A critical analysis of HIV/AIDS - Essay Example

Task: A critical analysis of HIV/AIDS The following write up includes a brief history of HIV/AIDS, its character as an infection and means of transmission. The essay then discusses HIV/AIDS epidemiology with reference to sexually active black African heterosexuals in the UK. This group was chosen because despite being only less than one percent of the UK population, it accounted for almost thirty percent of novel HIV diagnoses in 2010. The article will then discuss types of prevention including prevention of sexual transmission, prevention of infection from mother to child, sex education and treatment as a preventive strategy. The essay will then address preventive strategies employed to combat HIV/AIDS infections universally but with a bias in the sexually active blacks in UK. Lastly, the write up will critically evaluate the effectiveness of those strategies and the hindrances to effectiveness and then conclude with recommendations to address such issues based on identified evidence. HIV/AIDS became known in UK in the beginning of 1980s. Since then the population of people detected with HIV has increased almost doubling in 1990. At first, the disease was most prevalent among MSM, inject drug users and blood products recipients. Up to the end of 2010, almost 2000 people had contracted HIV through infected blood products (HPA). Of these, only twenty percent of these cases were undetected by 1994. For a period of seven years starting in 1994, there was an average of 2350 diagnoses every year. The rate of increase steeped in 1999, and peaking in 2005 with estimated diagnoses of up to 7900. Since then these numbers have since reduced but still remain high. For the last one and a half decades, the significant rise in diagnoses has been related with heterosexual related infections. In 2010, such exposure contributed for 42% of new diagnoses (HPA). Various groups are considered to be at a higher risk of HIV. One of these groups includes MSM. By 2010, this group had reached over fifty thousand. This included those already dead. According to NAT, novel infections in this category have steadily increased since 1999, and reached the highest in 2007. Another risk group is persons who inject drugs. Up to 2010, about 5,300 cases had been attributed to drug use. The figure for this year was 111. The other risk group is newborn children who acquire it from their mothers before, shortly after or during birth. By 2010, cases attributable to MTCT reached about 1943. HIV is a virus that attacks the defence system. In particular, the virus attacks T-helper cells. These cells are tasked with the synchronization of the activities of other defence cells. Weakening of the T cells reduces the body’s effectiveness in fighting diseases. This process is made possible by the presence of CD4 on the surface of the T-cells. This protein helps the virus to hold on to the T-cells before gaining access into the cells. Once inside, the virus multiplies, and is thus able to attack more cells. With time, the virus leads to dangerously low levels of T-cells present to fight infections. The amount of these T-cells is determined by a CD4 test. Without control, the CD4 count reduces to dangerously low levels and the individual advances to the AIDS condition. The progression of HIV infection can be divided into several stages: initial infection, asymptomatic stage, symptomatic and the advancement from HIV to aids. The first stage takes several weeks and is characterized by periodic flu-like sicknesses. In a significant percentage of the people, these signs are profound enough to warrant a visit to the hospital. However, the virus is not easily detectable at this stage. At this stage, the marginal blood contains huge quantities of the virus. The defence system produces HIV antibodies in response to the virus. This is seroconversion. After seroconversion, the virus is detectable through blood tests. In the second stage, a longer period is spent; approximately ten years. Major symptoms are absent, though there may be lymphadenopathy. The level of the virus in the marginal blood significantly reduces. People at this stage are very infectious and the virus is detectable in the blood. During this time, major viral activity occurs in the lymph nodes. The minute amounts that leave the lymphatic system and detectable by viral load test. During the third stage, the viral activity, due to the period, has destroyed most of the defence cells. The virus also changes in nature and becomes more pathogenic, more destructive, and the body is unable to replace the T-cells at the same rate as they are destroyed. During this period, intervention is critical. Administration of antiretroviral drugs helps to avert further weakening of the defence system. However, without this intervention, the symptoms of HIV increase. Opportunistic diseases become more frequent, and their treatment becomes difficult because the real cause of the diseases is the lack of immunity, which continuously decreases. In the final stage, harsh opportunistic infections occur. These include terminal sicknesses such as cancer, especially, of the blood vessels. This marks the advancement to AIDS. An alternative way to check entry to this stage is the CD4 count. If it is less than 200 cells/mm^3 or below 15 percent, then the person has advance into the AIDS condition. HIV develops from the time of entry in various stages: entry, reverse copying and assimilation, copying and translation and assembly budding and maturation. At entry, the virus attaches itself on cells with the CD4 protein. This process ends with the release of viral cell contents into the human cell. The next stage involves the conversion of the viral RNA into DNA matching human heritable material. This is facilitated by enzymes. The DNA is then taken to the cell nucleus and integrated into the human DNA. During the third stage, the integrated DNA is activated and the cell deals with the viral DNA as human DNA leading to replication of the virus. During the last stage, the HIV particles are let out from the cell to infect more cells. The virus exists in two strains; HIV-1 and HIV-2. They are transmitted in the same way and both cause AIDS. However, the second strain is mostly found in Africa. It is also not easily spread and its incubation period is longer. By December 2010, MSM accounted for 44% of all detections (HPA). Heterosexual sex accounted for 45%, while drug use, MTCT and blood products accounted for 5, 2 and 2 percent respectively. The rest were attributed to other unknown causes. The biggest mode of transmission of HIV in the UK is heterosexual sex. This has bypassed MSM, which for a long time was the leading mode of transmission. In the last fifteen years, approximately 48 thousand detections were made among Black Africans in the UK. Only thirty percent of these cases were not because of heterosexual sex. This turn in these statistics shows that the number of women with HIV is increasing. In 2010, the ratio of men to women was 2: 1 as compared to 7: 1 in 1994. Though outdone as the most common mode of transmission, male gay relationships contribute the second largest population of diagnoses. There has been an observed trend in the increase in these figures as seen in three years leading to 2007. MSM contributed more than 23,600 of new detections. There is a high population of people in this category living with HIV. For example, by 2009, about thirty five thousand MSM were living with HIV. Disturbingly, about nine thousand of these cases were unaware of their serostatuses. Transmission though injections during drug use is quite low in the UK. It accounted for only 1.8 % of novel infections in 2010. The end of the same year, this category accounted for about five percent of all cases ever reported in the UK. Over the years, following improved antenatal health care, there has been continual decrease in the number of infections resulting from MTCT. Only 51 cases were attributable to this mode in 2010. The total contribution of this mode to the national total of HIV detections has been about 19,000 cases. Infection though blood products has been prevented since 2002. Since then, there has been no case attributed to this mode in the UK. Among all other ethnic groups present in the UK, Black Africans have been the most affected. They accounted for twenty-five new detections in the country in 2010. Four percent of all blacks living in the UK are living with HIV. This is a significantly high percent compared to one percent among the Caucasians. Apart from the new infections, the African population has accounted for 42% of all cases ever detected in the UK. In this population, the main mode of transmission is through heterosexual sex (90 percent). Additionally, a large number of these were acquired in Africa. There has been noted lack of testing among the African population in the UK. The effect of this is that antiretroviral interventions are least effective when diagnosis is made. This has been interpreted as an emergency need for more HIV testing among the Blacks. Among the black population in the UK, one percent was born in Africa. This represents 423,420 females and 410,716 males. Of these, 26000 came from South Africa, while other common wealth countries accounted for 28000 of these migrations. Since 1997, the number of new infections among Black Africans increased sharply reaching its peak of above 3500 new infections in 2003. This trend as accompanied by a similar trend in the population of the total Black African population living with HIV. However, these trends have reduced since 2003, but still remain high. Prevention strategies adopted defer with the prevention group in question. For several years, the MSM group has been the recipient of most of the attention regarding HIV prevention strategies. Notable, is the CHAPS campaign. This campaign enjoys national coordination. Its monetary requirements come from the Department of Health and coordinated by several organizations. This campaign is led by the THT. This initiative is involved in designing and making of sexual well being promotions, provision of printed materials on HIV and electronic literature to be utilized by MSM. They are also involved in providing support materials on sexual well being topics for utilization by health professionals. CHAPS is also actively engaged in evaluation and development. This involves research to guide future interventions, and to base such actions on evidence. This serves to develop information on need, to appraise existing interventions, basic research, program mapping, and awareness conveyance. Another crusade is the LGMHPP. It is coordinated aversive effort carried out by organizations involved in the fight against HIV. Several healthcare authorities share the financial requirement s of the project. This campaign emphasizes several mitigating and preventive measures. These include making condoms available, utilizing media to pass deterrence messages, written literature, counselling and group work. Among the Black Africans, NAHIP is the most profound campaign in UK. The Department of Health provides fiscal resources needed. It is under the control of the African HIV Policy Network in liaison with other groups that seek to avert the spread of HIV among Black people in the UK. This initiative has been involved with noteworthy interventions, among them, the Do- it-Right-Africans-making-healthy-choices. This project supply information on sexual well being through written materials and electronic sources. It is also involved in provision and improvement of access to condoms. It is advocates for testing. Another initiative has been the Beyond-Condom campaign, which encourages dialogue, among Africans, concerning numerous issues including sexual health and the establishment of a safer intercourse culture. The target includes various religious groups, and is available in several translations. There has been a waning concern over the transmission of HIV among drug users. During the early years following HIV initial detections, a lot of coverage was done on drug users. During that time, HIV spread was very prevalent among drug users. Needle exchanges were started in 1986 to supply hygienic needles, knowledge and support to drug users. Since then prevalence among this group has significantly reduced, and remains constant. Health facilities, pharmacies and other groups run the needle exchange program. Another major prevention strategy employed is the provision of education and awareness regarding HIV. It is an important strategy across the risk groups. Knowledge increases self-protection and fights stigma associated with HIV. Unfortunately, the level of awareness in the UK has reduced significantly since 2000. Among the most affected are people above fifty years who have been largely affected by lack of information. Among this group, HIV detections increased worryingly in the period 2000-2010. In response to this, the government, for example in England and Wales, emphasises secondary schools to offer education on HIV/AIDS, this is incorporated in the Sex and Relationships Education. However, it is not part of the national education curriculum. An attempt to make sex education compulsory failed in 2009 due to its omission in the Children and Families bill. To prevent MTCT, all mothers take a HIV test before delivery. This strategy had a 95 percent success rate in 2008. Antiretroviral drugs are administered to HIV positive mothers to avert MTCT. The result has been a reduced rate (0.7 percent) in MTCT in 2010. HIV testing is another preventive strategy that UK governments seek to employ in the fight against HIV. The British procedures dictate that testing should be available at GUM clinics (NAT 10). It should be conducted as part of regular STD testing. This should be without considerations to risk factors, and following discussions prior to testing. Treatment drugs have been available in UK since 1987. This has significantly reduced the number of people dying due to HIV and associated sicknesses. HPTN052 trial of heterosexual couples showed a 96 percent reduction in possibility of HIV transmission. For example among 1000 HIV positive individuals with a viral load of below 400 copies/ml having sex with a negative partner over one year, only one transmission would be expected to occur. Probability of using ART as a prevention strategy is being utilised in PEP, and in upcoming technology in prevention (NAT 7-16) Several statistic trends lead to doubts about the effectiveness of strategies among black people whose main mode of transmission is heterosexual sex. Surveys indicate that 42 percent of Black African heterosexuals are diagnosed late (HPA). According to Awuor, Black African communities in England account for the highest undetected heterosexually acquired HIV. Many of them are tested when the infection has advanced and the viral load is soaring. This significantly reduces survival chances, because starting ART with a high viral load may not be very effective, and increases the probability of advancement to AIDS and death (Carter and Gazzard). Though various reasons are cited for this phenomenon, it underscores the ineffectiveness of the intervention strategies aimed at increasing awareness. Factors that may be contributing to this ineffectiveness include traditional, social, and structural hindrances. These include limited access to testing and care, stigmatization, provisional immigration regulations and lack of African representation in formulation, design and implementation of intervention strategies (WHO and Fakoya et al). The reasons revealed by various studies concerning the reason for late testing indicate lack of proper and accurate information regarding HIV. These reasons include worry of deportation if tested positive, dread of ruined relationships, lack of knowledge on availability of testing locations and apprehension over changed working and living conditions (Dodds et al. 23). Further studies have shown that stigma associated with HIV influences status revelation among Black Africans. In comparison to other groups, heterosexual black people were the least likely to reveal their serostatuses to spouses, family, colleagues at work and acquaintances (Elford et al.). Another impediment to the success of intervention strategies is related to socioeconomic dynamics. A large percent of Black Africans encounter various economic challenges, making HIV just one of their many problems, and of no major priority (Ibrahim et al.). The rampant infection rate among the African population UK may indicate the HIV situation in their countries of origin. Additionally, one’s nativity may influence the number of one’s sexual partners. This is possible due to traditional practices in such societies (Chinuoya and Davidson). Another major setback is the duration of residence in England. Those who have assumed residence for a shorter period constitute the largest percentage of the late testing population. This is because they may not even know the location of health facilities to take HIV tests (HPA). This phenomenon arises because when these people immigrate into UK, the immediate needs are centred on provision of basic needs. This result in reprioritisation of healthcare needs (Gould). Due to the long time that processing of immigration papers, there is a long period of uncertainty. During this period, they have problems securing meaningful employment. The accompanying financial and social challenges may lead into risky behavior. Due to the fore mentioned hindrances to effective implementation of preventive strategies, there is a need to rethink and re-strategise in order to avoid compromising the milestones already achieved. This is most plausibly achieved by basing these new strategies on the attempt to overcome these constraints. There is need to invigorate the awareness campaigns in a more behaviour-change oriented design (GHP 18-19). Behavioural orientation would seek to ensure that the high rates of awareness translate into decreasing rates of new infections, in a higher rate than presently witnessed. The high rates of awareness, presently, do not have an accompanying behavioural change. People still think themselves as invincible; others get infected but not themselves (Bonell and Imrie 155-157). Due to this, intervention strategies should encourage more participation by the target group. For example, the strategies devised for the Black Africans should ensure that this target group at the design up to implementation level. This would demand more funding from the government. Additionally, pre-existing socio-cultural conditions, that have been revealed to hinder effective implementations of preventive measures, should be considered in the design and implementation of strategies. HIV should not be viewed as an isolated problem, but a one among many interrelated challenges facing this group (Prost 17-19). Due to the variance in cultural composition among the Black African population, there are diverse health needs among the group. This calls for a multi-agency concerted effort, not only to improve practice, but also to synchronise services provided. This in turn would result in uniformity, so that users gain access to faultless and uninterrupted services while in UK. UK HIV infection rates are relatively lower than those of other parts of the world. However, these rates are among the highest in Europe. UK has made major developments in the management of HIV. These achievements are in danger of being compromised due to relaxation of efforts to avert HIV. Therefore, there is a need to, continuously, review preventive strategies to include new discoveries and technology and to incorporate new social dimensions that were hidden or unknown before. Works Cited Health Protection Agency. Sexually Transmitted Infections in Black African and Black Caribbean Communities in the UK: 2008 report. Health Protection Agency, 30 April 2010. Web. 10 Dec 2011. Gazzard, B.G. British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. Medscape Today, 24 December 2008. Web. 10 December 2011. Carter, Michael. Many Patients Taking HIV Drugs Can Now Expect to Live into Their 70s. Aidsmap, 25 July 2008. Web. 10 Dec 2011. Michael, D. 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