HIV/AIDS: Prevention and Treatment - Research Paper Example

?HIV/AIDS: Prevention and treatment and what steps have been taken in the past 5 years and what needs and is being done in the future HIV AIDS: Then and now - Strategies for prevention, treatment and control Abstract It has been over two decades since the Acquired Immunodeficiency Syndrome (AIDS) was first identified in the year 1981, followed by the discovery of its etiological agent known as the Human Immunodeficiency Virus (HIV) in the year 1983 (HIV.com, 2011). However, despite rapid developments in all sectors around the globe, there still seems to be no massive transformation in the field of healthcare and especially in the manner in which the disease was perceived, in terms of the magnitude of its outreach, and the impending deaths caused by it. This is largely owing to the fact that, nearly three decades on, there is still no sign of any major breakthrough in the form of a vaccine that could help prevent the spread of the deadly virus. In the absence of valid medical means to curb the virus, the interventions and programs established and implemented by the international bodies, remain the only feasible way to help transform the dominant ideologies and prevent the disease from spreading any further. Counseling and educative programs are increasingly sought as vital means of curbing the virus and spreading awareness. This paper on HIV / AIDS helps in gaining a broader understanding of the topic on hand, and throws light on the various policy measures adopted by governments and local agencies globally; the efforts undertaken during the past five years, the current status, the successes and failures of the programs currently being implemented and recommendations for change. It also includes a theoretical perspective to broaden understanding regarding the subject. Problem statement HIV / AIDS is a deadly pandemic which has gripped a major section of the global population, since decades, and with no effective vaccine in sight, it is highly unlikely to be eradicated completely from the face of this earth. Annually, approx. 5000 people die each day, due to AIDS and with over 15 million people living with HIV the mortality rate is likely to rise even further, in the near future (USAID, 2011). In the absence of corrective measures, and a global collaborative effort, combating the menace caused by the deadly virus, seems highly unlikely. The only feasible alternative, hence, is to address this issue through adoption of robust and effective policies at national as well as international level; raising awareness through educative programs; and to ensure its effective implementation across all sectors. The basic objectives, hence, include: to study, examine and analyze various policies and initiatives undertaken for prevention of HIV / AIDS so far to critically discuss the various challenges posed and the impact of current policies on the epidemic to identify the gaps in the policies which are currently being implemented and to suggest possible changes to address the issue Introduction Nearly thirty years on and the struggle to fight against one of the world’s deadliest diseases continues with same gusto. As the virus spreads and expands both in number as well as outreach, with hardly any medical relief in sight, the policy makers and health care sectors worldwide, continue to struggle to defend humanity against its unrelenting accession. Although humanitarian efforts on a global level have helped organizations to address the issue in a more assertive manner, the situation still remains critical due to the sheer outreach of the deadly disease and its lethal consequences which continues to claim millions of lives worldwide. HIV / AIDS is regarded as the one of the most common reasons for death among the youth, which in turn is caused by unprotected sexual intercourse due to lack of availability of condoms in certain areas. Certain other routes of transmission include: the transfer of the disease from mother to child; use of contaminated medical tools such as syringes and needles; as well as the transfusion of contaminated blood (UNAID.org, 2010). According to available statistics, the total number of people living with HIV globally was on a rise during the year 2008 which was estimated to be approx. 33.4 million cases (Avert, 2011). Statistics suggest that an overwhelming majority of population, reeling under the pressure of this epidemic, are third world countries, who have little or no access to policies and programs aimed at preventing the spread of the disease. Also the awareness regarding the disease is relatively lower in such countries as compared to its developed and industrialized counterparts. Figure 1: Percentage of people living with HIV worldwide during 2009 Source: Avert.org Although owing to persistent efforts at national as well as international level, the impact of the pandemic has been reported to have slowed down in recent times, it continued to be on rise in areas such as Eastern Europe as well as Central Asia, while the sub-Saharan regions dominated the AIDS landscape with most number of registered cases, i.e. as many as 71 per cent of all registered cases, during the year 2008 (UNAID.org, 2009). Despite negative reports during the past five years, substantial steps were taken to improve the current plight, which seemed to have borne fruits in the past one year. The statistics regarding the same are discussed in the subsequent sections. Literature Review: Despite the global commitment to fight against the rising pandemic, it is still on the rise and that too at an alarming rate. There were estimated to be around 40 million people infected with HIV / AIDS by the end of 2005, a whopping increase from a humble 35 million in the year 2001 (UNAIDS, 2005). During the year 2005, the number of newly infected population rose to 5 million resulting in 3 million deaths, a substantial rise as compared to the previous years. The low income countries continued to rule the roost, lead by Sub-Saharan Africa and followed by several Asian countries and parts of Eastern Europe as well. Figure: Global Statistics However, available statistics suggest, that despite such rise in HIV infected people each year, globally several countries have made substantial progress. The knowledge regarding the disease among one of the worst hit groups i.e. the youth, showed remarkable improvement. This has further helped in reducing their chances of adopting preventive measures such as using condoms or restricting the number of partners for sexual intercourse etc., among others. Figure: Young people’s knowledge regarding HIV / AIDS Source: UNAIDS Report, 2010 This has also led to a simultaneous and substantial rise in the use of condoms by young people in the vulnerable age group. According to UN report on AIDS, as many as 11 countries of those severely affected by the pandemic, reported the use of condoms by its youth. Views and Counterviews: The report presented by the UNAIDS as well as other researchers clearly highlights and applauds the significance of reduction in the number of partners or the rise in use of condoms by a highly vulnerable section of the population i.e. the youth. However, reports such as these, clearly overlook the significance of propagating abstinence of long term and simultaneous relationships with more than one partner. This point, although crucial for preventing the spread of the epidemic was hardly noticed by researchers worldwide, until recently and hence programs to preach the benefits and losses of the same remained absent from the policies being implemented (Epstein, 2008). The neglect of such a critical aspect could lead to flawed interpretations and conclusions regarding awareness among youth. For instance, the failure of the UN’s report to acknowledge the significance of concurrent partners in attracting AIDS among the youth, would lead to neglect of this aspect and ultimately result in little or no change in the number of cases registered each year. It is thus, of utmost significance for the international agencies and governing bodies to take into consideration all such trivial yet inevitable aspects while designing polices for change. The lack of knowledge regarding concurrent partners might leave the youth at a high risk of contracting the virus, and spreading it among others, thus leading to a further rise in the total number of people affected with the disease. Furthermore, flawed or inaccurate interpretations of the data collected might also lead to disastrous consequences which in turn may hamper the policies and programs current in progress. For instance, the last UN report, stressed on the fact that the reduction in number of AIDS infection in Uganda, was mainly on account of increase in use of condoms, however, the fact that such a fall, could also be on account of reduction in the number of sexual partners, was totally and conveniently ignored. The study of behavioral shift is of utmost importance, for international organizations, policy makers and researchers alike, and such flawed misinterpretations could lead to disastrous result and misguide future studies. Similar claims were made by the UNAIDS 2008 report whereby the increasing use of condoms by the gay community in Thailand and US was directly associated with the substantial reduction in number of AIDS related cases registered during the year although, the fact that there was a notable decline in the number of partners among such communities was clearly ignored. Furthermore, the report also stated that there was a substantial fall in the number of HIV positive cases during the year, despite of a significant rise in number of partners was observed. This claim was highly untrue as there was hardly any substantial evidence pointing towards such a trend (Epstein 2008; Potts et al. 2008). Such gross misrepresentation of crucial data could lead to inaccurate conclusions, and flawed policies, which naturally, fail to address the real issues. Similarly, tall claims have been made by yet another national governmental group i.e. the PEPFAR. The PEPFAR is a U.S. government initiative, alternatively known as the United States President's Emergency Plan for AIDS Relief, to help prevent the spread of the lethal virus across the globe (PEPFAR.gov, 2011). The programs launched by this organization, too, failed to address the issue of concurrent partners and the role it plays in spreading the virus, similar to the UN report. The efforts put in by the agency mostly revolve around the significance given to having only one partner or encourages sexual intercourse only with one’s spouse or regular partner. However, similar to the UN initiatives, it ignores the role played by concurrent partners in increasing the possibility of attracting the disease. The programs advocated by PEPFAR mostly advocate the cultural values, such as loyalty, fidelity, sex after marriage etc., as a tool to prevent the disease from spreading any further. It has further claimed that all the countries reeling under the pressure of this pandemic, and particularly those with a high prevalence rate, must adopt and practice abstinence from sexual activities, delay their sexual ventures, and / or practice monogamy as a means to combat the attack of this virus (Avert, 2009). However, although the programs and policy initiatives of this organization seem appealing at first, it is highly unreasonable to focus the preventive efforts on one particular group rather than addressing the society and larger community as a whole. This program is highly discriminative in nature, since it clearly focuses on one specific section of the society while conveniently forgoes the duties and responsibilities of the others. Another significant flaw in the programs advocated by the PEPFAR include, the policy to promote the use of condoms among highly vulnerable groups such as prostitutes, or sexually active youth. This policy is highly discriminative in nature, apart from being highly impractical. This is because, it clearly dismisses the role played by the other groups in spreading AIDS. The policy in fact should be targeted at youth in general, regardless of their profession or sexual activity. The rise in awareness is of crucial significance, rather than targeting the supposedly vulnerable groups. Theoretical Perspectives: Symbolic interactionism: Women are regarded as one of the most vulnerable sections of population who are disproportionately affected by HIV / AIDS. This is mainly on account of the rigid socio-cultural trends which are prevalent among some of the low income countries, which incidentally happen to be among the worst hit regions. Theories exploring and understanding the complex social structures may help in understanding the problem in a better manner and help the policy makers in devising appropriate plans of action accordingly. The mental health of women suffering from HIV / AIDS is directly related to their ability to cope with the illness, which in turn plays a major role in influencing their diagnosis, and treatment and help them deal with the emotional stress accompanying the same. Women are even more concerned with their ill health, since they run and manage their families including taking care of household chores and children, and at times, even their grand children. The diagnosis of such a deadly disease may render them incapable of making right choices, especially with regard to adopting a right and positive approach to all the remedial measures. Such problems and issues, specific to women may be addressed appropriately by trained caregivers. The implementation of a theoretical perspective which takes into consideration the feminist and symbolic instructionism aspects would help the policy makers in comprehending precisely, the manner in which factors such as gender, power and socio-cultural stigmas affect the responses of women towards palliative care. Symbolic instructionism emphasizes the significance of understanding the various explanations and significance of illness, the impact of illness, and the need to adapt the services and programs in accordance with each individual case, rather than applying a blanket rule for all those affected. The factors to be taken into consideration while devising policies in accordance with this theory include: the socio-cultural background of the patients; geographic location; type and level of emotional stress experienced; past and current behavior etc., among others (Emlet, 2004). Social Constructionism: This theory stipulates that the social reality of any individual is established through human action as well as through the interpretation of such actions (Howard & Hollander, 1997). It further states that the community at large, must be viewed as both - objective as well as subjective reality and the theoretical understanding of the same must be applicable to both equally. The objective reality stipulates that the social norms are generated from human actions while the subjective reality aspect contends that the social world is adapted in accordance with the location of individuals and the social structure surrounding them, it is also regarded as an outcome of their social and individual beliefs (Berger & Luckman, 1966). Giddens (1997) states that human culture is amazingly diverse and the acceptability of social and behavioral norms differ from the geographic location of each community. These differences are then translated into cultural differences which is unique to each community. The cultures thus formed, govern the manner and pattern of behavior among such individuals. This includes the acts governing sexual activity among the individuals, which may further lead to contracting of the deadly virus (Vance, 1989). For instance, in some cultures, the practice of polygamy is quite common where a man takes on many wives and sex with multiple partners is encouraged, as a social practice. Behavioral Theory, Social Learning Theory and Peer Education Peer education is a form of behavioral theory which revolves around the change in behavior and attitudes of individuals. The social learning theory posits that individuals learn through observation and such an act may lead to creation of idols and model behavior the rest of the group. Such idols and models can then, in turn influence change among the rest of the population by influencing them to change their behavior (Bandura 1986). Fishbein and Ajzen (1975) contend that in accordance with the theory of reasoned action, individuals can play a key role in changing the perception, thoughts and behavior of other individuals, while the diffusion innovation theory, states that individuals often act as agents of change, and can influence the rest of their social group to behave a certain way (Rogers 1983). The policy makers can influence entire communities to change their attitudes, perception and behavior regarding certain critical issues and adapt the behavior of their models or idols, in order to steer them towards more healthier alternatives and reduce the impact of such global pandemics as HIV / AIDS. Key obstacles: The social stigma and the resultant discrimination that arises out of it, is regarded as one of the most significant obstacles in the quest for reducing the impact and spread of the deadly virus. It also prevents the individuals affected by it, to have access to genuine and effective treatment, thus ending up as helpless, marginalized, and a highly vulnerable group of individuals. Women and children are by far, the worst affected of the lot. The fear of society and the social stigma that follows, is touted as one of the key reasons for the rapid spread of the disease in the African regions. Another key aspect of societal pressures that prevents individuals from accessing proper health care facilities, after being diagnosed with HIV / AIDS is the fear of discrimination which may follow, once an individual is declared to be suffering from it. Such fear, of being outcast and ignored from the society, prevents individuals from acknowledging their status. This not only harms their personal health but also endangers the lives of those living around them. Current status of the problem Currently, in the year 2009 the number of individuals diagnosed with HIV / AIDS was estimated to be approx. 2.6 million worldwide. This is a drastic reduction from the number of people affected during the previous decade. Figure: Source: Global UNAIDS Report, 2010 The incidence of HIV / AIDS in as many as 33 countries has fallen sharply between the year 2001 and 2009 by approx. 25 per cent; of which 22 countries belong to the sub-Saharan African region, which ranks among the top most countries with most HIV / AIDS affected people. Even this region saw a drastic decline to an estimated 1.8 million in the year 2009, from about 2.2 million during the year 2001. Such a trend bears testimony to the fact that the efforts put in at global level, have indeed been successful in curbing the spread of the deadly virus. Figure: Source: UNAIDS 2010 Report Need and Proposal for change The study of various research reports suggest that the youth severely lacks appropriate knowledge required to ward off the disease and hence is still among the most vulnerable groups, followed by women and children. Moreover, it has also been observed that the youth often lack proper tools to address this issue, and hence cause even more incidences of HIV / AIDS among them. In countries where there is adequate knowledge, the access to life saving drugs, condoms and clean sterile equipments is a rarity. Factors such as these create all the more problems for this highly vulnerable group to ward off, the accession of this deadly virus. Today, we live in a highly dynamic world, which owing to rapid development in technology, and globalization has shrunk like never before. Outdated methods and approaches, hence might not help in eradicating the pandemic altogether, but can however be restricted to a substantial extent, by working with close collaboration with global planners, care givers and health care policy makers. Establishing or associating oneself with social coalitions set up to lessen the impact and vulnerability of HIV infected individuals can go a long way in addressing this issue. Social care groups must work in tandem with the health care givers, in order to ensure that violence and incidences of sexual abuse among women and children are addressed in a strict manner, in order to protect this group from contracting the disease. References Avert.org (2009). Worldwide HIV & AIDS statistics commentary [Online] Available from: http://www.avert.org/worlstatinfo.htm [Accessed: 11th Feb, 2011] Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall. Berger, P.L & Luckman, T. (1966) The Social Construction of Reality, A Treatise in the Sociology of Knowledge, Allen Lane, Gt. Britain, Penguin Books, Pp. 65-166. Emlet, C. A., (2004). HIV / AIDS and older adults: challenges for individuals, families and communities, Springer Publishing, Pp. 88 - 92 Epstein, H., (2008). AIDS and the Irrational, BMJ 337, Pp. 1265?7. Fishbein, M. and Ajzen, I. (1975). Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley. Giddens, A. (1997) Sociology, 3rd Edition, Polity Press & Blackwell Publishers Ltd., UK. HIV.com (2011). [Online] Available from: http://www.hiv.com/ [Accessed on: 11th Feb, 2011] Howard, J. and Hollander J. (1997) Gendered Situations, Gendered Selves; the Gender lens Sage publications, Inc. vol. 2, Pp.17, 35. PEPFAR.gov (2011). About PEPFAR [Online] Available from: http://www.pepfar.gov/about/index.htm [Accessed: 11th Feb, 2011] Potts, M., Daniel T. H., Douglas K., Swidler, A., Marseille, E., Klausner, J. 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