they need to not spread the virus. In Moscow, Russia’s biggest city, only 9% of HIV positive MSM are on ARV therapy (Mogilnyi et al., 2016). Moreover, Pre-exposure prophylaxis is not available in Russia despite numerous studies stating its use in reducing transmission close to zero with no significant side effects (McCormack, S et al.,2014). (Fonner et al., 2016).

Individual mechanisms that affect health

The neglected epidemic in Russia has caused the prevalence of HIV to increase but the population is affected further than this as a result of stigma and discrimination. To look through the individual’s perspective, someone living with HIV are more specifically affected by the stigma and abuse they face in their daily life. This leads to mental health issues and a greater probability they will engage in high-risk behaviour as they feel their actions are taboo and to be done in secret. These negative social attitudes towards the marginalised HIV population only exacerbated by policies that repress their rights, safety, and legal protection, increase one’s vulnerability to discrimination and harm to their psychological needs.

The most recent study done on mental health issues and high-risk behaviour concerning HIV in Russia is by Amirkhanian et al., (2011). The study made a few summary points, the first being out of the people in the sample with HIV, 58% had a sexual relationship with HIV-negative partners, of them, 52% engaged in unprotected intercourse. Of the PWID in the sample, 47% still share needles. It is obvious from these statistics that those who become aware of their status are out of touch with any information to help or guide them and surrounded by stigma the individual is reluctant to reach out. As a result, the risky behaviour which they engaged in is continued which will inevitably cause a spread of HIV possibly to people outside these high-risk groups.

This social suppression of HIV populations is linked to an increase in mental health problems. For the individual this can result in a breakdown of relationships and livelihood. A few examples by The Guardian (Cain, 2017) have shown the effect of stigma on one’s lifestyle, Katia explains “if I told my father I had HIV, he wouldn’t understand. He’d run away from me” or Vladislav, who lost his job when he revealed his status. The breakdown of the individual’s life usually results in isolation and fear of being targeted further and therefore increased risk of developing a mental illness. The same study by Amirkhanian et al., 2011 revealed that those living with HIV in Russia have higher psychological distress levels than normal, 39% with probable clinical depression, and over 37% having anxiety levels similar to psychiatric patients. The devastating effect of a highly stigmatised and discriminated population is shown through such high levels of psychological distress.

Conclusion

Although the HIV crisis in Russia needs immediate attention there is still a lack of recent and accurate figures due to the fear and stigma surrounding the virus, which only impedes further progress. The lack of involvement from the government in multiple spaces means no funding for drugs and new centres to reduce transmission and no campaigns to limit discrimination in the workspace and health care. As a result, we are seeing an increase in both prevalence of HIV but also psychological distress of the sufferers.

When the social status nor the circumstances are no longer coherent, a global pandemic ascends as people continue to scramble off in ignorance. The Human Immunodeficiency Virus or infamously known as “HIV” is a major social implication that everyone must aware of. As noted by the World Health Organization (2017), HIV is a virus known to corrupt the cells of the immune system—deteriorating and impairing their respective functions. As a result of handicaps, HIV may evolve forth into its advance stage, AIDs, which is more noxious and incurable. Nevertheless, statistics by the Global Health Observatory (2017) states that about 70 million people are infected with HIV, 35 million have perished while 36.5 are currently fighting the said virus. Needless to say, that HIV is a rising medical issue, some people who’ve ought to combat HIV are still present in the contemporary. With persistence and positivity, these people do not only deal with the said ailment but also with the people who constantly criticized and degraded their beings. The aforementioned people are simply the society putting on its facade. In 35% of countries (including the Philippines), 50% of the people are described to have a discriminatory attitude amongst people with HIV. Regardless of having HIV, discrimination and bigotry are two factors that hinder growth and acceptance in society. Without being said, HIV continues to be an urgent issue given the pandemic nature and the baseless claims held by society.

According to Nall (2018), cases of HIV are first found in a country named Congo were hunters that kill chimpanzees for a living accidentally have contact with the animal’s blood. By 1968 few cases of AIDS are found in the Midwest by transferring HIV through sexual intercourse. The year 1980 is the vast spread of AIDS all over the United States of America. Through its vast spread and a scandalous way of transferring from one person to another. HIV has been one serious implication in society. According to Cloete, et al. (2010), HIV – positive patients tend to have fears of being rejected and discriminated not by gender but by their health status. AIDS-related stigma includes being called a ‘whore’ or a person who sleeps around a lot. For some patients that are members of the LGBTQ+, they’ve been told that AIDS is a ‘black’ and a ‘gay’ disease. The said stereotyping boils down to the argument of discrimination and bigotry amongst people diagnosed with HIV. HIV stigma and discrimination affect the emotional well-being and mental health of people living with HIV. People living with HIV often manifest the stigma they experience and begin to develop a negative self-image. According to Sidibe (2017), Internalized stigma or self-stigma happens when a person takes in the negative ideas and stereotypes about people living with HIV and start to apply them to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and hopelessness. These feelings can keep people from getting tested and treated for HIV. There are ways on how a complex issue as HIV stigma can be addressed. Some small things will make a big difference. According to CDC (2019), The words we use matter. When talking about HIV, certain words and languages may have a negative meaning for people at high risk for HIV or those who have HIV. We can be part of the movement to stop HIV stigma by being intentional and thoughtful when choosing words and to use supportive rather than stigmatizing the language when talking about HIV. Talking openly about HIV can help normalize the issue. It also provides opportunities to correct misconceptions and help others to learn more about HIV. According to Stang, A.L. et al (2013), HIV stigma is continuous in a fear of HIV. The lack of information and awareness combined with outdated beliefs lead people to fear to get HIV. Many people think of HIV as a disease that only certain groups get and the most common group is the LGBTQ +, which leads to negative value judgments about people who are living with HIV. According to Wei Chong PH., et al (2016) Social stigma and discrimination, based on an individual’s behavioral characteristics or identity, and HIV-positive status, are major barriers to accessing HIV prevention and services, including HIV testing and counseling, among men who have sex with men worldwide. As a result, MSM (men who have sex with men) do not reveal their same-sex behavior to others including health care workers. They also do not access HIV prevention services in fear that their sexual identity would be exposed or they would encounter discrimination from health care workers.

Famous figures like the famous singing legend from Queen—Freddie Mercury, has uplifted and motivated people who have HIV. HIV, often depicted as life-long sickness, does not ridicule a person’s essence and humanity. Thus, programs and motivational talks are manifested to voice out awareness with regards to the said communicable disease. As stated by Meiers (2012) , topics such as HIV/AIDS must empower people into changing their mindsets, lengthening their patience and fostering empathy towards people to voice out their fears and confusion. By shedding light upon people who have HIV, the shame and humiliation that they are withholding are terminated and thus, are used as transformed into fuel to spread well. In doing so, Serophobia—the fear of people with HIV/AIDS—is invalidated for the real fear is what society has to utter. “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that” said Martin Luther King, Jr., which serves as a reminder to not foster hate but rather to extend love to the sick and deprived.

In conclusion, education is the key that unlocks all doors that conceals ignorance. The implementation of school-based sex education is still taken into proper deliberation for it may spark into irksome ideas. HIV is a major social implication that is frankly present in contemporary. Although the said disease is uncurable, preventive measures and proper knowledge may prevent from acquiring it. As recently recommended by the Centers for Disease Control and Prevention (2019), the only way to impart information and awareness about HIV is to get tested yourself. Disclosing a person’s HIV status may pave off better treatment to prevent getting into worse scenarios. Hence, the proper knowledge can outweigh ignorance so that acceptance may overcome hatred.

Human Immunodeficiency Virus, or otherwise known as HIV, is an autoimmune disease, causing harm to those infected by attacking the immune system (NHS, 2020). This attack on the immune system leads to symptoms including tiredness and reduced ability to fight off other illnesses (NHS, 2020). Once an individual has suffered from HIV for around 8 to 10 years, whilst receiving no treatment, the virus turns into Acquired Immune Deficiency Syndrome, which is also referred to as AIDS (Mayo Clinic, 2020). Deemed as an epidemic, it is estimated between 23.6 million and 43.8 million have died from HIV/AIDS since it first broke out in 1981 (UNAIDS, 2020). HIV/AIDS is most commonly spread through unprotected sex or sexual activities, which is going to be discussed in this essay. When considering gender relations, it is extremely important to emphasize its relevance upon the spread of HIV/AIDS and analyse how both genders play different roles in spreading the virus which will be discussed throughout. Furthermore, it is crucial within this discussion to analyse the relevance of poverty concerning the efforts to provide treatment. The treatment introduced to help combat the spread of HIV/AIDS does not consider the implications of the medication upon those in extreme poverty. This essay is going to address both the extreme relevance of gender and poverty in terms of the spread and treatment of HIV and AIDS, by developing the points touched on above with reference to ethnographies such as Simpson (2009), Bentely et al., (2004) and Kalofonos (2010).

Whilst considering how gender relations are particularly important in terms of the spread of HIV/AIDS in Africa, we can first turn to how particular groups of young males in Zambia participate in the narrative of having extramarital sexual partners. As a consequence of the males having sexual relations with both their wife and extramarital partner, there is an increase in the likelihood of spreading HIV/AIDS between all three people (Mantell et al., 2006). This can be supported by UNAIDS (2004), who identified that women most commonly become infected with HIV and AIDS as a result of unprotected sex with a male who tested positive for the virus. Similarly, this behaviour has been identified in Simpson’s (2009) ethnography investigating ‘Boys to Men in the Shadow of AIDS’, which analysed the relevance of masculinities in relation to the spread of HIV/AIDS in Zambia. In the ethnography, the narrative that having multiple sexual partners outside marriage was recognised as a feature of African sexuality (Simpson, 2009). One of the several men interviewed included Promise, who would engage in unprotected sex with his girlfriend, Doreen, after drinking and becoming “loose”, then would return home and have unprotected sex with his wife (Simpson, 2009). Promise justified his unprotected sex with multiple people based on the common narrative that if he were to ask his wife, Susan, to use condoms then the wives would then have evidence of their girlfriends. Promise explained this, claiming: “[t]here is a problem in marriage if you decide to use a condom. The wife will not trust you. She will suspect. Why? Why are you using a condom?” (Simpson, 2009, p.104). Therefore, men fear asking their wives to use condoms, which exacerbates the spread of HIV/AIDS, as not only are these particular group of men believing that it is acceptable to have a wife and girlfriends, but they will have multiple different girlfriends throughout their lifetime. This Zambian case demonstrates how gender relations play a significant role in the spread of HIV/AIDS throughout Africa. Through the belief and social acceptance of having multiple partners, Zambian males play a considerable role in spreading the virus. Within this small group of men interviewed in Simpson’s work, the prioritisation of not damaging the little trust within their marriage means that they instead choose to put their health and others health at risk, by risking the contraction and spread of HIV/AIDS.

Whilst considering gender relations and the imbalance between them, concerning the spread of HIV/AIDS as discussed above in particular groups of males, there has been a focus on trying to encourage female-initiated prevention methods, such as the female condom. Through focusing upon female protection methods, such as female condoms, it removes issues surrounding males’ fears about using condoms as discussed above (Mantell et al., 2006). Therefore, if the women were to take control of contraception, if they had suspicions surrounding their partner’s behaviour, they could break the imbalance of power between the male and female, and choose to use the female condom without their partner’s permission. However, the issue of trust within relationships becomes a further issue, rather resulting in the male to suspect the female of being unfaithful. Bentley et al., (2004) conducted an ethnography exploring the international perception surrounding female-initiated prevention methods in regards to the spread of HIV/AIDS. Focus groups in Zimbabwe and Malawi reveal the possible distrust caused, with one male participant claiming “If I want to be promiscuous, I can take this product and give it to my partner. It shouldn’t be sold to women, because they will just use it to have sex with other men” (Bentley et al, 2004, p.1161). Here, this participant reveals how gender relations make it difficult to limit the spread of HIV/AIDS in particular groups within Africa in multiple ways. Not only do these groups of men resist using condoms themselves, but also resist women trying to protect themselves. This supports the view that gender is important when considering the spread of HIV/AIDS, as clearly some groups of men are spreading the disease more than women due to their reluctance to use condoms.

Poverty plays a significant role in influencing the treatment of the HIV/AIDS epidemic in Africa, particularly those with very low or no income. The treatment for HIV/AIDS is an antiretroviral drug, which is commonly referred to as ARV, which aims to reduce the effects of the disease on the body (WHO, 2020). This medication is successful on the basis that it prolongs the patient’s life compared to if the medication were not taken. Evidence of this success can be identified in KwaZulu-Natal, a province of South Africa, where the introduction of free ARVs has had a significantly positive impact, by extending the lives of those HIV/AIDS positive by around 11 years (Cousins, 2016). Despite the success of this treatment for particular individuals, being placed on this medication ultimately has extremely harmful effects for those who are suffering from poverty too, due to the increased hunger caused from the medication (Kalofonos, 2010). Kalofonos’ (2010) ethnography consisted of in-depth research into the impacts of the ARV treatment, particularly of the poorest in the society, conducting participant observation in testing centres and HIV/AID clinics. In Manica, Mozambique, around 54% of the general population were suffering from extreme poverty, spending less than one dollar a day, and it would cost $0.40 (or 9.6 meticais) to access the correct amount of food a day (National Directorate of Planning and Budget, 2004). In Kalofonos (2010) Batista discusses his conditions as a HIV positive patient. Batista had a stable job for 8 years, and casual work after losing his job due to the company closing. A consequence of him becoming ill meant this work stopped. Batista was responsible for his 14 family members, to provide food for his family alone it would cost around 4,000 meticais, however, at the time of the ethnography, the month prior he had only earned around 300 meticai (Kalofonos, 2010). The World Food Program in Mozambique provided food packages for individuals which consisted of “36 kg of rice, 18 kg of Corn-Soy Blend, 6 kg of beans, and 1.5 litres of oil” (Kalofonos, 2010, p.368). This is considered a sufficient amount of an individual, however, for Batista and others alike who are responsible for a large number of people the amount does not suffice. Once the food is divided up amongst Batista’s family of 14, those ill with HIV/AIDS do not get access to enough food in comparison to what their body is demanding. It is important to note that Batista was considered to be affluent in Manica. In comparison to others in the area, many would be deemed too unfit to work and would therefore be suffering from higher levels of starvation and deprivation. With his low income discussed above, this is how poverty hinders the treatment of HIV/AIDS. These individuals with low or no income cannot afford to sufficiently top up the food packages they receive to the necessary amount. As a result, many are dying due to the hunger caused from their ARV treatment and limited employment opportunities causing poverty.

In regards to the impact of poverty on the efforts to provide treatment, organisations were established to help limit the impact of not having access to sufficient amounts of food had on HIV/AIDS positive individuals whilst receiving treatment. These organisations intended to provide food for those in need and suffering from HIV/AIDS, however, they had limited funds and the number of those suffering from HIV/AIDS made demand outweigh supply. Further problems included the corruption in the process, for example, it was speculated the food supplied which was intended to help those most in need, was rather being sold for profit or not being distributed to the most vulnerable (Kalofonos, 2010). At World AIDS Day 2005, an association member, Serafina confessed after watching the governor of Manica speak “[t]hey are all eating the money themselves.” (Kalofonos, 2010, p.372). The consequence of these suspicions, therefore, has led to some non-government organisations withdrawing the help from these countries, which further inflates the problem of poverty and its impact upon the treatment of HIV/AIDS, leading to more suffering from starvation.

To conclude, this essay has explored how both gender and poverty have a significant influence on the spread and treatment of HIV/AIDS in Africa. Regarding gender relations, particularly men’s sexual behaviour encouraged the spread of HIV/AIDS, such as Promise, who was having unprotected sex with both his wife and consecutive girlfriends (Simpson, 2009). Gender relations impacted this, as he believed it was down to the women to provide the condoms. The resolution to fix the impacts of gender relations explored have been ultimately unsuccessful, due to the continued theme of suspicion if a female were to take control and use female prevention methods. Moreover, the impact poverty has upon the efforts to treat HIV/AIDS was analysed, revealing how even with the introduction of free ARV medication prolonging the lives of patients, these individuals are suffering due to extreme poverty prohibiting them from accessing the food they need, as identified in Kalofonos’ (2010) ethnography. The organisations set up to try and combat the implications of poverty upon efforts to provide treatment were ultimately redundant due to the corrupt organisation, prohibiting the supply of food reaching those most in need, further fuelling the impact poverty has upon those receiving treatment. Considerable work is necessary to help resolve the consequences of gender relations and poverty upon the spread of HIV/AIDS. There needs to be a paradigm shift in the understanding of how both genders are impacting the spread of the disease and education for both genders. Although there needs to be a nationwide change, it is important to approach the issue at local scales due to vast socio/economic/political variations between countries in Africa (Coast, 2006). Resolving the impact of poverty is reliant upon the honest organisation and distribution for those most in need whilst suffering from HIV/AIDS, ensuring that those with no income or extremely low income receive sufficient amounts of food for themselves and the family. In summary, both gender relations and poverty are extremely influential upon the spread of HIV/AIDS in Africa, and will continue to be influential until problems within these societies are resolved.

Introduction

Papua New Guinea (PNG) is a country faced with an array of diseases with malaria being one of its mascot epidemic as the tropical Climate facilitates external breeding environment for malarial parasites. However, HIV has gained rapid popularity since the first recorded case of an infected patient diagnosed in 1987 (The Virus Spreads, 2014). Human Immunodeficiency Virus or commonly referred to as HIV is a type of virus that weakens the immune system by attacking the CD-4/ T-Helper Cells of White Blood Cells that protect our body from disease causing pathogens.

[image: Image result for HIV virus]Once HIV effectively weakens the immune system, the host’s body is left in a condition called Acquired Immune Deficiency Syndrome (AIDS). Thus, the patient is susceptible chiefly to developing TB and Pneumonia. HIV was reported to have infected 75 million people and killed about 32 million people globally by World Health Organization (HIV/AIDS, 2017). But, the essay will scope out few of the many characteristics; like its signs and symptoms and diagnostic tests, treatment options and practical measures that prevent its spread. And also discuss why HIV is a public health issue and the role of a physiotherapist in the management of a diagnosed patient’s management.

Characteristics

Signs & Symptoms and Diagnostic Tests

Firstly, an infected patient with HIV is referred to as a carrier. A carrier might be infected with either one of the two types of HIV; HIV-1[footnoteRef:1] or HIV-2. Regardless of the type of virus the host will experience common signs and symptoms: [1: HIV-1 is more common than HIV-2

HIV-2 is more genetic; it is specific to people in parts of West Africa ]

SIGNS SYMPTOMS

• Fatigue -Fever
• Swollen Lymph Nodes -Ulcers in the mouth/tongue
• Weight loss -Abdominal pain
• Chronic Diarrhea & persistent vomiting -Opportunistic diseases

Doctors access obvious signs and symptoms but it’s not that simple to determine whether its HIV due to the fact that Cholera and TB display similar signs and symptoms. Saliva and Blood is collected for Enzyme-Linked Immunosorbent Assay (ELISA) Test for a more precise result. A positive ELISA Test usually indicates that the patient is positive with identifiable antibodies in the blood that were produced by the virus upon infection.

Treatment Options and Prevention

There’s no cure for HIV/AIDS because it is a retro-virus. A retro-virus only has RNA and an enzyme called reverse transcriptase that facilitates its conversion into a DNA strand inside the host’s cells. The DNA strand cunningly incorporates itself into the host’s DNA, where more of the virus is produced. In this advanced science and medical age, far better treatment is available for patients to increase life expectancy[footnoteRef:2] and live healthy and normal lives. The main anti-retroviral regiment available for HIV patients are a group of medicine taken in combination which is collectively called Antiretroviral Therapy (ART). ART is administered by specialists like Infectious Disease Doctors or General Practitioners to suppress the growth and infection rate of the virus. [2: Life Expectancy: average number of years a person is expected to live. It varies in different countries. ]

Overtime, doctors and scientists have ultimately come to know and understand more about the disease than ever before. The search for the cure has been so long and yet, doctors and scientists are persistent and diligent in the laboratories currently trying to come up with even more improved treatments and possibly a cure.

Moreover, studies in 2010 have shown that the number of deaths by HIV/AIDS has declined from 1993-2000 mostly because of preventive measures applied by both infected and non-infected within a given population (Brady, 2010). Health Promotion and HIV/AIDS awareness plays a vital role. HIV is almost all the time transmitted via unprotected sex with an infected partner but there are other ways HIV is viable to be transmitted, thus preventive measures are fundamentally important.

Preventive Measures

• Get tested for HIV and STDs
• Refrain from risky sexual behaviors
• Have one sexual partner
• Use Condoms
• Use sterile needles & razors

There are also ways that you cannot contract HIV where most people are so sensitive about and always end up discriminating and stigmatizing an infected person. HIV is not transmittable through sharing of eating utensils, kissing, dry humping and hugging or even cough because it is not an airborne disease.

HIV a Public Health Issue

Secondly, PNG was distinctively ranked 145 out of 177 countries in the world infected with HIV/AIDS in 2008 (Dinnen, Vicki Luker and Sinclair, 2009) . HIV/AIDS has caused a havoc socioeconomically and spiritually in a developing country who is trying to keep up with the ever changing world. With lack of basic health services in the remote areas with little to no access by roads, geographically mountainous and the only way to deliver health services is by small cargo-planes. As a consequence, ART Treatment is usually at one major town or city. Therefore, an infected person is vulnerable to spread the disease between the imbalance of ART availability and access. The Highlands Region of PNG has the largest HIV/AIDS population with Enga Province leading the prevalence rate[footnoteRef:3]. [3: Prevalence rate is the proportion of persons in a population who have a particular disease at a specified point in time or over a specified period of time]

Certain cultural practices also encourage the steep infection rate where in some provinces like Chimbu, young people usually come together in a ceremony colloquially known as ‘kukim nus’ to dance in sitting position beside the fire and then have sex with one or two partners at a time. The people of Oro, Central and Sepik Province have long been known for their initiation tattoos which the virus can be transferred from the needles. All aspects considered, HIV/AIDS is a major public health issue in the country.

On the other hand, first world countries like Australia, have much lower prevalence rate and have a sense of control over the disease. ART and testing clinics for HIV and common STDs are strategically placed in every rural areas as well as in major cities, towns and suburbs.

Patient Management by Physiotherapists

Thirdly, the need for Physiotherapists and Rehabilitation for the management of diagnosed HIV/AIDS patients have never been realized until recently. Besides the common symptoms arthritis, sloppy gait, osteoporosis & dyspnea are obvious areas where a physiotherapist can correct. Patients are referred to a physiotherapist after stable treatment that shows the patient’s positive progressive recovery.

A physiotherapist help improves the patient’s gait by having the patient walk on treadmills and doing simple muscle strengthening exercises like stepping-over objects, climbing stairs and lifting small weights. Patients are also advised to do push-ups and squats for joint compression. Dyspnea can be a long term symptom for HIV/AIDS patients however, breathing lessons can reduce some extent of the difficultness.

Proper diet for sufficient bone growth and healthy bone rehabilitation is best recommended by a physiotherapist.

Conclusion

Finally, to conclude, HIV is a very unique communicable disease and cunning that even our immune system is fooled. By the time the immune system realizes its presence, its already too late. HIV/AIDS is killing and infecting millions of people world-wide however, ART has proven to have prolonged the life of infected patients and live healthy normal lives.

Since HIV is present in blood, semen and vaginal fluid, it is recommended that a person should have only one sexual partner and avoid unsterilized razors & needles to avoid contracting the virus. HIV is crippling the county, especially the highlands region that maybe due to the fact that they have cultural practices that make it vulnerable for young people to contract the disease.

Physiotherapists were thought to have no significance in the rehabilitative management of HIV/AIDS patients but now play a vital role in getting patients to live healthy lives. Patients are encouraged by physiotherapists to do simple activities and exercises to improve gait, dyspnea and weak joints.

References

1. Brady, M. T. (2010, January 1st). doi:10.1097/QAI.0b013e3181b9869f
2. Dinnen, Vicki Luker and Sinclair. (2009, March 12th). (V. L. Dinnen, Ed.) Retrieved Febuary 23rd, 2020, from https://press-files.anu.edu.au/downloads/press/p94091/pdf/book.pdf
3. Fact file: The AIDS problem in Papua New Guinea. (2014, December 11th). Retrieved February Tuesday 17th, 2019, from RMIT ABC: Fact Check: https://www.abc.net.au/news/2014-12-11/the-aids-problem-in-papua-new-guinea-fact-file/5936666
4. Steyl, T. (2015, April). doi:10.4102/sajp.v71i1.286
5. World Health Organiztion. (2017, January). Retrieved February Friday 21st, 2020, from HIV/AIDS: https://www.who.int/gho/hiv/en/ & https://www.who.int/gho/hiv/hiv_text/en/

INTRODUCTION

HIV, Human immunodeficiency virus is one of the worlds most consequential public health challenges. People infected or at risk of being infected with this virus are largely found in low- and middle-income countries. Since the start of the pandemic, over 70 million people have been infected with HIV and about 35 million people have died from it. According to the World Health Organization, 36.9 million people globally were living with HIV in 2017. Of these, 1.8 million were children under the age of 15. (Unaids.org, 2019). In 2017, there were 940,000 deaths from HIV related causes worldwide. The WHO African region is the most affected region with 25.7 million people living with HIV in 2017 and accounting for over two thirds of new HIV infections globally. (World Health Organization, 2019).

In 1999, scientists discovered a virus that was contained in chimpanzees called Simian immunodeficiency virus, SIV. SIV spread to humans from chimpanzees in 1930 as a result of humans eating chimpanzees for meat and contact with their infected blood. The virus adapted itself to the new human host and developed into HIV-1. HIV-2 originated from Sooty Mangabey Monkeys in a similar way as HIV-1. It is not as prominent and is less infectious than HIV-1. The first confirmed case of HIV was in 1959. HIV-1 was detected in a blood sample taken from a man in Kinshasa in the democratic republic of Congo. Over decades HIV spread across Africa and to other parts of the world.

HIV attacks a type of white blood cell called the CD4 cell. The CD4 cells are components of the immune system that help fight off infections and diseases. Infection with HIV makes it harder for the immune system to fight off infections and diseases and therefore it progressively deteriorates and eventually becomes deficient. HIV can progress into Acquire immune deficiency syndrome (AIDS), its most advanced stage. Adults with a healthy immune system are said to have a CD4 count of 500 to 1500 cells/mm3. When the CD4 count decreases below 200 cells/mm3, the person is said to have AIDS. (Healthline, 2019). The most common way of transmitting HIV is through unprotected sex. There are other ways HIV can be transmitted. These include: sharing of contaminated needles and sharp objects and transfer from an infected mother to her child during child birth and breastfeeding. HIV can be maintained using antiretroviral therapy, however, there is currently no cure for it. In 2017, 21.7 million people were accessing antiretroviral therapy.

ANALYSIS

HIV affects all dimensions of the life of infected individuals and their community. There are social, cultural, psychological and economic impacts.

People living with HIV often experience neglection, discrimination and stigmatisation from society. They are denied certain healthcare benefits, they are excluded or treated poorly by family, friends and co-workers and at its extreme, might even experience physical violence as a result of their status. There are many myths and misconceptions made up about people living with HIV. HIV is thought to be associated with behaviours like homosexuality, sex-work, drug use, etc that some cultures or religions may perceive as wrong. Stigma could also come from people whom may not understand how HIV is transmitted and so assume and fear that it may be transmitted through social interactions or contact. HIV related stigma could bring about certain consequences like job loss, loss of reputation, estrangement from loved ones, loss of marriage and childbearing, denial of insurance and discrimination. People living with HIV could be denied access to health care, equal opportunities for employment and children living with HIV could be denied education. The stigma around HIV discourages people from getting tested and being aware of their status due to fear of rejection and so they continue to engage in unprotected sex without any knowledge of their status. This could also lead to late diagnosis and HIV could possibly progress into AIDS which makes treatment more difficult and therefore could cause death.

HIV is more prevalent in low- and middle-income countries where diagnosis and treatment may be less accessible due to lack of resources and insufficient funds. In 2017, only 75 percent of all the people living with HIV were aware of their status. The lack of diagnosis is one of the biggest challenges for this pandemic as this hinders the early knowledge of one’s status and therefore treatment is not provided at an early stage which could lead to the progression of HIV into AIDS and can lead to further transmission of the virus. Socioeconomic standing often affects the likelihood of contracting HIV and determines access to HIV treatment. People of higher socioeconomic status can afford to pay for treatments while those of lower status, might not be able to afford these treatments. HIV affects those of lower socioeconomic standing and those living in poverty-stricken areas at a higher rate.

Homelessness and poverty have been associated with risky sexual practices like trading sex for money. Unprotected and unsafe sex is the most common way to transmit HIV.

Lack of education can result in a higher HIV rate because people are not made aware of the various ways HIV can be contracted, ways to prevent contraction and the possible outcomes of having unprotected sex.

Women living in low-income households may not have accessibility to prenatal care that could test them for HIV.

HIV status could also have a negative impact on socioeconomic status by hindering infected individuals from being able to work and earn pay. There is a high unemployment rate amongst people living with HIV due to stigmatisation and discrimination. This cause a lower standard of living and quality of life for not only the people infected with HIV but their partners and children or anyone they might be taking care of. This will also make them more vulnerable to other infections and would leave them without a way to access treatment. Infected people are also at a loss of education due stigmatisation or lack of funding.

HIV affects the psychological coping of the people infected and their loved ones. People with HIV could experience depression due to exclusion and discrimination and may develop mental health issues and begin to abuse drugs or may even be pushed to attempt suicide. Family members of the infected could face repeated trauma of possibly losing a loved one. Family members could also face social pressure and discrimination.

CONCLUSION

HIV has brought about some social, psychological and economic issues. This study has highlighted these problems and their possible solutions. It identifies the Importance of support from the government and the community for individuals infected with HIV and also highlights the importance of education amongst the people in the community and people living with the pandemic.

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HIV (Human Immunodeficiency) is a virus that damage cells and our immune system. It also weakens the body ability to be able to fight infections and diseases. HIV can be primarily transmitted through the means of sexual intercourse. HIV is a virus that develops to AIDS if not treated as early as possible, the virus is most commonly passed from person to another person through the means of bodily fluids during sex, it can also be passed on through blood to blood contact, often by sharing needles or injecting drugs or equipment and breastmilk, HIV can be passed from mother to her baby during pregnancy, birth and breastfeeding.

HIV virus is a very serious issue that affects people’s lives, especially women in the UK, there are about 101,200 people living with HIV in the UK and of that 69 % are men and 39% are women, and of the 13% were undiagnosed therefore were not aware of they were living with this condition. HIV is a severe matter to women who are pregnant with this virus. Getting pregnant with this virus can be very dangerous for both mother and baby. Therefore, getting tested should be mandatory and can be beneficial to keeping the mother and baby healthy throughout the pregnancy. If the mother gets tested positive, then there is provision for the mother and baby good treatment with care and support which can reduce the risk to the low level for the baby achieving the best possible health outcomes also depends on early diagnoses and contribute to early treatment. This process is easy and will be the most important decision that the mother can make in her life. (NHS, Terrence Higgins Trust). Therefore, it’s important for the mother to get tested as early as possible so that they can both be supported and care for throughout the pregnancy.

When women first realised they are pregnant they seek for medical attention immediately, this is because they feel that it is important to do that or just because this is what they are brought up to do, for reason, some of the pregnant women may ask to get tested for many reasons and they want to know if their baby is doing fine, Most of the pregnant women only do the minimum required testing, and that they also think that if there are any issues that may occur that their GP will notify them. I think that yes this may be true, but it should also be the responsibility of the pregnant women to own up to their responsibility to look after their health and be aware of their body.

This is because infected pregnant women pass the HIV to their baby during pregnancy or delivery and through breastfeeding. In UK its medically advice the infected mother not to breastfeed rather bottle fed (formula Milk), Remember that HIV cannot be cured or vaccination but can be treated due to advances in treatment and understanding at least pregnant women living with HIV can expect a comparable life expectancy as someone who is HIV free, but if most of the infected pregnant people not get treated as soon as possible AS there are great chances they will develop an AIDS because of their infection. During that period the baby in the womb is most vulnerable from the birth until they have reached approx. six months. Because the child immune system and body are more sensitive to get infected easily in a way that where their bodies are not due to certain things and that is why the baby is the higher risk of getting infected, If the baby gets infected while in the womb, then their life chances will be reduced, But as a mother who may be aware of their disease when finding out about their pregnancy status then their Doctor will immediately put both the mother and the baby on intensive care such as prescribing drugs to be administering during the pregnancy such as antepartum ART, antiretroviral drugs to reduce the risk of perinatal transmission and Zidovudine prophylaxis for the infant born to mother to suppress viremia during pregnancy which this case the baby in the womb is becoming less infected.

Though the cost of treating someone especially mother and baby with HIV in the UK is estimated at around £18,000 per year, and as new improved drugs are becoming available then the cost of antiretroviral treatment is also increasing. This is important irrespective of the cost also remember that we are talking about health here. Remember that if the disease goes without untreated for a very long period of time then it can become very dangerous for the mother most especially the baby so therefore, I strongly agree to the idea of pregnant women getting tested HIV and I personally believe that getting tested for others such as STD, and all other types of diseases should be mandatory as well when dealing with pregnancy. I feel this way because, if somebody wants to be a good mother enough that will also care about their children or child they should endeavour to do everything possible by taking care and having precaution for the baby early before everything will be complicated that will result that the baby life chances will be lessened to the point where nothing can be done to in order to help to with the situation, therefore women should get mandatory HIV tested.

The campaign success as part of public health is also important to raise awareness and as part of HIV wider community the PHE was funded to prevent HIV BY Terrence Higgins Trust, it delivers a nationally coordinated programme of HIV prevention to work with African people and gay-related men. The campaign aims to raise awareness HIV testing, use of condoms use and other preventive measures in place to reduce the rate of HIV.

On the other hand, pregnant women have their right, as human rights need to be considered and they should be offered a choice not to force them in getting tested. Pregnant women also have right to challenge the view of the others, with the availability increase rate of ART therapy and there should also be the consideration and the level of impact in the life of the pregnant women. There is no sufficient consideration as to the effect or impact it will have on the pregnant women and their families. Many pregnant women feel that they are been pressurised into the HIV testing during the pregnancy stage and they don’t receive enough pre-test counselling support and, they are not being properly informed and their consent into it. Most of the pregnant women who may have tested positive to the HIV may experience or face more stigma and discrimination in their life especially for their partners, friends, community and family’s members that other men who may have tested positive to the HIV testing. Because of that consequences, the immense number of pregnant women diagnosed during pregnancy don’t let their spouses or husband know about their status because they are afraid or fear of blame of being abandoned, neglect, physical assault and abuse.

The pregnant women do sure do disclose of their HIV status may also face dramatic consequences and negatively repercussion for telling them the truth and the on their own children’s well-being may be affected. Therefore, it is unfair to for pregnant women to test for HIV during the pregnancy solely or mainly to aid in preventing perinatal transmission and if there are no adequate support and availability resources and support services that may protect the pregnant women’s right, and which will also enable them to have full access to amenities and live healthy life after an HIV diagnosis and to engage them in the new era of programme and policies that affect pregnant women’s lives. There’s a need to create changes in the universe that encourages HIV Testing before pregnancy so that women in society can be able to make informed choices. Men must also be brought into the testing process through couple counselling before pregnancy and provide voluntary counselling and testing programmes outside the antenatal care setting. In addition, people living with HIV have a unique expertise and are very effective as colleague counsellors. They have been underutilised in the health care sector to provide support to diagnosed people and to help eliminate AIDS-related shame and stigma in the community.

There are significant disparities in the prevalence, morbidity and mortality rates of women in Swaziland in comparison to Australia when regarding human immunodeficiency virus, acquired immunodeficiency syndrome (HIV/AIDS) There are a multiplicity of risk factors associated with these significantly different statistics between the two, including education and gender, which also impact individuals in their respective countries. The current statistics in regards to HIV AIDS. In 2017, it was estimated that there were 27, 545 people with HIV in Australia (Paynter, 2019) A survey in 2011 showed that 32% of the Swazi population between the ages of 18 and 49 were living with HIV (Cohen, 2017)

There are multiple risk factors that may present themselves and make individuals more likely to contract HIV/AIDS. These risk factors differ between Australia and Swaziland, and can be attributed to the social determinants of health; specifially focusing on the determinants of gender and education, this essay will be looking to presenting issues such as child marriage, health literacy, access to treatment and the social stigma of women with HIV/AIDS. Child marriage is a significant risk factor for young girls in Swaziland ; child marriage is cultural solution to a poverty problem and exposes young girls to contracting HIV/AIDS from men in unprotected sex or rape. This is a risk factor that can be attributed to the social determinant of gender. Child marriage is most prevalent in Lubombo (where 14% of women aged 20-49 were married before the age of 18) and Hhohho (12%) (Fitzgerald, 2017).In many contexts, early sexual debut – including that which takes place within child marriages – is associated with increased lifetime risk of HIV infection (Girls Not Brides, 2019) Young girls in these marriages are often left with no autonomy over their bodies and therefore have an increased likely hood of contracting HIV/AIDS as they cannot decide on who their sexual partner is or who they are potentially sleeping with also, if polygamy is practiced by the man. Child marriage was criminalised by the Australian government in march of 2013 and there is currently no available data in regards to child marriage in Australia; this is not currently a risk factor in Australia for HIV/AIDS. In regards to accessing the appropriate treatment for HIV/AIDS, many individuals may be too ashamed to access the care that they require. A survey conducted by the Swaziland Network for People Living with HIV/AIDS (SWANEPHA), discovered that 45% of people in Swaziland who know they are HIV-positive refuse to go to clinics to receive treatment as they do not want to be recognised as having HIV/AIDS (Cohen, 2017)

HIV/AIDS can be spread through various body fluids, including vaginal fluids, semen and breast milk. Unprotected sex is a very major risk factor for the transmission of HIV/AIDS and is significantly impacted by the social determinant of education. Education and the implementation of sex education could potentially decrease the transmission of HIV/AIDS through the use of condoms. In Australia, 78% of the female population has obtained a secondary schooling,(‘Australia Gross Enrolment Ratio Primary And Secondary Both Sexes Percent’, n.d.) compared to Swaziland where 37% of the female population has obtained secondary schooling (UNICEF, 2006) If a person is not educated on a particular issue, unless exposed to it by another part of their daily life, they are most likely to be unaware of it and therefore not be able to recognise or avoid the risk factors that increase the likely-hood of that issue presenting itself. HIV/AIDS programs have been implemented into Swaziland school by UNICEF, Nxumalo et al. (2014) suggest that HIV/AIDS educational programmes and campaigns targeted at students and the youth must be presented in a way that is motivating and stimulating, or they will fail to yield the desired results; According to the Australia Federation of AIDS Organisations (AFAO) It is essential to provide an effective level of sexuality education in schools to promote the sexual health of all young Australians (Paynter, 2019)

In Australia in 2015, 108 of the 1,025 people diagnosed with HIV were female – indicating that females made up 9.5% of those recognised as HIV positive that year (Taaffe, 2013), compared to Swaziland in 2015 where the 190 000 adults who screened as HIV positive, 120 000 (63.16%) were women(UNAIDS, 2015), wherein 39.2 percent of pregnant women who were screened presented as HIV positive. (Fitzgerald, 2017) HIV transmission at birth and approximately 17,000 children are exposed to HIV infection at birth annually (UNICEF, 2006) Education is the key to effective prevention, but unfortunately poor health literacy may lead to mothers who are carriers passing HIV/AIDS onto their children, through vaginal birth or breast feeding. If women do not seek AVT, or if they are unaware they carry HIV/AIDS, passing the disease onto others can happen by mistake and in children often lead to death through a very compromised immune system. The passing on of HIV/AIDS to children may also be prevented by appropriate access to healthcare and where to receive it. These women face the double disadvantage of not being aware of how to prevent HIV/AIDS, but also being too scared to receive treatment due to severe social stigma of those with HIV/AIDS.

It is important when liaising with countries facing long term, poverty challenges that the source of the problem is recognised before implementing any other forms of intervention. Working with communities for 10-15 years or more is crucial in ensuring that there is the potential for long term changes. Increasing primary and secondary school retention rates for particularly girls in Swaziland may remove them from situations such as child marriage, allow them to become independent and gain employment, increase their health literacy and positively influence their sexual health choices. By providing safe school buildings and facilities, trained educators and up to date curriculum this may be implemented and provide long term change. Educating parents in Swaziland on the importance of education for themselves and their children, the ways HIV/AIDS can be transmitted and where to receive treatment through either one on one care or health clinics may also benefit communities. Providing vocational training for individuals who find themselves unemployed or unable to obtain education may also allow the community to participate in activities together, empower individuals who have tested positive for HIV/AIDS and break the social stigma also. Although Australian women do not experience the same likely-hood of contracting HIV/AIDS, education and prevention is still key in ensuring that these statistics do not increase. Regular sexual education in secondary schools, universities and work-places may be implemented and provide individuals with an increased health literacy in regards to the prevention of HIV/AIDS. Signs and posters in bathroom stalls in public places providing help lines, or access to a health professional if an individual is concerned about their current HIV/AIDS status or has any concerns about their health may also be beneficial.

Overall, It is clear to see that significant disparities between gender as well as education can impact on an individual’s likelihood to contract HIV/AIDS, and that there are also significant differences in the experiences of these determinants between women in Swaziland and Australia. In Swaziland, these problems are being challenged by multiple organisations such as UNICEF, UNAIDS and others who are working to eradicate the high levels of HIV/AIDS experienced by women and children. In Australia, there are also many organisations such as the AFAO who aim to provide education and support for all individuals.

Introduction

HIV represents human immunodeficiency infection. The infection can prompt AIDS if not treated. Dissimilar to some different infections, the human body can’t dispose of HIV totally, even with treatment. So once you get HIV, you have it forever (CDC, 2019).

HIV assaults the body’s invulnerable framework, explicitly the CD4 cells (T cells), which help the insusceptible framework ward off contaminations. Untreated, HIV lessens the quantity of CD4 cells (T cells) in the body, making the individual bound to get different diseases or contamination related malignant growths (CDC, 2019). After some time, HIV can pulverize such a large number of these cells that the body can’t ward off contaminations and sickness. These shrewd contaminations or malignant growths exploit an extremely powerless insusceptible framework and sign that the individual has AIDS, the last phase of HIV disease (CDC, 2019).

No powerful fix at present exists, however with appropriate medicinal care, HIV can be controlled. The drug used to treat HIV is called antiretroviral treatment or ART (CDC, 2019). In the event that individuals with HIV accept ART as recommended, their viral burden (measure of HIV in their blood) can get imperceptible. On the off chance that it remains imperceptible, they can live long, sound lives and have viably no danger of transmitting HIV to a HIV-negative accomplice through sex. Prior to the presentation of ART in the mid-1990s, individuals with HIV could advance to AIDS in only a couple of years. Today, somebody determined to have HIV and treated before the ailment is far cutting edge can live about as long as somebody who doesn’t have HIV (CDC, 2019).

Epidemiology

The HIV pestilence has moved in the course of recent years, from the main announced cases in the mid1980s, to an expected high of 3.7 million new diseases in 1997, to declining new contaminations and AIDS-related mortality all through the 2000s (Unknown, 2013). In 2012, roughly 9.7 million individuals in low-and center salary nations were on antiretroviral drugs (ART). This development of ART inclusion has significantly improved endurance among individuals living with HIV (PLHIV), bringing about an expansion in the quantity of PLHIV to an expected record-breaking high of 35.3 million of every 2012. Increased access to ART has deflected an expected 5.2 million AIDS-related passings in low-and center pay nations from 1995 to 2010, with a 28% decrease in passings from 2006 to 2012. Even as PLHIV live more, the occurrence of new contaminations keeps on declining. An expected 2.3 million new HIV diseases happened in 2012, which is a 34% lessening from 2000 (Unknown, 2013). Overall rate for grown-ups 15 to 49 years old arrived at a pinnacle of 0.11% in 1997 and diminished to 0.05% in 2012. The best decline in HIV frequency is among kids, which has been diminished by 52% in 10 years. Many reasons exist for this abatement in rate, including decreased irresistibleness of PLHIV on ART, extension of projects for counteractive action of mother-to-kid transmission (PMTCT) of HIV, and presentation of damage decrease programs concentrating on more secure sex and effort to high-chance populations.

Since the start of the pestilence, 75 million individuals have been tainted with the HIV infection and around 32 million individuals have kicked the bucket of HIV (WHO, 2018). Universally, 37.9 million [32.7–44.0 million] individuals were living with HIV toward the finish of 2018. An expected 0.8% [0.6-0.9%] of grown-ups matured 15–49 years worldwide are living with HIV, in spite of the fact that the weight of the pestilence keeps on changing extensively among nations and districts (WHO, 2018). The WHO African district stays most seriously influenced, with about 1 in each 25 grown-ups (3.9%) living with HIV and representing more than 66% of the individuals living with HIV around the world (WHO, 2018).

The study of disease transmission of human immunodeficiency infection (HIV) contamination in the United States has changed essentially in the course of recent years (Moore, 2011). HIV/AIDS (HIV/AIDS) is at present a malady of more prominent statistic assorted variety, influencing all ages, genders, and races, and including numerous transmission hazard practices. At any rate 50,000 new HIV diseases will keep on being included every year; in any case, one-fifth of people with new contaminations may not realize they are tainted, and a generous extent of the individuals who realize they are contaminated are not occupied with HIV care (Moore, 2011).

The primary revealed instances of HIV/AIDS in Malaysia were in 1986. Since that time, there are presently more than 100,000 detailed instances of HIV diseases in the nation, and more than 16,000 individuals have kicked the bucket from AIDS as of December 2013 (PTfoundation, 2014).

The pestilence in this nation is focused inside infusing drug clients (IDU), sex laborers (SW), transgender (TG) and men who engage in sexual relations with men (MSM) people group. Toward the finish of 2012, Malaysia was evaluated to 81,900 individuals living with HIV (PLHIV) since the primary case was distinguished 27 years back (PTfoundation, 2014). In 2013 3,393 new HIV contaminations were accounted for, which implies that consistently just about 10 Malaysians become HIV tainted (PTfoundation, 2014).

Most of new HIV diseases are found in youthful grown-ups matured 20 to 29 (31% of cases in 2013) and those matured 30 to 39 (35% of cases in 2013) (PTfoundation, 2014). It is imperative to take note of that around 66% of new HIV contaminations are found in grown-ups matured 20-39, which is worried since this is the age go in which residents are generally gainful. As the scourge advances we likewise note an expanding level of moderately aged individuals living with HIV (PTfoundation, 2014).

In Malaysia, we see a higher pace of HIV transmission through sexual transmission (74% of cases in 2013) as opposed to infusing drug use (22%). The official number of diseases transmitted through hetero intercourse has expanded from 45% of cases in 2012 to 51% of cases in 2013 (PTfoundation, 2014).

The quantity of HIV positive ladies has been expanding too (PTfoundation, 2014). In 2001, the proportion of HIV positive men versus HIV positive ladies was 10:1, yet in 2013 this apportion has significantly changes to 4:1.

Content

Except for forte projects which are dissipated the nation over, HIV+ customers are normally overseen inside the setting of a general restorative program. This has little respect for the necessities that are explicit to this customer populace. It is fundamental that nurses have the right stuff and information to viably think about people who are living with HIV. Nurses must have the option to evaluate all customers for their danger of HIV disease. Numerous patients with HIV are very late to analysis which can have a conceivably negative effect on their reaction to treatment. It is significant that all medical attendants can distinguish the particular hazard factors that put individuals in danger for disease and that they can mediate for the benefit of their customers to guarantee that they get testing. For customers who present with HIV contamination, nurses should have the option to survey for indications of invulnerable trade off, including gauge bloodwork. They additionally should have the option to decide the customer’s status, including whether they are on treatment and in the event that they are getting normal essential consideration follow‐up (McCall, 2013).

Finishing a general nursing evaluation of customers who are living with or in danger for HIV disease

Physical evaluation of all body frameworks for indications of:

• Immune trade off
• AIDS characterizing ailments
• Indicator ailments, for example, oral candidiasis, herpes zoster or vaginal candidiasis

  Baseline evaluation including:

• Utilization of unlawful medications/liquor/tobacco
• Emotional wellness history
• Essential consideration development
• Gauge blood-work including CD4 and CD4 division and viral burden
• Chance practices, for example, perilous infusing drug use and unprotected sexual movement

  Comprehensive medication history:

• incorporates a rundown of recommended, over the counter, natural enhancements, and so forth.
• If taking extra prescriptions, the medical attendant will measure
• Medicate sensitivities

There are innate employment worries in thinking about wiped out individuals. Other than the difficulties associated with giving care to individuals who are typically not feeling admirably, nurses likewise need to settle with human misery and the passing of patients. The force of the AIDS pandemic makes extra difficulties for wellbeing laborers: aside from the way that they could likewise be tainted, they need to manage an expanding number of individuals who experience the ill effects of a deadly illness for which no fix has been found at this point.

Examination of the information uncovers that HIV/AIDS amplified the remaining burden of nurses for different reasons: an expansion of patients with HIV/AIDS-related diseases; the escalated kind of care that is required by numerous individuals of these (perishing) patients; and an absence of strengthening support (Hall, n.d.). They need to adapt to these difficulties while managing staff deficiencies and deficient hierarchical support in their work environments. The mystery encompassing the sickness appears to decrease their efficiency (all patients must be treated as possibly HIV positive) increments their dread of virus, and stands up to them with different moral issues in regards to themselves furthermore, their accomplices, and PWA and the individuals (accomplices, family members, parental figures) associated with them. Mystery likewise upsets nurses in their endeavors to avert further spreading (Hall, n.d.).

Healthcare laborers including nurses may likewise be tainted with the infection. They may experience uneasiness just as dread that their status will get known at work, which may prompt expanded truancy, stress, and lower execution. From various perspectives the approach of the AIDS plague has strengthened and widened the difficulties looked by nurses as human services suppliers in organized social insurance. Taking care of AIDS patients is physically and genuinely exhausting and impacts on nurse’s outstanding burden also, work related feelings of anxiety. The circumstance is bothered by an absence of hierarchical help, ability deficiencies and the predominance of HIV among nurses. In future this may prompt diminished profitability, expanded whittling down, lower resolve, and more mishaps, which could genuinely compromise the nature of medicinal services (Hall, n.d.).

The ‘triple threat’ of HIV/AIDS for the wellbeing workforce is a three-pronged risk. To begin with, there is an expanded remaining task at hand and aptitude requests because of AIDS. In certain nations, half 70% of emergency clinic patients are HIV-positive. Second, wellbeing laborers are becoming sick and kicking the bucket in numerous nations. Thinking about the wiped out isn’t just requesting however dangerous. Third, wellbeing laborers must adapt to the psychosocial worry of offering palliative consideration to expanding quantities of biting the dust patients alongside thinking about their very own wiped out family and family members (Tawfik & Kinoti , 2006). These elements lead to expanded low spirit, burnout and non-attendance. Moreover, dread, shame and segregation influence inspiration and execution.

During a pandemic, nurses and other medicinal services suppliers face a lopsided danger of presentation to HIV contrasted with the overall public, and may fear contracting HIV or transmitting it to helpless family members (Medscape, 2019). Balancing the requests of work with the need to secure and think about self and family may demonstrate incredibly hard for some nurses. Some may feel the individual chance is too extraordinary and decline to think about contaminated patients. The consequences for the social insurance framework could be significant (Medscape, 2019). Nurses must figure out how to utilize the devices they have, similar to their code of morals during HIV pandemic. They aren’t relied upon to set out their lives. Nurses must think about themselves before they can think about others (Medscape, 2019).

Conclusion

Regardless of the geographic heterogeneity of the HIV plague, expanded antiretroviral drugs inclusion will diminish frequency in all areas. Expanded access to antiretroviral drugs joined with explicit aversion intercessions pertinent to nearby populaces and settings may diminish frequency further. The most ideal ways for nurses to guarantee that their dangers are limited and that they will have a sense of security proceeding to play out their occupations during a pandemic are to get instructed about the realities and ramifications of a potential flu pandemic, to get comfortable with their expert code of morals, and to get associated with pre-pandemic arranging endeavors at their human services associations.

The Philippines belong to most countries who experiencing the continually epidemic HIV, human immune deficiency virus that can destroy your immunity particularly the white blood cells that helping your body to keep away from foreign substances and killed them. AIDS or acquired immunodeficiency syndrome is different from HIV, it is a syndrome that can be acquired to a person which is infected with the virus and there is no cure for it, but it can be controllable by the antiretroviral treatment for life long and healthy life. People fear how this virus can infect them and they don’t have enough knowledge for this virus. HIV/AIDS can be transferred to another person through sex in an infected person, by not using condoms or contraceptives and if the blood of the infected person enters the person body like practice of injection drug use (IDU).

According to the department of health 2005, that most cases who acquired this virus are heterosexuals. Men who are having sex with men or bisexuals. They have the highest risk that can have this virus without proper using of contraceptives and safeties. Every year the number of people who are getting infected is increasing and this is not good for the country. Moreover, young people at the age of 15 to 24 years old are also infected by this virus and sexual contact it was estimated at 89% National Epidemiology center at the DOH, while according to the Philippines National AIDS Council (PNAC), that the most risk is the sex workers (FSWs) including with Male to Male and Injection drug use. This are the evidences showing that the epidemic of HIV/AIDS are annually rising and increasing its number every year, this is alarming, and we need to be aware to the issues happening to our country especially this kind of problem that we need to take care of.

There are several agencies and organizations that helping the people to prevent HIV. First, is Philippine National AIDS Council (PNAC). This was created to advice the government on the development of policies to aid the people who is infected by the virus and prevent the HIV/AIDS. This organization made a policy making body through governmental and non-governmental agencies. Likewise, the Philippine AIDS prevention and control act mandates implementation to control this disease. On the other hand, Research Institute for Tropical Medicine (RITM) and University of the Philippines Los Baños (UPLB) made a forum to help the people who are infected this infectious disease, to achieve their goal to solve and face this disease. There are more agencies and organizations with the same objectives as those examples given. Students and Researcher are doing their best to study and find cure to prevent HIV/AIDS.

The government are acting step by step to lessen the HIV/AIDS. They made a program like Condom Distribution Programs (CDPs) their goal is to promote the distribution of condoms among people at high risk to sexual transmission of HIV especially youth. With the help of the individuals and group level-interventions they are sharing their knowledge, skills and trainings to prevent HIV/AIDS. Schools clinics and hospitals are prioritized to give and distribute condoms among the students by Department of health to prevent the unwanted pregnancies and sexual transmission of HIV/AIDS by the Department of health. This will alert them on how HIV/AIDS can destroy their lives. Moreover, they strengthen the education to the youth to be aware to this issues that our country facing today. Government did also a non-formal education to the people that can be held inside of the schools and health institutions and outside the community. In addition, we Filipino citizens can encourage the government to collaborate on different government, to have links to health services, and lastly, is to establish trainings to prevent HIV/AIDS.

Proper use of contraceptives, education, programs and trainings will be very useful to combat this disease let’s do our best to cooperate with each other and collaborate with other countries. let’s help each other by disseminate the information about how to prevent this epidemic; HIV. As a youth and a Filipino citizen let’s do our best to spread awareness for the better and development of our country.

Introduction

Nowadays, Acquired Immunodeficiency Syndrome (AIDS) is one of the most serious problems faced by many countries. AIDS is caused by Human Immunodeficiency Syndrome (HIV). It is considered to be an advance stage of HIV infection. HIV attacks the immune system of an individuals and makes them susceptible to other infections and certain types of cancers (WHO,2019).

HIV was firstly identified in 1981 (HIV.gov,2019). Countries with high prevalence of HIV infection include Swaziland, Lesotho and Botswana. 27.20% of Swaziland’s population is affected by HIV. 25.00% and 21.90% population of Lesotho and Botswana are affected by HIV respectively (chepkimoi,2019). This is the world’s sixth leading cause of death among young men and women (Glenville,2010). 25 million have died as a result of HIV infection (Todd and Spickett,2010).

People affected by HIV, face problems such as social isolation, lack of family support, unemployment, homelessness, fear of infecting others and depression. Till now no cure has been developed for HIV infection (WHO,2019). Therefore, HIV patients should be treated with respect and care and should be supported by possible ways.

The background of disease, symptoms and treatment methods of AIDS will be discussed, leading to the topic of interest which is socio-economic problems faced by HIV victims and thereby raising awareness about this life-threatening disease.

Background of HIV and socio-economic problems faced by HIV victims

Scientists identified the source of HIV infection is to be a type of chimpanzees in West Africa. HIV is the mutated form of Simian Immunodeficiency Virus (SIV), which is the chimpanzee version of immunodeficiency virus. The virus might come into contact with humans, during hunting. The virus slowly spread across Africa and later into other parts of the world (The AIDS Institute,2018). HIV spreads through bodily fluids and most often by sexual contact with infected partner. The virus enters to the body through the lining of the vagina, vulva, penis or mouth during sex. The most common route of transmission, especially among men who sex with men. There are some other ways HIV spread from person to person such like sharing needles, syringes, other items for injection drug use and during the breast feeding as well. HIV is not spread through casual contacts such as skin to skin contacts, hugging, shaking hands, kissing, wearing the same cloths, sharing a toilet or bedding, air or water and also it would not spread through mosquitoes or other insects (Murrell,2018).

The current social and individual perception is that it is a shame to be infected with HIV. All human rights must be enjoyed by HIV positive individuals: the rights to free motion, health care, education, jobs, compatibility with their capacity. Nobody has the right to restrict freedom or individual rights merely because, regardless of nationality, gender or sexual orientation, they are infected with HIV (Procedia-social and Behavioral Science,2013).

The premature death of big numbers of young adults has an inevitably impacts societies affected by HIV. Houses and families bear the brunt if AIDS poverty. The effects on home and families begins as quickly as a member of a household being to suffer from HIV related illness. Three kinds of effects can be differentiated in this regard. The first one is the loss of family members’ revenue and households output, in specific the breadwinner’s life. The second effect is household increases and medical expenditure. The third effect is the indirect costs arising from the absenteeism of family members from college or work to take care of them.

There is increasing proof that AIDS has a catastrophic impact on economic growth and earnings. It is very important to have a job for infected individuals. It gives them a sense of economic security, fulfillment and keeps them occupied. But AIDS decrease the number of healthy employees, especially skilled employees. In general population, infection often leads to unemployment, withdrawal by wife or partner, family or community, inter personal owing to guilt and shame, taboo and social stigma. Societal, financial and cultural effects are usually catastrophic for HIV positive people and their families.

Infected people’s professional and social rejection often leads to the destruction of private and community ties and profound moral, cultural and financial distress. For these reasons, infected individuals often tend not to reveal their status to their wife or frequent sexual partner (UNAIDS,2001).

HIV patients face some social integration issues such as family negligence, physical abuse, verbal abuse, deprivation of love and care, accused of spreading the virus, moving away when infected individuals passed by, not permitted in social gatherings, asked to leave the place and kids were dismissed and were not permitted to play with other kids (International Labor Organization,2003).

People do not convict HIV patients, do not isolate them in their home or work place, do not frighten them with suffering and death. Prepare them for a smooth journey to death in the terminal stage, do not take many relatives to see the patient admitted in hospital and do not distinguish them from spouses or kids because they are the greatest support for them. It is essential for them to spend beautiful time together with their family (Kirloskar,2013).

Symptoms and diagnosis

People can identify the HIV disease by some symptoms. Not everyone will have the same symptoms it depends on the person and what stage of disease they are in. There are several types of symptoms of HIV such as fever, headache, rash, muscle aches and joint pains, sore throat, swollen lymph glands mainly on the neck, fatigue, chronic diarrhea, rapid weight loss, extreme and unexplained tired and night sweats. Some of these symptoms can be so mild that people might not even notice them (Avert.org,2019).

Those who have HIV suffer more in their life. For example, people living with HIV are twice as likely to depression compared to those who are not affected by this disease, trouble on getting services and their needs those who infected by this, loss of social support and isolation, going through changes in their physical appearance or abilities due to HIV/AIDS and the loss of relationships or even death (National Institute of Mental Health,2016).

Treatment and the way people need to take care HIV patients

There is no cure for HIV/AIDS, but there are different types of drugs are available to control this virus. Such treatment is called Antiretroviral therapy (ART). Each class of drug blocks the virus in different ways. Now ART is recommended for everyone, regardless of CD4 T cell counts. CD4 T is a cell that normally protect the body from infections and other types of diseases. In HIV treatment taking several pills at specific time is very important in their life. Each medicine comes with its own unique set of side effects. Some of the treatment side effects are nausea, vomiting and diarrhea, heart diseases, weakened bones and bone loss, breakdown of muscle tissue, abnormal cholesterol levels and higher blood sugar (mayoclinic,2018).

People who have infected with HIV need care and support from their friends, families and community, especially when they are ill. Friends and family members are concerned that they may be infected when caring for the HIV person. But it has been discussed previously that how HIV can be passed and cannot be passed. People can assist those infected by displaying love, respect and support, by knowing the facts about HIV/AIDS and by speaking publicly about the disease, by helping them to decrease stress and stressful situations, by helping them to provide balanced and nutritious meals and also by encouraging them to receive the therapy when they are sick. There may be circumstances where individuals need to wash body fluids or blood from someone who infected with HIV. To avoid direct contact, it is essential to use rubber or plastic gloves or other obstacles such as plastic bags or dense cloths (KwaZulu-Natal Department of Health,2001).

Future trends

HIV research has gone a long way since the disease was discovered in the 1980’s. ART was a major milestone that has changed the lives of millions of people, but the goal now is to find an HIV cure before 2020. One of the most advanced functional HIV cures in development seeks to inhibit the ability of the virus replicate and produce more copies of its own genetic material of itself. A comparable method is frequently used to treat infection with herps, and although it does not completely eliminate the virus, it can prevent its spread. Although there are several approaches that could eventually bring about a functional HIV cure, some changes still remain ahead. One of the biggest concerns about any HIV treatment is the ability of the virus to rapidly mutate and develop resistance, and for many of these new approaches there are still no data as to whether the virus can become resistant (Fernandez,2018).

Preventive measures

As the functional cures have not reached the late-stage of clinical testing it seems likely that the goals of having an HIV cure by 2020 will not be achieved. However, this year is likely to mark a significant milestone as the first late stage tests being that year. It successful, the first functional HIV cure could be approved in ten years (Fernandez,2018).