Health Services Research: AIDS-Related Stigma

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Table of Contents

Introduction
Interesting aspects of Health Services Research
Specific areas of study
Problem statement
Literature review
Methodology that will be used
Expected results
Significance of the study
Works Cited

Introduction

With the emergence of increasing cases of diseases and infection, there has been an increase need for health care services. There is a need to have quality health care services that are easily accessible. Several programs are available that advocate for the accessibility of healthcare services indifferent parts of the world (Aday & Anderson, 208). It is desirable that the healthcare providers respond promptly to cases that need an urgent medical attention. Besides, the services also need to be available to the patients at cheaper costs that can be afforded by many individuals. These factors have attracted attention of different researchers and many studies have been carried out in relation to health services. In a broad perspective, health services research is concerned with the ability of the people to access quality health care services. Accessibility to health care services is also affected by the customers’ knowledge of the care and willingness to receive such care (Aday & Anderson, 210). The researches also examine the costs of such health services, how such costs affect individuals’ abilities to obtain the services, and the ultimate effects on their health. In particular, such researches how factors like the technological developments, socio-economic conditions, and the management and organizational structure of the health care institutions affect the accessibility, quality, and cost of healthcare services provided to patients.

In order to get reliable information on these aspects of health services, the researchers often collect data from groups of individuals, families, or health care institutions based in the communities. Relevant pieces of information could also be obtained from the healthcare organizations and other organizations like insurance companies that provide medical cover or life insurance. The information could also be obtained from various government departments and agencies. The information obtained from the analysis of the research findings are used by the healthcare organizations and policy makers to improve on the delivery of quality healthcare services to the people. It will enable such agencies to restructure the management and organization of the healthcare institutions according to the kind of relationship that was observed. It will shed light on the appropriate ways of providing financial support to the medical centers in order to improve on their operations. Based on the findings, a proper medical scheme can be developed that enables individuals with financial problems to obtain healthcare services at subsidized rates. The findings from such studies can also provide foundation for other studies in this and other related fields.

Like many other researches, health services research also has certain challenges. One common challenge is the large and diverse geographical settings in which such researches have to be conducted. An effective management decision or health care policy will be developed based on information from a larger geographical area, as that will be the representation of the entire population. The information from such areas may not be uniform due to lack of homogeneity in the population under study. Besides, the research applies a set of unrelated theories, statistics, and principles usually drawn from different disciplines. The researches also require long durations and may require secondary data that dates back to several decades ago. This is also costly owing to the expanse of the geographical area of study.

Interesting aspects of Health Services Research

Even though the field of Health Services research has the challenges so described, some factors contribute to my interest and ability to explore concepts within the field. Firstly, I have always had ambition to serve the public by initiating development and reform agendas. Health services research contributes to the social development in the communities as it adds onto the accessibility of social amenities in the community. In line with the objective of community development, pursuing a career in the field of Health Services Research will improve my understanding of the biological and socio-economic factors that affect human health. Secondly, my previous work experiences also contribute largely to the interest developed in this field. Health service is challenging due to the diverse concepts, principles and the processes involved. The tasks that I have performed in the last two years have endowed me with skills that are appropriate to pursue a career in health care services. My engagement with UNAIDS in Nepal for the last two years involves participating in programs related to management of diseases like HIV/AIDS, tuberculosis, malaria, and other diseases common in females or children. This role and the others performed earlier involve managing projects or programs, planning/conducting researches, collecting data, and writing reports from of the researches. Such engagements remove the barriers that would drive one away from this field. Besides, I have a good understanding of application software necessary in the management and analysis of data obtained in the researches.

Trials (or clinical trials) in health services research are defined protocols that are applied in medical and health-related studies to collect data that can be used for an intervention in health care (ClinicalTrial.gov, para.3). The studies can focus on the effectiveness of the medical equipments and devices, the drugs used for a given disease or infection, a combination two or more drugs, the diagnostic procedures applied in the health institutions, or the therapeutic practices involved. They are generally meant to improve on the quality of health care services. These studies involve collection and statistical analysis of data pertaining to these factors through experimental treatment or by observation (ClinicalTrial.gov, para.3. Having served at different establishments and in different capacities such as programs assistant, research assistant, research analyst, and as accounting assistant and paralegal, I developed more interest in an analytic approach to the improvement of quality of health care services. In particular, my task as a program assistant at UNAIDS has been focused on the prevention and treatment of infectious and chronic diseases. The knowledge of packages like MS Office, Stata, and SPSS provide a strong foundation for such studies. Besides, the tasks involved exposure to different individuals over large areas geographical regions. The information drawn from such trials is often more reliable than that obtained from trials in a single region as it takes into consideration the different factors.

Specific areas of study

The area of clinical trial is also wide and can be subdivided into treatment trials, prevention trials, screening trials, diagnostic trials, and supportive care trials (ClinicalTrial.gov, para.23. The areas that I find most interesting are supportive care (quality of life) trials and prevention trials. Quality of life trials is concerned with the quality of life of the individuals suffering from some long-lasting infection. The studies often carried out to establish the effectiveness of the drugs in use by the patients. They also focus on how comfortable the victims are with the treatments in the healthcare center. On the other hand, preventive trials attempt to prevent individuals from getting an infection or by preventing a re-infection by the same disease. The prevention could be achieved through vaccination, taking minerals and vitamins, or change of the individual’s lifestyle (ClinicalTrial.gov, para.23. Such trials involve an experimental group and a control group. The control group is not subjected to any treatment whereas the experimental group receives the treatment. An analysis of the differences that might occur in the outcomes of the two groups will evaluate the effectiveness of the drugs or procedures to be used.

Problem statement

HIV/AIDS epidemic is currently a global issue with several efforts being made each time to manage the infection. Even though there is no permanent cure, there treatment mechanisms that have been developed to enable the infected individuals live longer. However, the challenge that is still faced is that a substantial proportion of individuals living with HIV/AIDS, especially in the developing countries, are reluctant to use the medication and neither are they aware of their health status. Such individuals are reluctant to go for voluntary counseling and testing to check their HIV status. One of the factors that could lead to this denial or negligence is poverty. The individuals could be aware of the antiretroviral therapies that are available for managing the disease. They have ideas that one of the requirements in the management of this infection is to eat well and avoid stress. However, with the poor financial status, such individuals opt to live and die in their ignorance than to check their health status only to be unable to live positively with the infection. The stigma caused by the infection is another factor leading to such laxity.

This is evident in both the developing and the developed nations. The individuals infected with the disease are still perceived differently in different parts of the world (Herek, 1). Even though there are several diseases that are fatal, this infection is often viewed as a death permit. It is also perceived, in several instances, to be the effects of a promiscuous unethical behavior. An individual would not want to identify himself with the infection due to the picture that the other members of the community have on such infection. Besides, the antiretroviral drugs are to be taken throughout the life of an individual after testing positive. This is seen as unnatural as several individuals may not be comfortable with daily intake of drugs. The study to be conducted shall examine the current level of AIDS-related stigma as well as how it affects the seeking of an individual’s health status. The study will also examine the views of various individuals on the effectiveness of ARVs.

Literature review

The emergence of HIV/AIDS in the 1980s was accompanied by stigma in relation to the infection. During this period, individuals with the disease or those suspected to be infected by the disease were reportedly discriminated in several ways. The individuals could be isolated from their family members or relieved of their employments (Herek, 1). Several aspects of the disease could be the cause of such stigma. One of the factors is the effects of the infection on human physiology. By weakening the immune system, the infection increases the individuals’ vulnerability to other deadly infections. It is thus seen as more of a threat to life than the other infections since it is degenerative (Herek, 3). Secondly, the disease is mainly spread through sexual contact. This raises the issue of immorality in relation to the infection. Stigma often arises in situations where a disease is believed to be under the responsibility of the bearer (Herek, 3). Those infected by the disease are believed to be associated with immoral behaviors like homosexuality, drug abuse, and promiscuity. Stigma was also caused by the people’s misunderstanding of the mode of transmission of the disease. Many felt that any bodily contact with an infected person would result into an infection (Herek, 2). The other issues of concern in relation to the infection were related to the religious beliefs. Such beliefs portrayed the infection to be a result of an immoral and irresponsible behavior like prostitution. It was observed as a punishment that such individuals received due to their immoral acts.

With the emergence of development of treatment and preventive measures for the disease, it was believed that the stigma related to the disease would be reduced significantly. This might not be the case in same instances (Herek, 1). The AIDS-related stigma continues to take different directions. In deed, the availability of treatment measures reduces stigma especially among the infected individuals. However, this creates further challenges related to the disease. Many individuals still believe that the introduction of the therapies to manage the infection will lead to further infection since there will be no physical distinction between the individuals living with the disease and those without the disease. The healthy-looking individuals with ill motives are more likely to infect the others intentionally. Besides, it is also hard to obtain the drugs in some instances (Forsythe, 4).

Methodology that will be used

The research will be carried out in five community hospitals over a period of four months. Data will also be required pertaining to health records over some period before the research. Arrangements shall be made with the nurses at the health institutions to collect these sets of data.

The first face of the research will involve an AIDS awareness campaign. An intensive aids awareness campaign will be conducted in the regions served by these health institutions. This is in line with the programs of the health departments’ fight against the deadly disease. The campaign shall address on the misconceptions about the disease, the “unnecessary stigma” surrounding the disease, and the use of antiretroviral therapies by those infected by the disease. The campaign shall be conducted for a period of one month. After this, data will be collected for a period of two months on those who turn out for various health care services at the centers. The number of individuals who turn out for voluntary counseling and testing shall be noted. The individuals that are subjected to compulsory testing owing to their medical conditions will also be noted over this period. The status of these categories of individuals will also be noted.

The hospitals will also provide the records of how the individuals living with the disease use the medication. In the last part of the studies, a telephone interview will be conducted to test the effectiveness of the campaign on the stigma caused by the infection. Fifty individuals will be selected from the patient directories from each of the hospitals, considering those served during the study period. The respondents will be required to provide the degree to which they agree with the statements that stigmatize the infection. These statements “The disease is a threat to life,” “The infected victims have been immoral and irresponsible with their behaviors,” “the disease is a curse,” and “those living with HIV/AIDS are just like other people.” The responses to these questions will be given in a scale of five points between “Strongly agree” on one end and “Strongly disagree” on the other end. Regardless of the HIV status of the respondents, they will also be required to provide their views on the effectiveness of the drugs available for the treatment of the infection. This will also be provided in a scale of five points. The suggestions of the respondents on the use of the therapy will also be sought.

Expected results

As has been stated, stigma related to this disease takes on different forms depending on the developments that have been made in its management. Since there are mechanisms for prevention and temporary treatment of the disease, it is expected that few individuals will still regard this as a threat to life. However, following the controversial issues concerning its mode of transmission, it is expected that a significant proportion of the individuals will still consider the disease as a punishment following immoral sexual behaviors. Individuals living with the disease will still be considered as unique buy several individuals.

It is also expected that despite the awareness campaigns will have no significant impacts on number the individuals seeking to know their status voluntarily. It is expected that the majority of individuals that go for HIV tests do so as a directive from the medical practitioner. In several cases, these individuals are expected to be positive of the disease.

A greater percentage of the individuals on drugs are expected to express confidence in the effectiveness of the ARVs. However, it is expected that a substantial proportion of this category will express their worry about the need to take drugs daily throughout their lives. Suggestions are expected for types of medication that can be used in longer intervals with the same effects. Some evidences are expected from the records at the health centers showing HIV/AIDS patients who have deliberately stopped taking drugs, suggesting that they were fed up with the routine.

Significance of the study

The results that are expected from this research will be very useful in the continued management of HIV/AIDS. The results will show that the management of HIV/AIDS is yet to be faced by other challenges despite the measures that have been put in place. They will provide insights on the new direction that AIDS-related stigma has taken in the recent past. Based on the expected results, counselors and AIDS educators that are concerned with prevention of the disease and re-infection by the infected individuals will be able to incorporate other techniques to improve on the individuals’ perception of the disease. More appealing awareness campaigns would then be developed improve the understanding of the disease. Current campaigns stress on living positively with the infection. However, most people still believe that living positively is expensive. The appropriate campaigns should illustrate positive living in a simple life.

The results will also catalyze further intensive research on treatment mechanism that could be easily adopted by the patients. It is expected that a significant proportion of those living the disease, and are on medication, are not comfortable with the daily intake of drugs, and are likely to stop on the way. This calls for development of therapies that can be after some regular intervals. It would be desirable if a drug is developed that is effective ad can be taken after some regular but longer intervals, say weekly, monthly, quarterly, or even annually.

Works Cited

Aday, Lu A and Anderson, Ronald. “A Framework for the Study of Access to Medical Care.”Health Services Research, Pp.208-220, 1974. Web.

ClinicalTrial.gov. Understanding Clinical Trials. 2007. Web.

Forsythe, Steven S. “The Affordability Of Antiretroviral Therapy In Developing Countries: What Policymakers Need To Know.” Family Health International. N.d. Web.

Herek, Gregory M. “AIDS and Stigma.” American Behavioral Scientist, 42(7), 1106-1116. 1999. Web.

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