Running head: HIV/AIDS RESEARCH PAPER 1

Health Impact Framework/Research Paper

HIV/AIDS

Delaware Technical Community College

NUR 310 Global Health

Caitlin Harvey RN

April 3, 2017
HIV/AIDS Research Paper 2

Abstract

This paper discusses HIV/AIDS related to global health. HIV/AIDS has such a global

impact on health it is important that we look at this disease and how to implement interventions

worldwide. With the health topic of HIV/AIDS medical professionals take a look at

socioeconomic factors, long lasting protective interventions, clinical interventions, counseling,

education, and future interventions. Also, within this paper there is a focus on professional

opportunities in the global health field.

Introduction

When examining social injustice and its impact on healthcare one, of the most notable

disease processes in current society can be found, HIV/AIDS. Human immunodeficiency virus

more commonly known as, HIV, is a viral infection that attacks and weakens the immune

system. Specifically this, disease targets and attacks the white blood cells known as T-Helper or

CD4 cells. The destruction of these cells impairs the body's ability to fight infection and can lead

to numerous secondary infections, which eventually become life threatening (HIV/AIDS

Basics, 2014).

When HIV has matured in the body and the immune system has become weakened to the

point where it is unable to fight off disease, the HIV carrier is considered to have Acquired

Immune Deficiency Syndrome (AIDS). AIDS itself is not a viral illness; instead, it is a set of

symptoms caused by the targeted destruction of the CD4 cells, leading to a weakening of the

immune system. Currently, there is no known cure for HIV or AIDS, however with early

detection and proper medical treatment the HIV can be controlled (HIV/AIDS Basics, 2014).

HIV/AIDS is a current global epidemic. This disease currently affects more than 36.7

Million people worldwide (HIV/AIDS Basics, 2014). Of these, more than 1.8 million infected

are children (<15 years of age) (HIV/AIDS Basics, 2014). It is estimated that more than 2.1

Million new individuals are infected with the virus every year (HIV/AIDS Basics, 2014). A

significant number of HIV-positive individuals come from developing middle to low-income

nations (HIV/AIDS Basics, 2014). The most affected area of the world is sub-Saharan Africa

(HIV/AIDS Basics, 2014). It is estimated that more than 66% of all new HIV infections

worldwide in 2015 were transmitted in the sub-Saharan region of Africa (HIV/AIDS Basics,

2014).
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HIV/AIDS is believed to have claimed more than 35 million lives since the epidemic was

noted (HIV/AIDS Basics, 2014). This number continues to rise, as many of those who are

infected do not have access to proper testing to make a diagnosis. These undiagnosed cases of

HIV contribute to many of the new cases of the virus. It is believed that as many as 40% of all

infected individuals with the disease, do not know that they are infected (HIV/AIDS Basics,

2014).

Socioeconomic Factors

Some of the greatest factors contributing to spread of the HIV are socioeconomic in

nature. The vast majority of HIV-infected individuals are typically seen in lower-income nations.

There are many factors to be considered when assessing why these socioeconomic issues factor

into the spread of the disease. Generally, in these lower-income countries, access to education is

limited when compared to a more developed country. This lack of education, towards prevention

and treatment leads to an increase in the spread of the disease. Another factor to consider is the

lack of access to qualified healthcare providers. In many of the lower income nations, high

quality healthcare is not available to all of their citizens. Even when healthcare is available,

many of the citizens of these lower income countries are unable to afford the care they require to

maintain their health. This lack of access to quality health care coupled with limited education is

a recipe for the increased transmission of the HIV (HIV/AIDS Basics, 2014).

Changing the Context to Make Individuals Default Decisions Healthy

One of the most effective ways to help make a large-scale impact on health, in general, is

to make default decisions easier so that individuals can be healthier. This can be obtained by

making critical preventative measures easily accessible. To decrease the prevalence of HIV,
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healthcare organizations need to collaborate and make access to many of these measures more

readily available, especially in developing nations. By increasing the accessibility to free

condoms and other prophylactic devices, it is easier for the population to make the right decision

when it comes to safe sex practices. By increasing safer sex practices, the prevalence of this

sexually transmitted disease would decrease significantly. Another critical resource that could be

made more accessible would be free HIV screenings. By giving increased access to these

screenings, the 40% of infected individuals who are unaware they are infected will likely be

drastically decreased (HIV/AIDS Basics, 2014). Increased knowledge of infection will allow

these individuals to make healthier decisions to help prevent the further transmission of the

disease.

Long-Lasting Protective Interventions

Another effective way to make an impact on a health problem is through the

implementation of long-lasting protective interventions. One of the most successful of these

interventions in the prevention of HIV/AIDS is the promotion of male circumcisions. In many

developing nations, this procedure is not readily available. By increasing the population's access

to such a procedure, it has been shown to drastically decrease the transmission of HIV/AIDS

(Male circumcision for HIV prevention, 2017). Another key factor is to increase the early

detection of the disease. With the early detection of HIV, the disease is much more medically

manageable. With the decreased viral loads seen in the early stages of the disease, treatment is

found to be more effective and can reduce the likelihood of retransmission (Adherence to ART |

Adult and Adolescent ARV Guidelines | AIDSinfo, 2014). By identifying an individual to be

HIV positive early, it also limited the number of sexual partners they may have unprotected sex

with compared to if they were not made aware that they were HIV positive (HIV/AIDS, 2016).
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Clinical Interventions

An important step in impacting the health of the HIV population can be in clinical

interventions. One of the most important and often overlooked clinical interventions in the

management of HIV/AIDS is nutritional consultation. As HIV weakens the immune system, it is

even more important that these individuals have a healthy balanced diet in order to make sure

their bodies have the nutrition needed to help fight any secondary infection that may

arise(HIV/AIDS Basics, 2014). Another consideration for nutrition is that many HIV patients

may end up with an oral fungal infection known as thrush. This infection can be especially

painful and lead to decreased oral intake, which in turn can affect a patient nutritional status

(HIV/AIDS Basics, 2014).

Another major clinical intervention the nurse can assist in is in infection prevention. As

mentioned previously the HIV attacks the infected individual's immune system, targeting the

cells that help fight off infection. With this decreased immune system a patient is more likely to

obtain secondary infections, which can lead to life-threatening complications. The nurse can

intervene by educating the patient the importance of such infection prevention techniques as

hand hygiene and wearing a surgical mask whenever in a public location.

A third clinical intervention to in the treatment of HIV is supporting the patient through a

medication regime of antiviral medications. When initiating a patient on a medication regime,

many factors need to be considered. The healthcare team should do a thorough evaluation of the

patients knowledge and ability to succeed on such a regime. Many factors can influence the

likelihood of success on a regime. For example, patients who are prescribed a once-daily

medication regime show significantly better medication compliance when compared to those

who are prescribed a twice-daily regime (Adherence to ART | Adult and Adolescent ARV
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Guidelines | AIDSinfo, 2014). Other factors for the nurse to consider when the patient is being

assessed for the initiation of a new medication regime is to assess the patient's current knowledge

about HIV as well as any psychosocial challenges such as substance abuse, levels of support at

home and any history of mental illness. Once the determination is made to initiate a patient on a

new medication regime, the focus of the nurse turns towards education and access. The nurse

should provide the patient with resources to obtain drug coverage and provide them with

education on self-monitoring for potential side effects of the medication. The nurse will also

continuously monitor the patient on subsequent visits for signs of medication compliance as well

as assess the patient for any potential issues with compliance. This will consist of surveying the

patient about compliance and providing any assistance the patient may need to remain compliant.

Counseling and Education

The last step in the health impact pyramid is counseling and education. At this level, the

impact is more individualized and directed to provide specifically targeted education to high-risk

populations to make a difference. The main target populations for HIV/AIDS education would be

homosexual men, African Americans, and low-income populations (HIV/AIDS Basics, 2014).

According to the Centers for Disease Control and Prevention, gay and bisexual men

account for an estimated 54% of individuals who are diagnosed with AIDS in the United States

(HIV/AIDS, 2016). The prevalence of HIV/AIDS in the homosexual community has taken a

major toll. It is estimated that current 4.5 million gay and bisexual men are living with HIV

(HIV/AIDS, 2016). Of this population, it is believed that 1 out of 7 homosexual men in the

United States who has HIV is unaware they are infected (HIV/AIDS, 2016). These statistics,

along with the increased risk from unprotected anal sex, makes this population the most likely to

contract HIV. With this is mind, it is important for this population to be at the top of the list in
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targeted populations for education and counseling. Education should be placed around safer

sexual techniques including the use of proper prophylactic devices. With the ever present threat

of homophobia as well as the stigma that is attached to homosexuality, homosexual men are at a

higher risk for developing concurrent mental health issues that can benefit from counseling from

the nurse.

Other groups that the nurse can help provide targeted education to are low-income

populations. This population has seen increased level of HIV infections (HIV/AIDS Basics,

2014). The disease in these lower income populations perpetuates itself through a vicious cycle.

As individuals become infected with the disease, they become ill. As these individuals become

ill, they are unable to maintain gainful employment. With the lack of funds from inadequate

employment, these patients find it difficult to be able to obtain adequate nutrition, which

advances the disease process. Another key impact to low-income populations is the lack of

access to adequate healthcare and educational resources. Many lower income populations either

do not have access to education or leave education early in order to provide for their families.

This once again perpetuates the cycle of health risks. Nurses can help combat this by providing

education to these lower income populations. By entering the nations and communities where

education is lacking and providing this targeted education, nurses can have an impact at a

localized level.

Future Interventions

One of the keys to lowering the health impact of HIV/AIDS is through innovations in

future interventions. One of these key innovations revolves around developing and increasing the

availability of low-cost diagnostic testing for rural countries. The two main aspects of this sector

that are being developed are rapid point of care testing (RPOCT) and mobile testing laboratories.
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The development of RPOCT has recently been backed and funded by such organizations as the

World Health Organization (WHO), the Bill and Melinda Gates Foundation and the Clinton

Foundation (Stevens, Gous, Ford, & Scott, 2014). With such an interest from large-scale donors,

the science of RPOCT has made incredible strides in recent times. The ability to rapidly and

effectively provide point of care testing will allow for larger scale testing operations in remote

areas of previously underserved countries.

Another innovation that will aim at increasing access to quality and reliable HIV testing

is mobile laboratories. Recent pilot programs have been conducted in areas of Zimbabwe, South

Africa, and Thailand. Dubbed Project Accept this intervention mobilized multidisciplinary

teams to go into rural areas of previously underserved populations and not only test but also

provide post-test support services to patients who tested positive (Project Accept Study Group,

2013). The increase in projects like this will allow for greater access in these rural areas to

testing as well as the social support needed after diagnosis. This outreach to the community helps

spread the message of education and helps fight may of the stigmas attached to a diagnosis of

HIV/AIDS. The goal is to help change behaviors of infected patients thus decrease the spread of

the disease.

Finally, the most anticipated future innovation directed at diminishing the health impact

of HIV/AIDS is being made in the research and development of a potential HIV vaccine.

Recently released preliminary research shows that HIV requires a specific chain of amino acids

in the bloodstream in order to replicate (Yuani et al., 2017). Scientists have recently been able to

replicate a fake version of that amino acid, which in turn, stops the replication of the virus

(Yuani et al., 2017). It is believed that this may be the first step in developing an effective HIV

vaccine to diminish the virus' ability to replicate and stop the replication at the cellular level.
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Professional Opportunities in the Global Health Field

There are many great opportunities for growth with a career in the global health field.

These opportunities can include policymakers, health care ambassadors, and researchers. Each of

these fields is currently growing at an incredible rate and offers a rewarding career experience.

The need for policymakers has come to a head in recent years. With many national and global

health care reforms this is an extremely desirable career opportunity. Policy makers can utilize

their nursing knowledge and experience to help drive the future of global health.

Another great opportunity within the global health field is that of a health care

ambassador. These individuals travel to underserved regions of the world and help share their

knowledge and experience and help drive global education to targeted populations around the

world. These ambassadors can act as front line educators and practitioners. They may also act as

teachers and mentors for future leaders in healthcare. The health care ambassador promotes

wellness and health lifestyle choices through education and support.

Potentially, the opportunity in the global health field that has the potential ability to make

the greatest impact to the largest population is in global health research. With a recent focus from

many major philanthropists, on the importance of making an impact in global health, the need for

innovative researchers has never been higher. These individuals can make major impacts with

such breakthroughs as vaccines, pharmacological interventions, and ultimately, cures for many

of the diseases around the world.

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References (E)

Adherence to ART | Adult and Adolescent ARV Guidelines | AIDSinfo. (2014, May 1).

Retrieved from https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-

guidelines/30/adherence-to-art

HIV/AIDS. (2016, September 30). Retrieved from https://www.cdc.gov/hiv/group/msm/

HIV/AIDS Basics. (2014, July 14). Retrieved from https://www.aids.gov/hiv-aids-basics/

Male circumcision for HIV prevention. (2017). Retrieved from

http://www.who.int/hiv/topics/malecircumcision/en/

Project Accept Study Group. (2013, July 1). Project Accept (HPTN 043): A phase III

Randomized Controlled Trail of Community Mobilization, Mobile Testing, Same-Day

Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand. Retrieved

from http://www.cbvct.med.ucla.edu/protocol.pdf

Stevens, W., Gous, N., Ford, N., & Scott, L. E. (2014, September 08). Feasibility of HIV point-

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http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0173-7

Yuan, Z., Wang, N., Kang, G., Niu, W., Li, Q., & Guo, J. (2017, January 20). Controlling

Multicycle Replication of Live-Attenuated HIV-1 Using an Unnatural Genetic Switch.

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