Health Impact of HIV/AIDS

Health Impact Framework Research Paper: HIV/AIDS

Delaware Technical Community College

NUR 310 Global Health

Veronica Payne

December 5, 2018

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Health Impact of HIV/AIDS

Abstract

The diagnosis of HIV is no longer a death sentence, it is a treatable disease. With access to

proper health care and medical management, HIV positive individuals may lead long and healthy

lives. The burden of this disease, however, varies greatly from wealthy to poor regions around

the globe and is still considered an epidemic in specific regions. Where you are born, should not

determine whether you live or die. Governments, non-governmental organizations, and

healthcare professionals are tasked with the responsibility to combat this disease on population

wide and individual based levels.

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Health Impact of HIV/AIDS

Health Impact Framework Research Paper: HIV/AIDS

“Rarely has a single pathogen had a greater impact on the human condition than HIV”

(Skolnik, 2016). In 2013, the World Health Organization (WHO) estimated that 35 million

individuals globally were living with HIV/AIDS, with only 12.9 million being treated with

antiretroviral therapy (ART). In that same year, 2.1 million individuals were newly infected and

1.5 million individuals died from HIV-related deaths. No country, wealthy or poor, is immune to

HIV/AIDS. However, the prevalence of HIV varies considerably by region and country. “The

Global Burden of Disease Study 2010 indicated that HIV was the sixth leading cause of death for

all age groups globally but the second leading cause of death in sub-Saharan Africa. For people

aged 15-49 in sub-Saharan Africa, HIV was the leading cause of death” (Skolnik, 2016).

The heaviest burden of the HIV/AIDS epidemic has fallen on low- to middle-income

countries, “the region with the highest prevalence rate of HIV/AIDS is sub-Saharan Africa,

where 4.7 percent of the adults 15-49 years of age are HIV-positive… South Africa has an adult

prevalence rate of 18 percent” (Skolnik, 2016). In sub-Saharan Africa, an entire generation of

children have been orphaned, an entire workforce has been disabled, and an already frail

healthcare system has been stressed beyond its limits. “HIV has significant social and economic

consequences, especially in high prevalence countries in sub-Saharan Africa, which go beyond

its impact on morbidity and mortality. HIV affects family cohesion, business, trade, labor, the

armed forces, agricultural production, education systems, governance, public services, and even

national security” (Skolnik, 2016). The cost of treatment is often a substantial portion of a

poorer individuals income. “Many of the lowest-income countries that are providing therapy for

people living with HIV spend less per capita on health each year than the costs of HIV

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Health Impact of HIV/AIDS

treatment” (Skolnik, 2016). As with most communicable diseases, HIV/AIDS disproportionately

affects the poor.

In a wealthy developed nation, such as the United States, there are numerous resources

for individuals to be tested for HIV and receive treatment for HIV/AIDS. “A person living with

HIV who takes HIV medicine as prescribed and gets and stays virally suppressed can stay

healthy and has effectively no risk of sexually transmitting HIV to HIV-negative partners”

(HIV.gov, 2018). By the end of 2015, an estimated 1,122,900 adults and adolescents were living

with HIV in the U.S. Fifteen percent, or one in seven of those, were unaware of their infection.

Among all adults and adolescents living with HIV, diagnosed or undiagnosed, 63% received

some HIV medical care, 49% received continuous HIV care and 51% had achieved viral

suppression (CDC, 2018). The CDC estimates that the number of annual HIV infections in the

U.S. declined by 8% between 2010-2015 (from 41,800 to 38,000). Improvements in the U.S. can

be made in helping young people know their status, in 2015 among people 13-24 who were

living with HIV, an estimated 51% didn’t know (CDC, 2018). Even in the U.S. the burden of

this disease disproportionately affects the poor. “HIV diagnoses are not evenly distributed across

states and regions. People in southern states accounted for more than half of new HIV diagnoses

in 2016, while making up 38% of the nation’s population” (CDC, 2018). “Southern states are

some of the poorest in the U.S., while wealth lives mostly in the Northeast and Mid-Atlantic

regions” (Mekouar, 2015). Unlike sub-Saharan Africa, the United States has numerous federal

departments and community organizations involved in the HIV/AIDS response. With the

passage of the Affordable Care Act in 2010, “new opportunities for expanding health care

access, prevention, and treatment services for millions of people in the U.S., including many

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Health Impact of HIV/AIDS

people with or at risk for HIV. Importantly, for people living with HIV, there are new

protections in the law that make access to health care coverage more equitable” (KFF, 2018).

Application of HIV/AIDS Epidemic To A Five-Tier Health Impact Pyramid

In relation to the HIV/AIDS epidemic, a five-tier pyramid illustrates the impact of public

health interventions, while providing a framework to improve the health of populations and

individuals. The bottom level of the pyramid illustrating population-wide interventions that have

the greatest impact for the most people. Moving in an ascending fashion to the top tier of the

pyramid, which illustrates counseling and educational interventions, that are individually

focused. “Comprehensive public health programs should generally attempt to implement

measures at each level of intervention to maximize synergy and the likelihood of long-term

success” (Frieden, 2010).

Socioeconomic Factors

The base of the five-tier pyramid represents efforts to address socioeconomic

determinants. Socioeconomic status refers to an individual’s educational experience, economic

status, social and work environment and access to healthcare, all of which are key determinants

of health. “Socioeconomic status is a strong determinant of health both within and across

countries” (Frieden, 2010). Individuals who are better off have the knowledge and income to

protect themselves and treat illnesses. As an individual’s education and income improve, so does

their health status. For example, in sub-Saharan Africa, polygamy is a common practice that has

contributed to the spread of HIV/AIDS. Demographic and Health Surveys have showed that, “as

husband’s education rose to the secondary level, polygamy declined” (Hayase, Liaw, 1997).

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Health Impact of HIV/AIDS

Certain cultural factors and health beliefs have hindered the fight against the HIV/AIDS

epidemic, especially in sub-Saharan Africa. “Stigmatization of HIV/AIDS in many societies has

led to unwillingness to allow people with HIV to attend schools or be employed, get health care,

live in certain places, or even live with their families. Stigma has also been a major constraint to

people’s getting tested or treated for HIV” (Skolnik, 2016). In 2006, former President of South

Africa Jacob Zuma, publicly stated that he did not use a condom and showered after having sex

with an HIV positive woman to reduce his risk of being infected. “AIDS educators now fear that

while female-to-male HIV transmission is indeed less common than male-to-female

transmission, Mr. Zuma’s explanation could be interpreted as meaning men are not at risk…

Statements like that can throw years of hard work down the drain” (Pearce, 2006). In addition,

statements like that negatively influence The Health Belief Model as it applies to condom use in

practicing safe sex. “The premises of this model are that people’s health behaviors depend on

their perceptions of: their likelihood of getting the illness, the severity of the illness if they get it,

the benefits of engaging in behavior that will prevent the illness, the barriers to engaging in

preventive behavior” (Skolnik, 2016). Jacob Zuma’s careless statements have the potential to

discourage young followers from practicing safe sex.

Changing the Context

The second level of the five-tier pyramid represents interventions in public health to

encourage healthy decisions. Manipulating the environment “to make healthy options the default

choice, regardless of education, income, service provision, or other societal factors” (Frieden,

2010). In the context of the HIV/AIDS epidemic, this means making preventative measures

affordable and readily available, like public distribution of condoms and safe sex campaigns.

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Health Impact of HIV/AIDS

“Changing the context to make condoms ubiquitously available and acceptable makes education

about their use more effective” (Frieden, 2010).

Long-Lasting Protective Interventions

The third level of the five-tier pyramid represents long-lasting protective interventions,

like immunizations, that reach individuals and do not require closely monitored clinical care.

For example, in the context of the HIV/AIDS epidemic, “male circumcision, a minor outpatient

surgical procedure, can decrease female-to-male HIV transmission by as much as 60%. Scale-up

could potentially prevent millions of HIV infections in Sub-Saharan Africa” (Frieden, 2010). In

July of 2012 the Food and Drug Administration (FDA) approved the pre-exposure prophylaxis

(PrEP) drug known as Truvada. “PrEP has been found to be effective through trials conducted

across the globe” (Hoff et al, 2015).

Clinical Interventions

The fourth level of the five-tier pyramid represents direct clinical care and interventions.

In the context of the HIV/AIDS epidemic, this includes post exposure prophylaxis (PEP), which

involves taking antiretroviral medications (ART) after potential or known HIV exposure. “HIV

antiretroviral therapy in the infected partner decreases the risk for transmission to the uninfected

partner by 96%. Therefore, antiretroviral therapy not only is beneficial to the health of persons

with HIV infection, but also reduces the risk for continued transmission” (CDC, 2015).

Education at the individual patient level is incredibly important when a patient is taking ART. If

taken incorrectly or doses are missed, the development of drug resistance could occur. “At least

a third of patients do not take medications as advised, and nonadherence cannot be predicted

from socioeconomic or demographic characteristics” (Frieden, 2010).

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Health Impact of HIV/AIDS

Counseling and Education

The fifth and top tier of the pyramid represents counseling and educational interventions to

individuals or specific groups. “An example of successful evidence-based educational

intervention is trained peer counselors advising men who have sex with men about reducing HIV

risk” (Frieden, 2010). Nurses, acting as educators and counselors, have the opportunity to

change individuals’ perceptions on disease prevention and treatment. Nurses following The

Health Belief Model, can educate patients on the risks of engaging in unsafe sexual interactions,

the severity of HIV and other sexually transmitted infections, as well as identify any barriers that

might prevent individuals from protecting themselves and or others. It is the responsibility of the

nurse and any health care professional to offer, “behavioral counseling to reduce sexually

transmitted infections” (Frieden, 2010).

Recommended Future Interventions

The Bill and Melinda Gates Foundation is considered to be one of the leading non-

governmental organizations in the fight against the HIV/AIDS epidemic. “The goal of our

program is to accelerate the decline of HIV infection worldwide and save lives by ensuring

expanded and simplified HIV treatment and improved and effective use of interventions to

prevent new infections” (Gates Foundation, 2018). The United Nations has set a sustainable

development goal to end the AIDS epidemic by 2030. Working towards a vaccine should be a

goal of every nation. The Bill and Melinda Gates Foundation is leading the way. “We continue

to invest in efforts to develop an HIV Vaccine. Although developing a highly effective vaccine

remains a substantial scientific challenge, even a vaccine with partial efficacy and limited

duration could help dramatically reduce the global incidence of HIV” (Gates Foundation,

2018).

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Health Impact of HIV/AIDS

Professional Opportunities in the Global Health Field

“Recent decades have witnessed a burgeoning interest in improving health and health

systems in low and middle-income countries. With the increase in program funding came

parallel increases in the number of university programs in the U.S. and Europe offering

concentrations or degrees in a global health field” (Eichbaum, 2015). Pathways to careers in

global health can be through data collection, education or research, on a national or multinational

level. Global health is a vast field, with numerous opportunities. There are numerous non-

governmental organizations, such as, The Red Cross, Doctors Without Boarders and Operation

Smile.

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Health Impact of HIV/AIDS

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