Community Health Problem Analysis - Research Paper Example

?HIV/AIDS in the Seattle population Background: Acquired Immunodeficiency Syndrome or AIDS, as it is commonly referred to as, is a chronic, debilitating infectious immunosuppressive disease which is associated with high morbidity and mortality. Currently, the world is facing a global HIV/AIDS epidemic with increasing numbers of individuals being infected and dying from AIDS. HIV/AIDS not only poses a great burden on the heath care system but also has several economic and social implications. HIV/AIDS poses a great burden on the economy as it results in enormous healthcare-provision related costs and also results in an overall loss in productivity as it mostly inflicts individuals during the prime years of their lives, when they are economically most productive (Global Health Council, 2010). In the face of this ever increasing problem, several strategies have been developed and enacted worldwide for the effective screening, timely diagnosis, treatment and monitoring of HIV/AIDS and the sixth Millennium Development Goal (MDG) aims to control and counter the spread of this ailment by the year 2015 (Global Health Council, 2010). This paper overviews the scope and magnitude of the burden of HIV/AIDS in the Seattle, Washington population, identifies and discusses the existing issues related to the provision of optimal care for individuals affected by HIV/AIDS and proposes some recommendations to overcome this issue. Epidemiology: Ever since the first case of AIDS was diagnosed in America in the year 1981, the incidence of HIV/ AIDS has been on a continual rise (AVERT, 2010). In the last several decades, an exponential rise in the incidence and prevalence of HIV/AIDS in the United States has been witnessed and this can be gauged from the fact that currently, approximately over a million people with HIV and AIDS are residing in the United States (UNAIDS, 2010) and each year almost 50,000 individuals are newly infected by HIV in the United States only, one-fifth of whom are unaware of their disease status (Moore, 2010). Moreover, it has also been observed that even in developed nations such as the U.S, a significant fraction of individuals who are aware of their disease status are not involved in accessing the health care facilities for this disease (Moore, 2010). In order to devise effective screening, diagnostic, treatment and monitoring strategies for HIV/AIDS, a clear understanding of the various risk factors and modes of transmission is required. It has been elucidated that there are several groups of individuals which are particularly at risk for contracting HIV/AIDS. These high risk groups include injection drug abusers, men who have sex with men (MSM), i.e. homosexual individuals, and from an infected mother to her infant (Beyrer, 2007). Moreover, it has been found that there are three main modes of transmission of HIV/AIDS, viz. via contact with infected body fluids, such as blood, semen, etc; via sexual contact with infected individuals and vertical transmission from the mother to the fetus during the antenatal period or during birth via passage through the birth canal (Leblebicioglu, 2007). Most preventive strategies for HIV/AIDS are focused on the reduction of transmission of HIV/AIDS via these routes and creating awareness amongst the general population, and in particular amongst those who are at high risk for contracting and transmitting HIV/AIDS regarding this debilitating disease. Scope of the Problem in Seattle, Washington: The magnitude of this problem in the state of Washington is reflected by the statistics reported by the U.S Centers for Disease Control and Prevention (CDC) which reveal that in the year 2007, the Seattle metropolitan statistical area ranked 24th in the number of Aids cases reported annually with a case rate of 10.9 per 100,000 population (Public Health - Seattle & King County, 2011). Moreover, a study conducted by the Department of Public Health - Seattle & King County elucidated that King County was the top amongst all Washington counties having the highest AIDS rates and Seattle had the highest AIDS rate within the King County (Public Health - Seattle & King County, 2011). Another important parameter which reflects the overall state of HIV/AIDS in the Seattle region over the last few years is the proportion of the total U.S cases contributed by the Seattle metropolitan statistical area. As opposed to contributing to 1.01% of the total AIDS cases in the U.S during the year 1992, it was found that by the year 2007, the Seattle metropolitan statistical area contributed only 0.82% of the total AIDS cases in the U.S (Public Health - Seattle & King County, 2011). Resources available to provide services to Persons with AIDS (PWA): In the state of Washington, several organizations and resources are available for the aid and guidance of individuals who are suffering from HIV/AIDS. One such resource is the Lifelong AIDS Alliance which is an organization which aims at providing support to individuals whose lives have been inflicted by HIV/AIDS and also focuses on preventing the spread of HIV within the community (Lifelong AIDS Alliance, 2006). This organization provides support in various forms for persons with AIDS (PWA), which can be broadly categorized under three main themes, viz. Care services, prevention/education and advocacy (Lifelong AIDS Alliance, 2006). The care services provided by this organization are not limited to just diagnostic or management services but also include services such as housing arrangements, on both temporary and permanent basis and provision of insurance (Lifelong AIDS Alliance, 2006). In addition, this organization also facilities access to HIV/AIDS-related care by the affected individuals by means of a program termed as AIDS Care Access Project (ACAP). Moreover, where case managers provided by this organization are involved in tending to all aspects of HIV/AIDS related management of the people, there are several other programs initiated by this organization such as Mental Health Access Program (MHAP) and Seattle Treatment Education Project (STEP) which are aimed at providing a holistic approach of care for individuals with HIV/AIDS (Lifelong AIDS Alliance, 2006). The MHAP aids HIV/AIDs inflicted individuals in accessing mental health care, while STEP focuses on ensuring compliance to treatment regimes by these individuals (Lifelong AIDS Alliance, 2006). Another organization which is available to provide resources to persons with AIDS residing in Seattle, Washington is ‘People of Color Against AIDS Network,’commonly known as POCAAN. Since AIDS is most prevalent amongst communities of color, this multi-cultural organization focuses on the provision of AIDS prevention services to this subgroup of the population. This organization aims to unite colored individuals belonging to various races, socioeconomic status and sexual orientation on a common platform to improve the accessibility of the existing AIDS-related health care services and awareness programs by all alike without any bias or prejudice (People of Color Against AIDS Network - POCAAN, 2005). Similarly, on the national level, the Department of Public Health - Seattle & King County has introduced several programs for the surveillance and control of HIV/AIDS in Seattle under its HIV/AIDS program (Public Health - Seattle & King County, 2011). Under this program, various HIV/AIDS related service are provided, including and not limited to, screening for HIV/AIDs, Counseling for individuals who have the disease or are at risk of contracting it, treatment services, needle exchange facilities and conduction of HIV/AIDS related research (Public Health - Seattle & King County, 2011). Moreover, the Department of Public Health - Seattle & King County also collaborates with other community partners and provides them support and assistance in the form of campaigns and media development programs, technical assistance and aid in materials development (Public Health - Seattle & King County, 2011). An important program introduced by the Department of Health - Seattle & King County is the HIV/AIDS Surveillance and Epidemiologic Research which is responsible for conducting surveillance and reporting for identified cases of HIV/AIDS, an activity which has been mandated by the state. Moreover, under this program, public health research regarding the epidemiology, natural history, transmission and control of HIV and other STDs has been carried out. Barriers to overcome: There are several barriers to the provision of optimal care to individuals suffering from HIV/AIDS. Firstly, there is significant room for improvement in the services being offered by the Department of Public Health and other agencies for the screening and monitoring of HIV/AIDS in the region. For example, despite the introduction of various awareness programs and the presence of agencies offering services for individuals with HIV/AIDS, it was found that during the year 2009, between 9-18% individuals residing in the King County who were HIV-infected were unaware of their disease status (Public Health - Seattle & King County, 2011). This not only suggests inefficiency on the part of the providers of surveillance and health care services, but also reflects the existence of a major gap between the services being provided and their accessibility by the general population. Secondly, there is limited understanding of the services needed by individuals affected by HIV/AIDS. Most programs for HIV/AIDS focus on the provision of screening, diagnostic and treatment modalities. However, it is important to realize that HIV/AIDS demands a holistic approach to care which is not limited to a person’s physical well being only but also encompasses his/her emotional and physical well being. For example, the 2005 Needs Assessment Survey conducted by the HIV/AIDS Planning Council for the Seattle Eligible Metropolitan Area (EMA) revealed that the services provided to individuals with HIV/AIDS lacked in three main domains viz. mental health services, oral health care and substance abuse services (Public Health - Seattle & King County, 2011). Other issues include the lack of proper resources, both material and human resources. The HIV/AIDS program which was introduced by the Department of Health - Seattle & King County is funded on the federal level by the Ryan White CARE Act. However, these funds are inadequate to support all the activities conducted by this program and thus, the funding is supplemented by the City’s investments, especially for the provision of case management services, including both needs assessments and referrals (Seattle.gov, 2011). To further compound and aggravate this existing compromised situation, due to the current economic crisis, the normally allocated state funding to support the regional AIDS control activities was reduced by 14% as compared to 2010, resulting in a cut down in the allocated finances of $1,053,307. The resulting reduced amounts of funds have been reported to be inadequate to sufficiently support the AIDS surveillance, prevention and treatment strategies required to control the AIDS epidemic in the Washington State (Washington State Department of Health, 2009). Moreover, improper allocation of funds is another issue which hinders the implementation of effective HIV/AIDS programs. Statistics reveal that during the year 2009, almost $ 95 million cumulative federal and local funds were allocated to be utilized for AIDS prevention and control programs (Vargas & Fears, 2009). However, the proper allocation and utilization of these funds was questionable and this led to several stakeholders such as care providers losing interest in further investing their time and resources in such programs. Another significant barrier is the regulatory issues and the influence of various stakeholders in the formulation of policies regarding HIV/AIDS. For example, it has been elucidated that the congressional control over the AIDS control office had restricted the AIDS office's ability to control the transmission of HIV amongst drug injection users by preventing the utilization of monetary resources generated by taxes for a needle exchange program (Vargas & Fears, 2009). Such regulatory issues constitute a major hurdle in the effective and successful implementation of HIV/AIDS control programs. Recommendations: HIV/AIDS requires a holistic approach to care which is not limited to the provision of screening, diagnostic and treatment modalities only. Thus, the services provided for individuals affected by HIV/AIDS should not only encompass the diagnostic and management aspects of care but should also include other aspects of care such as mental health facilities, financial aid in the form of insurance plans, housing facilities, etc. Moreover, educational programs aimed at promoting the knowledge regarding the risk factors, transmission and hazards of HIV/AIDS should be introduced on a wider scale. Another important milestone to achieve in caring for patients with HIV/AIDS is to improve the available screening and diagnostic facilities by making them more accessible by the general population. As discussed above, despite the available facilities for screening and diagnosis, almost one-fifth of the individuals who are infected by HIV are unaware of their disease status. This has serious implications as these individuals contribute in further transmission of the disease. Therefore, it is recommended that screening for HIV/AIDs should be made a part of routine screening and should be offered to all individuals aged between 13-64 yrs (Public Health - Seattle & King County, 2011). Lastly, another important recommendation to improve the existing public health programs available for HIV/AIDS is to enact regulatory bodies to monitor the proper allocation of resources to HIV/AIDS control and surveillance programs and the proper functioning of agencies and organizations involved in offering services to individuals suffering from HIV/AIDS. References AVERT. (2010). HIV and AIDS in America. Retrieved February 11, 2011, from AVERT: AVERTing HIV and AIDS: http://www.avert.org/america.htm Beyrer, C. (2007). HIV Epidemiology Update and Transmission Factors: Risks and Risk Contexts—16th International AIDS Conference Epidemiology Plenary. Clinical Infectious Diseases , 981=987. Global Health Council. (2010). The Impact of HIV/AIDS. Retrieved February 11, 2011, from Global Health Council: http://www.globalhealth.org/hiv_aids/?gclid=CISz8KvJjKcCFcULfAod_UpPeg Government of the District of Columbia; Dept of Health. (2009). Heterosexual Relationships and HIV in Washington, DC. Washington DC: Government of the District of Columbia; Dept of Health. Leblebicioglu, H. (2007). HIV / AIDS: EPIDEMIOLOGY. Journal of Internal Medical Sciences , 7-10. Lifelong AIDS Alliance. (2006). Programs/Services. Retrieved February 12, 2011, from Lifelong AIDS Alliance: http://www.lifelongaidsalliance.org/careServices Moore, R. D. (2010). Epidemiology of HIV Infection in the United States: Implications for Linkage to Care. Clinical Infectious Diseases , 208-213. People of Color Against AIDS Network - POCAAN. (2005). Retrieved February 15, 2011, from People of Color Against AIDS Network - POCAAN: http://www.pocaan.org/home.html Public Health - Seattle & King County. (2011, February 8). HIV/AIDS program. Retrieved February 11, 2011, from Public Health - Seattle & King County: http://www.kingcounty.gov/healthservices/health/communicable/hiv/about/mission.aspx Seattle.gov. (2011). Public Health Initiatives and Funding: HIV / AIDS Prevention & Services. Retrieved February 15, 2011, from Seattle.gov: Human Services Department: http://www.cityofseattle.net/humanservices/foodhealth/publichealth/HIV_AIDS.htm UNAIDS. (2010). UNAIDS Report on the global AIDS epidemic. Retrieved February 11, 2011, from UNAIDS: http://www.unaids.org/globalreport/Global_report.htm Vargas, J. A., & Fears, D. (2009, March 15). At Least 3 Percent of D.C. Residents Have HIV or AIDS, City Study Finds; Rate Up 22% From 2006. Retrieved February 11, 2011, from The Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2009/03/14/AR2009031402176_pf.html Washington State Department of Health. (2009). 2010 Update to the 2005-2010 HIV Prevention Plan. Washington State Department of Health. Read More