Epidemiology: Human Immunodeficiency Virus (HIV)

The notion of public health comprises a variety of health care tendencies that either promote or deteriorate the overall state of human health in a particular area. However, despite the relevance of individual patterns of nutrition and other socio-economic determinants of health, the primary purpose of the realm of medicine is to ensure a safe environment in terms of health risks and various diseases. One of the major risk factors in the context of public health is communicable diseases, which may be defined as “illnesses caused by viruses or bacteria that people spread to one another through contact with contaminated surfaces, bodily fluids, blood products, insect bites, or through the air” (Edemekong & Huang, 2020, para. 1). Thus, the primary purpose of the present epidemiology paper is to look into the notion of the human immunodeficiency virus (HIV) as a prime representative of a communicable disease.

Description

In a society replete with various communicable diseases, people perceive HIV and AIDS as something relevant to the lower social classes, LGBTQ+ society, and injection drug users, with every person believing that there is no need to raise self-awareness on the matter. As a result, a conscious ignorance and stigmatization of the disease have led to its dissemination worldwide over the past decades (World Health Organization [WHO], n.d.). HIV could be defined as a communicable disease that affects one’s immune system and blocks the cells’ ability to combat infection within the human body (Centers for Disease Control and Prevention [CDC], 2021).

Causes

Since the HIV identification in society, there has been a heated discussion around the origins of HIV. The commonly accepted version states that people were infected as early as the late 1800s through the blood of chimpanzees (CDC, 2021). HIV is supposedly caused by the chimpanzee-hosted Simian Immunodeficiency Virus (SIV), which had similar detrimental effects on the primates’ immune system (“Origin of HIV and AIDS,” 2019). The disease itself is believed to originate from Central Africa and first tackled the US population in the 1970s.

Symptoms

One of the major challenges in terms of addressing HIV is the fact that testing is the only justified method of obtaining relevant information on the status. Generally, there are no commonly accepted symptoms specific to the virus. However, when considering the stages of the virus evolution, some symptoms may be manifested. Generally, HIV infection is divided into three major processes: acute HIV infection, chronic HIV infection, and acquired immunodeficiency syndrome (AIDS) (CDC, 2021). The very first stage is sometimes followed by such symptoms as fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, and mouth ulcers (CDC, 2021). Since such symptoms are common for quite a number of health conditions, it is of paramount importance to combine these symptoms with the possible precedents to the virus transmission.

Modes of Transmission

The stigma surrounding HIV transmission presents a challenge in terms of promoting HIV infection prevention, as many people believe the disease to be passed through a minor contact with the host. However, despite the misconceptions, there are only three major modes of HIV transmission, including unprotected sexual intercourse, shared use of needles and syringes, and mother-to-baby transmission (CDC, 2021). Some other transmission risks include oral sex, workplace, medical care, pre-chewed food, biting, kissing, and tattoos, and body piercings, but the incidence rate is so small that these cases are considered an extraordinary exception instead of a transmission regularity (CDC, 2021). According to the statistical data, 66% of the new HIV cases in 2018 were transmitted through male-to-male sexual contact, 23% were transmitted through heterosexual contact, with the rest of cases allocated to injection drug use (CDC, 2021). Thus, it may be concluded that such means of transmission demonstrate a critical lack of preventive education caused by stigma and social pressure put on the notion of HIV.

Complications

Apart from the acute HIV phase, infected people have seemingly no explicit health complications, while their immune system becomes gradually destructed by the HIV viral load. As a result, when living with either chronic HIV or AIDS, people become at risk of obtaining so-called opportunistic infections. These infections could be defined as infections that tend to occur more often in people with a weakened immune system (“HIV and opportunistic infections.” 2020). Thus, for example, while the vast majority of people may live with latent tuberculosis, it is people with HIV who are extremely likely to struggle with an explicit form of this disease. Other opportunistic infections include candidiasis, Salmonella infection, and toxoplasmosis (“HIV and opportunistic infections.” 2020). In the vast majority of untreated HIV cases, the ultimate complication is death caused by the immune system’s inability to combat any infection or bacteria entering the human body.

Treatment

Another major issue related the HIV infection is the fact that there is currently no cure for the health condition. For this reason, there exists a common stereotype that HIV leads to inevitable death. However, it is a severe misconception because the viral load may be controlled by antiretroviral therapy (ART), giving people the opportunity to live happily and with no complications for dozens of years (CDC, 2021). Considering the fact that ART is to be taken on a daily basis, it is important to find medications that cause minimum side effects for an individual. The modern context of ART includes a wide variety of medications, the cost of which is mostly covered by the government.

HIV Demographics

Considering the recent discoveries in terms of ART and HIV preventive health education, it would be reasonable to assume that the incidence of new cases across the US decreased. Indeed, from 2014 to 2018, the annual number of new diagnoses decreased by 7% (CDC, 2021). The US population living with HIV constitutes 1.2 million people (CDC. 2021). Such a prevalence justifies the endemic status of the disease, as instead of affecting many people at the same time, HIV is diagnosed within specific population groups in the area. Thus, in 2018, Blacks/African Americans were the ones affected the most, comprising 42% of new cases (CDC, 2021). The next position was taken by Hispanics/Latinos (27%) (CDC, 2021). Among people living with HIV, there were approximately fifteen thousand deaths in 2018, yet the cause of death might not relate explicitly to the HIV-positive status (CDC, 2021). HIV is considered an urban disease, as it prevails in metropolitan areas.

Reporting a Disease

HIV is a reportable disease, as newly diagnosed people have to receive therapy in order not to put at risk their sexual partners and kids. The modern patterns of reporting an HIV case require nurses to run diagnostic tests among patients and report positive results directly into the public health database providing no sensitive data about the infected individual (CDC, 2021b). In such a way, both public and medical professionals obtain an exhaustive understanding of the disease demographics and endemic centers.

Social Determinants of Health and HIV

The notions of health and well-being are highly dependent on external socio-economic factors. Developed by the US Department of Health and Human Services, the social determinants of health (SDOH) encompass such concepts as economic stability, education access and quality, health care access, and quality, neighborhood and built environment, and social and community context (“Social determinants of health,” n.d.). When analyzing the aforementioned demographic data, it becomes evident that ethnic minorities and the LGBTQ+ community are the ones affected by the disease. African Americans, Hispanics, and gay people continue to be some of the most discriminated and stigmatized groups. As a result, their access to proper health care and financial stability remains rather limited, creating a powerful link between the disease incidence and the SDOH (Mermin, 2018). It may be outlined that HIV infection is highly dependent on the development of social inequalities that eventually lead to the disparities in health care. Thus, social determinants of health contribute to the process of eradicating the gap between people affected by HIV and the healthy population.

Epidemiologic Triangle

When it comes to communicable diseases, it is of paramount importance to define the actors of the epidemiologic triangle in order to find the root and of the infection dissemination. The triangle itself consists of such concepts as the agent (“what”), the host (“what”), and the environment (“where”) (Aryal, 2019). In the context of HIV, the central agent is the immunodeficiency virus stimulated by its predecessor SIV. The agent is not detectable from the start, as it obtains a “window” period that allows the HIV infections to remain implicit for up to six months. The primary host of the infection is believed to be a chimpanzee, but current HIV research and treatment is focused on the human hosts who are at risk of becoming infected through injection drug use or unprotected sexual intercourse. Naturally, the perfect environment for the agent exists within social groups with a lack of sex education and explicit drug dependence. The environment itself is also stimulated by the fact that stigmatization of the disease blocks people’s intentions to test and get timely treatment. For this reason, the whole population should be notified and educated on the matter of HIV risk factors in order not to allow the virus to spread.

Community Health Nurse’s Role

The issue of HIV endemic within the US requires considerate public health intervention in order to raise people’s awareness and guide them through the process of living with the virus. Thus, the primary responsibilities of the community health nurse in this setting include “referring community members for HIV testing, linking them to care, accompanying them to clinic appointments, providing psychosocial support and making referrals to other services” (Busza et al., 2018, p. 328). In the paradigm of HIV treatment and diagnostics, community health nurses play the role of educators and supporters. Indeed, today’s social setting makes HIV status accompanied by severe depression, shame, and various other mental issues. For this reason, the community health nurse not only has the responsibility to collect primary data in order for the public health institutions to look into the issue, but they have to counsel people with HIV-positive status on the matter of resources available to learn more information about the virus and other people living with it.

One of the major responsibilities of a community health nurse is to promote HIV testing within the community and report new casualties to the national database. Real-time demographics allow both sociology and medical professionals to analyze the bigger picture and allocate public health resources according to the relevance within social groups. For example, there is a common issue that public health education, including sex-ed programs, is mostly available for the social groups capable of finding this information with practically no effort, as it is available online. The social groups that constitute the HIV risk groups are the ones not having extensive public health education programs. For this reason, tracking the casualties and updating demographic data provides community health nurses with the opportunity to allocate resources in accordance with the scope of relevance and immediateness.

National HIV Agency

When dealing with an endemic communicable disease, it is vital local authorities pay enough attention to the issue through the establishment of public institutions that guide both people living with HIV and medical professionals. In the US, one of the most recognized public institutions known as the Office of AIDS Research (OAR) is funded and supported by the National Institutes of Health (NIH) (OAR, 2019). As an institution, OAR places major emphasis on the questions of establishing research priorities, developing strategies for HIV treatment and control, and allocating funds according to the HIV prevalence and priorities (OAR, 2019). When it comes to the promotion of public health, OAR presents one of the most trustworthy web-based sources on the matter of HIV treatment, prevention, and public initiatives to raise awareness of this stigmatized health condition. The source. Thus, the following organization not only addressed the national support for the issue but promotes recognition of the disease on the national level.

Global Implication of HIV

Despite the efforts already put to end the HIV epidemic, the disease remains of the leading causes of death in the context of communicable diseases (“The global HIV/AIDS epidemic,” 2021). Unlike the US, where the new case incidence rate has fallen drastically over the years, there are regions where HIV remains endemic and extremely dangerous. For example, in Eastern and South Africa, more than half of the population lives with HIV/AIDS, whereas the new case incidence in Central Asia and Eastern Europe has increased by 72% (“The global HIV/AIDS epidemic,” 2021). Such daunting statistics justify the issue of stigmatization of HIV and unwillingness to talk about safe sex and implications of drug use.

Conclusion

Among a variety of communicable diseases known to the humanity, human immunodeficiency virus is considered a unique virus that cannot be cured and prevented with the means of vaccination. However, unlike other diseases, HIV/AIDS is somehow easier to avoid when educating people on the modes of disease transmission, encompassing drug use, mother-child transmission, and sexual intercourse. Thus, it is crucial for public health institutions to promote HIV testing, protected sex, and eradicate stigma and shame surrounding the concept of HIV/AIDS. Moreover, the best-case scenario to address this health issue would be to resolve the socio-economic issues that prevent social determinants of health from positive influence.

References

Aryal, S. (2019). Epidemiologic triad – agent, host, environment. Web.

Busza, J., Dauya, E., Bandason, T., Simms, V., Chikwari, C.D., Makamba, M., Mchugh, G., Munyati, S., Chonzi, P., & Ferrand, E. A. (2018). The role of community health workers in improving HIV treatment outcomes in children: lessons learned from the ZENITH trial in Zimbabwe. Health Policy and Planning, 33(3), 328-334.

Centers for Disease Control and Prevention. (2021a). About HIV. Web.

Centers for Disease Control and Prevention. (2021b). HIV surveillance. Web.

Edemekong, P. E., & Huang, B. (2020). Epidemiology of prevention of communicable diseases. StatPearls Publishing. Web.

HIV and opportunistic infections, coinfections, and conditions. (2020). HIVinfo. Web.

Mermin, J. (2018). CDC adds new HIV and social determinants of health indicators to NCHHSTP’s AtlasPlus. Web.

Office for AIDS Research. (2019). About the Office of AIDS Research. Web.

Origin of HIV & AIDS. (2019). Avert. Web.

Social determinants of health. (n.d.). Healthy People 2030. Web.

The global HIV/AIDS epidemic. (2021). Kaiser Family Foundation. Web.

World Health Organization. (n.d.). Why the HIV epidemic is not over. Web.

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