Ritical analysis of HIV in Saudi Arabia - Essay Example

? CRITICAL ANALYSIS OF HIV IN SAUDI ARABIA Introduction Acquired Immune deficiency Syndrome commonly referred to as AIDS, is among the principal public health issues of the present century. Actually, this health issue has enticed unprecedented attention across the globe, and besides, it has undeniably become a vocal point for priority concerns by different stakeholders including public health workers, politicians and the general public at large (Alrajhi, 2004). The reason behind this being that apart from being a new disease whose outcomes are fatal, there exists a precise amount of covert surrounding the disease and that no specific drug has being found out for its treatment. The present report makes use of the leaflet, which outlines the prevalence rate of HIV in Saudi, especially among non-Saudis. The leaflet also outlines various risk factors and ways of preventing the disease. From the leaflet, we realize that by the virtue that it can be hardy dissociated from sexual intercourse, the most predisposed group of individuals in a majority of the countries are the young people, who, with their peer pressure, physical violence and emotional pressure, are forced into unwanted and unprotected sexual activities. This therefore necessitated for these individuals to be protected from this killer disease (Saleh et al., 1999). Due to the prevailing background of the disease, the present study is based on the leaflet, which was conducted with the Saudi Arabian educational system as a target group in critically analyzing the ethical perspective of HIV in Saudi Arabian schools. As indicated earlier, the prevalence rate across the globe and for that matter in Saudi Arabia is higher among the youth, most of whom are students of second cycle and tertiary schools (Kingston, Harder and Al-Jaberi, 1985). Various public health policies that are available to promoting the interests of these students and in the minimization of the disease shall be discussed. Statistical Background on HIV in Saudi Arabia The need for an accurate qualitative and quantitative statistical data on HIV in the Kingdom of Saudi Arabia is an important issue for public discussion. This is because an authentic source of data promotes decision making and policy creation on the subject of HIV. It also creates a well informed population who would be abreast with HIV as an issue that concerns them. For example, after knowing through the statistical evidence of the prevalence rate of HIV among different demographic groups in the country, it becomes easier to appropriately allocate resources to the worse affected target group. It also becomes possible to target the right people for the right and most effective intervention as spelt out in the leaflet. It is on record that In the Kingdom of Saudi Arabia, the very first AIDS incident was diagnosed back in 1984 (Alrajhi 2004). Twenty years down the line that is as the sun was setting in 2003, the number of patients to have been reported for having acquired HIV type I was totaling to 1509. The larger percentage of these first victims having acquired the virus through blood transfusion and as a result, the leading transmission mode of the virus in Saudi became heterosexual. In this research paper, the distribution of persons infected with HIV, prevalence data, existing program, outlook and likely changes in the program are presented. Markedly, communities that had earlier been termed to be conservative are not, at their least, invulnerable from a sexually transmissible virus widely known to have infected over sixty million individuals in the world (Alrajhi, 2004). It has been evidenced that the Arab Region possesses an outstanding opportunity to bring to an end the spread of HIV and AIDS. Presently, more than five hundred thousand people in this region are living with HIV/AIDS, with 67000 incidents being new infections. Notably, 80% of the women in the Arab world get this killer disease from their husbands (UNDP, 2009). This is a clear indication that the women in this part of the world are progressively more predisposed to HIV infection. The cumulative number of all AIDS cases detected since 1984 until the end of 2004 amounted to 8919 cases, out of which 2005 cases are Saudis and 6914 cases are non-Saudis. Jeddah being at the peak of the list of the most affected cities in the Kingdom of Saudi Arabia, accounting for 15 per cent of the total cases UNDP (2009). In general, 78.4% of the victims were infected with the disease through sexual intercourse. On the other hand, sharing of personal effects -such as needles, transfusion of imported blood and mother-to-child transmission accounted for 21.6% of the aggregate. In Saudi Arabia, the rate of the spread of the disease among minors is 4.6% (UNDP, 2009). So far, the ability to make as estimation of the number of individuals living with HIV and AIDS in the Kingdom of Saudi Arabia remains a big challenge. However, there are likelihoods of this incidence increasingly measurably and more especially among the more susceptible subsets of the Saudi population (Barri et al., 1991). Groups in the Kingdom of Saudi Arabia that are routinely tested for HIV include prisoners, sexually transmitted infection (STI) patients and injecting drug user (IDU) patients at rehabilitation centers. These groups of people avail an insight to the infection levels among them at high-risk populations. In the Kingdom of Saudi Arabia, this ratio- resting at 4:1 has remained constant for the past one decade among the Saudi citizens (UNGASS, 2012). This does imply that the number of males who have been infected with the disease is considerably greater than that of the females. As time passes by, this ratio is expected to change since it has been noted that once and again the males are infecting their female sexual partners. This is the expected to be the case unless it happens that transmission is predominantly among male people who inject drugs (PWID) as well as same sex behavior among them. Conversely, there is a necessity for more information on these males versus females HIV infection test numbers over time if at all the figures are to be better interpreted. One of the reasons as to why the ratio of infected males to their counterparts among the non-Saudis has all through been lower than that of the Saudis might be the heterosexual transmission common among the non-Saudis. Alternatively, the same could have been so because of the equal numbers of males and females being tested (UNGASS, 2012). According to the leaflet, it is rather disturbing that people do not pay attention to this terrifying disease, thinking that they will not be next victim; they do not use any protection neither for them, or their partners, they do not pay attention are the needles new or not –they are not informed about this disease enough. For the non-Saudis, their HIV infection statistics is so obtained in a systematic manner on their legal migration to the Kingdom of Saudi Arabia to work. Those testing positive to HIV/AIDS among them are, without hesitation, extradited back to their mother country, but with the exception of those legible for treatments such as those born in the Kingdom or are spouses of Saudi nationals. While the cases of other immigrants get to be detected on their renewal of their residence status, there are those individuals who get to be detected following the routine testing of blood donors, suspected cases, tuberculosis patients, STI patients, IDUs and prisoners. This is so applicable to both the Saudis and the non-Saudis (Alothman et al., 2010). Medical and Educational Approach There is countless number of approaches that can be directed towards the fight against the disease. The ones that are seen as most suitable for the present situation of prevalence that has been described so far is that of the medical and educational approach. Generally, health promotion deals with the empowerment of people to take control of their own health needs without having to depend directly on others for basic health needs (Kingston, Harder and Al-Jaberi, 1985) and this demands that the people be given education and medical insight into the disease. This understanding of health promotion is in direct relation with the medical and educational health approach proposed by Pender (1982), which states that “The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.” What this means is that within the Saudi context, the issue of HIV can be looked at from a perspective whereby the multi-complexities of people can be utilized in making them take control of their health. By this, there are two major levels of interventions outline in the leaflet, which are the preventive model and the control model. By the preventive model, mention is being made of the need to equip the person with necessary education that ensures that the person does not become prone to contracting HIV all together (Alothman, Mohajer&Balkhy, 2011). According to the leaflet, mention is also being made of the need to educating affected people with necessary information in minimizing their risk levels even as they treatment for their infections. In sum, the health promotional model refers to a number of steps put in place by stakeholders including the government in ensuring that all citizens, be they affected or not affected, have enough control of their own health as far as HIV is concerned. Saudi Arabia has complex society that does not trust health organizations and they are not used to have disease such this one. They are living, on the first sight, very simply, without many pathogens that can lead to this disease. However, especially in these tacit societies, this disease is a severe plague. Their culture is such that there is no indecency; however, as it is in human nature, silence can only get worse. In this leaflet is presented how this disease is transmitted in Saudi Arabia; Using needles and skin-piercing instruments contaminated with the virus, such as using of non-sterile instruments for ear piercing, shaving, cupping and tattoo. Toothbrushes that may be contaminated with blood, contaminated dental instruments., Injecting drugs using a needle or syringe that has been used by someone who is infected ; as a baby of an infected mother, during pregnancy, labor or delivery, or through breastfeeding or as a result of a blood transfusion with infected blood and blood products. Notably, the Saudis undergoing the testing has been increasing as a result of the inordinate opportunities for testing been created, for instance, provider initiated voluntary testing in a number of the health facilities and grander acceptance of pre-marital testing facilities in the Kingdom (Alothman et al., 2010). Patterns of the same in the near future are also considered to be calling for a careful watch. Moreover, it is imperative that a track of the numbers and profiles of individuals undergoing tests be kept as time progresses (Alothman, Mohajer&Balkhy, 2011). The leaflet suggests a three-tier mechanism in the health promotion model. These are primary, secondary and tertiary. Primary shall focus on healthy people who have not contracted the HIV yet. For these people, the leaflet suggests a preventive measure, which has to do with the use of condom so that these people who belong to the primary category never become affected. . Condom is often prescribed as the primary in the leaflet for the prevention of HIV in people who are healthy and have not been infected already because sexual intercourse remains the number one cause of HIV in Saudi Arabia (Alothman et al., 2010). Subsequently, if sexual partners, especially those who are healthy use a condom, they stand a better chance of avoiding the virus because the condom serves as a detective barrier that prevents sexual fluid, from travelling to them. Apart from condom use which is captured in the leaflet, abstinence could also be a very effective measure for primary category of people who are not infected at all. This would however work best only among a group of young men and women who are not married. The leaflet also recognizes secondary category that have to do with healthy people who are with or without the disease. The difference with this secondary group is that they are thought to be involved in health risk behaviors, which increases their chances of being affected. To these people also, prevention of the HIV is the most suitable methodology as prescribed in the leaflet. Part of the methodology is for them to avoid all forms of unorthodox sexual relations such as homosexuality. Modern studies have actually showed that among same-sex partners, there are chances of 45 % higher for getting AIDS. The reason behind these findings is that especially in gay sexual encounters where the anus is used as the sexual canal, it has been found that the anal cavity does not produce as much lubricate fluid as the vagina does (UNGASS, 2012). Subsequently, the risk of having injuries and cuts in the course of sex is higher and so is the transmission of the virus. The same argument is true even for males who want to have anal sex with females. The leaflet actually outlines that with the secondary category, the aim for undertaking their preventive methodologies would be to prevent ill health or chronic ill health disability that may occur on permanent basis. Tertiary prevention is primarily concerned with ways of ensuring that affected people do not get to the asymptomatic stage of the virus’s effect. Even though the leaflet is not loud on these measures, there ways such as the need for affected people to avoid using used injections,? needles instruments and razors. This is because re-infection worsens the ill-health of affected people and pushes them closer to the asymptomatic stage of the disease’s risk. Affected people cannot know if the needles used or not, but they should be more careful and pay attention on personal accessories such as scissors, tweezers, and ultimately, whether the needles they take blood with are packed. Another measure has to do with the adherence to taking antiretroviral drugs to ensure that the health state of the affected people does not worsen (Barri et al., 1991). In addressing the HIV/AIDS epidemic, the Kingdom of Saudi Arabia has reported, through its national AIDS program that the program has been considerably scaled up. According to this reporting, the National AIDS program it not only having a stout and a well-manned central unit, but enjoys the services off more staff and better capacity. The above-mentioned meriting features, in combination with augmented political support have led to additional visibility for the AIDS program. Ethical Perspective of HIV in Saudi Arabia In this section of the study, the debate is narrowed to the ethical perspective HIV in Saudi Arabia. Specifically, the projection of the leaflet that there is more prevalence of HIV among non-Saudis as compared to indigenous Saudis is something that the ethical perspective takes a closer consideration of. According to the leaflet as a result of critical review of literature, it can be established that this trend is obvious because of the social lifestyle and activities of non-Saudis as compared to Saudis. For instance, it is an open secret that with the high moral and religious provisions for indigenous Saudis who are mostly Muslim, most of the risk factors that were discussed earlier as including alcoholism and sexual immorality does not apply to a majority of them. In high schools and other educational institutions for instance, reports show a very high expenditure on social activities for non-Saudis as against Saudis (Njoh&Zimmo, 1997). As recommended in the leaflet therefore, much more of the ethical perspective would also be linked to how rates of HIV can be reduced among this population of non-Saudis. The ethical perspective would generally take care of mandatory testing for HIV for people such as students who are admitted to second cycle and tertiary educational institutions, as well as other people with public interest like politicians, employees and opinion leaders. It would also take need of the disclosure of the HIV status of people who are tested. Over the years, there has been a debate as to whether or not the people mentioned should be made to take mandatory HIV test and when they do, whether or not their results should be made known. Generally, the argument has been that if people who are identified with HIV are made known and labeled, the chances that they would infest other people will be minimized because people who deal with them will take preventive precautions when dealing with them (UNGASS, 2012). There is however another school of thought that says that mandatory testing and labeling would infringe on the human rights and privacy of the people involved and thus constitute an ethical breach (Njoh&Zimmo, 1997). As the debates heat up on the best ethical practices to have as far as HIV in Saudi Arabia is concerned, stakeholders have tried to come to a central point whereby the National AIDS Program has also actively involved itself proactively with other multi-sectored partners in the fight against HIV. For instance the Program has included faith-based organizations, the Ministry of Interior, the media, Ministry of Sports and Youth Affairs and the Ministry of Social Affairs in ensuring best practices that exists in all these sectors are put together in ensuring that all people receive fair ethical treatment in handling issues of HIV. For instance, we see in the leaflet that the NAP has collaborated with the Ministry of Interior in the running of detoxification and rehabilitation programs for injecting drug users in a number of health care facilities, and a good example is the Riyadh based Al Amal Hospital (Al Mazrou et al., 2005). Instead of mandatory testing also, volunteerism has also been campaigned for through such involvements as ex-IDUs, medical students and nurses and people living with HIV/AIDS. This concept of volunteerism is geared towards outreach awareness campaigns and establishing peer support groups that will promote HIV/AIDS awareness UNAIDS(2008). A good example of this volunteerism campaign was the "Get to Zero New Infections, Zero Discrimination and Zero AIDS related deaths", which was successful thus heightening the efforts to raise your spirits of volunteer work in NAP in its entirety (Kingdom, Harder & Al-Jaberi, 1985). In most cases, it has been said that if the campaign for voluntarism can be strengthened and given a national focus, the need to depend on mandatory testing, which somehow falters against the ethical rights of people will no longer be necessary because all people will see the need to undertaking the test and also receive the right counseling on how to handle their sexual lives with reference to the results that their test turns out with (Alrahji, Halim & Al-Abdely, 2004). Devising a national public policy to address AIDS in Saudi Arabia By a national public policy, reference is being made to the need to ensuring that all the various interventions available in the health promotion model are integrated into a uniform paradigm that has the backing of central government. To this end, the civil society has been taking an active role in ensuring inclusive engagement. Its efforts have been through various campaigns aimed at increasing awareness, pushing for leadership development, availing training facilities and economic support to people living with HIV and their families and offering unemployment financial benefits. The civil society has also established various peer support programs for those individuals in the society living with HIV, semi drop-in centers and support and care programs. Illustratively, people living with HIV/AIDS have established various small support groups and network and a perfect example in the Al-Hosen- one of the active PLHIV network in the Kingdom of Saudi Arabia with separate networks both either gender. On the contrary, the civil society organizations are not in a position of availing treatment for HIV/AIDS (Obermeyer, 2006). Besides scaling up VCT effort and the services offered, there is also an ongoing training among the social workers and nurses (the health care workers) in both counseling and testing. This training has seen the inclusion of rapid testing as a new-fashioned initiative, with NAP being in the conveyor belt of availing more stocks in the field. Provision of antiretroviral therapy (ART) and medication for the citizens of the Kingdom of Saudi is freely offered in eight treatment centers across the country. A scale-up of services in these centers are so factored in as per the need of individual centers (Saleh et al., 1999). In the facilities where prevention of mother to child transmission (PMTCT) is undertaken, both mothers and babies do receive proper care, treatment as well as long-term follow-up. Nonetheless, not all ANC units have established prevention of mother to child transmission. (WHO, 2006). Conclusion In this leaflet, the primary, secondary and tertiary prevention from HIV in Saudi Arabia have been looked at. These preventive mechanisms were integrated into a comprehensive health promotion model where it was advocated for the prevention and control of HIV to be left in the care of the ordinary citizen. This was thought to be most effective if the approach to HIV education is taken from a national public perspective with a lot of respect for ethical rights of people. There is much information that can curb the scourge. However, the weakness of this leaflet is the promotion and prevention of this disease. People need to be informed about prevention, kept rallies; the disease unfortunately must be advertised. It is difficult to do this in Saudi Arabia because of their lifestyle, but the way must be found to penetrate to their head. This is the main disadvantage of this promotion, it is theoretically perfectly presented and is not given the idea how all this can be done in practice. References Al Mazrou, Y., AlJeffri, M., &Fidali, A. et al. 2005. 'HIV/AIDS Epidemic Features and Trends in Saudi Arabia', Ann Saudi Med. 25(2), 100-104. Alothman, A., Altalhi, K., Al-Saedy, A. & Al-Enazi, T. 2010. What is the Real Prevalence of HIV-Infection in Saudi Arabia', Infectious Diseases: Research and Treatment, 3, 41-44. Alothman, A., Mohajer, K., & Balkhy, H. 2011. Prevalence of HIV-Infection in Saudi Arabia',BMC Proceedings, 5 (6), 252. Alrajhi, A. & Abdulwahab, S. 2002. Screening for Human Immunodeficiency Virs in Patients with Tuberculosis. 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