Trends of HIV and AIDS in the USA - Assignment Example

HIV and AIDS: A Challenging Healthcare Issue Facing the USA Public The emergence of HIV and AIDS has posed a serious global healthcare threat (Avert, 2014). World Health Organization (WHO) estimates that around 35 million people are living with the virus in the world, with 19 million of them not knowing that they are infected. The condition does not only have far reaching effects on human health, but also on economy and the psychological well-being of the infected and affected. More than a million people are living with the virus in United States of America (CDC, 2014). This paper looks at HIV/AIDS in USA in thematic areas of its history, trends, implications, control and possible solutions. Part A: Background to the Healthcare Issue Human Immunodeficiency Virus (HIV) is like any other virus that attacks human beings. The difference is that this virus cannot be eradicated by the immune system. The virus is responsible for weakening the key parts of human immune system (CD4 cells or T-cells), such that it becomes ineffective in fighting diseases. With time, it causes Acquired Immune Deficiency Symptom (AIDS), at the final stage of HIV infection. With proper treatment however, a person can keep his/her HIV level low reducing the chances of developing AIDS (Aids.gov, 2014). The condition can be transmitted through unprotected sexual intercourse with an infected person, childbirth (from infected mother) and blood transfusion (exchange of blood from infected individuals). In 1981, United States of America became the first country to recognize HIV and AIDS as a new disease among gay men. However, the origins of HIV and AIDS are suspected to be in Africa (Avert, 2014). Since it was first discovered to the public conscience more than three decades ago to date, the disease has gained notorious reputation as a feared and controversial disease in modern medicine which leads to it being widely politicized and mystified (Avert, 2014). During the early 1980s, disjointed reports from many states, especially California and New York, claimed that small groups of men, most notably elderly men of Jewish/Mediterranean decent and young African Americans, were contracting a rare and new type of cancer and/or pneumonia. A common factor in the groups of individuals affected by this disease was that they were all homosexuals. In June 1981, the condition was first documented by the United States Center for Disease and Control and Prevention (CDC) and was named as Pneumocystis Pneumonia. By early 1982, the condition had acquired various names including ‘gay-related immune deficiency’, ‘gay-cancer’ and ‘gay compromise syndrome’ with approximately five new cases being reported per week. The acronym AIDS (Acquired Immune Deficiency Syndrome) was suggested in July 1982 at a meeting in Washington with the CDC first using the term in September 1982. During this time, the disease was also being diagnosed in heterosexual individuals and females as well. The then U.S president, Ronald Reagan first mentioned AIDS in September 17th 1985 at a press conference where he suggested that the condition was a priority to the government. Clinical trials involving a cancer drug, zidovudine (AZT), in September 1986 concluded that there were possibilities that the drug could decelerate the attack of HIV. The drug was approved by United States Food and Drug Administration (FDA) in 1987, and was in the market in 1989 as the first antiretroviral drug to treat AIDS. However, most Americans could not afford the drug as it cost approximately $7000 for a year’s treatment. Additionally, individuals were becoming resistant to AZT treatment. A breakthrough therapy, commonly referred to as Highly Active Antiretroviral Therapy (HAART), showed to reduce HIV by up to 99% in the mid 90s. The condition became a major cause of death among the citizens of USA in the late 80s and early to mid 90s with ever increasing infection and mortality rates. However, in 1997, for the first time since it was first reported, the number of deaths caused by the condition reduced. This was attributed to the antiretroviral therapies, public awareness, government support and the influence of celebrities such as the basketball player Magic Johnson, who publically revealed his status as being HIV positive. The condition, however, is still a major health care issue to date in America as it consumes a significant amount of taxpayers’ money annually. Part B: Trends of HIV and AIDS in USA The HIV/AIDS condition is almost always fatal if it is left untreated. The condition typically occurs in stages. The first stage is the acute stage that lasts for 2-4 weeks and the infected individual has flu-like symptoms, some individuals have no symptoms at all. This is the most infectious stage as the HIV microbes are produced extensively. The second stage is clinical latency where the virus is dormant, but still in the body; this stage can last up to a decade for people without antiretroviral therapy (ART) and decades for individuals on ART. The third stage is AIDS where the immune system is highly affected and opportunistic diseases affect the patient. In the USA, individuals with AIDS will typically live for 3 years if not affected by opportunistic infection and therefore, medication is paramount if the infected individual is to survive. The disease is transmissible at all the stages (CDC, 2014). The number of people living with HIV and AIDS is approximated to be 1.3 million people as per the CDC report of 2013 (Avert, 2014). Around 20% of the people with the condition are not aware of their status. New HIV infections per year are in excess of 45000 individuals since 2006 (Table 1). It is estimated that 13834 people with AIDS diagnosis died in the US in 2011, though it is not a certainty that the deaths were caused by HIV and AIDS-related complications. Table 1: Estimated new HIV infections per year Year Estimated new HIV infection 2006 48600 2007 56000 2008 47800 2009 48100 2010 47500 2011 49273 Source (Avert, 2014) Available treatment using antiretroviral therapy has made it difficult for people with HIV to acquire AIDS. For this reason, AIDS surveillance data is not the best measure of this condition, but rather HIV data is more important in measuring the trends of this condition. Annual new infection figures (Table 1) show a more or less stable rate of annual infection of between 47,500 to 49,300 in recent years with an outlier being year 2007, which had approximately 56000 new cases. Prevalence of AIDS in respect to regions show North East as having the highest prevalence rate, followed by South, West and Mid-West in that order (CDC, 2014), and has been reported in every state in America. Some groups are at greater risks of contracting HIV compared to others. Men who have sex with other men (MSM), such as homosexuals and bisexual individuals, are at greater risks of contracting HIV virus compared to other groups (Sullivan et al., 2009). For instance, in 2010, MSM was responsible for 78% of new infections among men and 63% of all new infections, although MSM represents only 4% of the total population. Other risk groups are heterosexual individuals and injection drug users who represented 8% of new infections in 2010 and 15% of people living with HIV. Women predominantly get infected with HIV from heterosexual contact (84% in 2010). Women represented 20% of new HIV infections in 2010 and 23% of people living with HIV in 2011. HIV and AIDS is disproportional to race and ethnicities in the USA. Black individuals who represent 12% of the population accounted for 44% of new infections of HIV in 2010 and 41% of individuals living with HIV in 2011. Hispanics represent 16% of USA population, but represented 21% of new infection in 2010 and 20% of people living with HIV in 2011 (Avert, 2014). Collectively, Hispanics and Blacks represent 28% of US population, but account for over 60% of individuals living with HIV and AIDS in 2011. In their analyses of survival for people at stage 3 AIDS, CDC reports that survival decreases with increase in the age of diagnosis (2014). Additionally, individuals of Asian and other Pacific Islanders were at greater risks than those of Hispanic, mixed races, white, blacks and American Indians in that order. Children infected from prenatal transmission also showed higher survival rates compared to infections from MSM, heterosexual contact and survival was least among people infected from injection drug use. Part C: Implications of the Problem Social Implications Stigma is probably the single most important social impact of AIDS in the world and indeed, the USA. A majority of people minimize contact with people who are known to be infected with HIV as people fear they might be somehow infected by the disease. Majority of American citizens know that the disease can only be transmitted by exchange of bodily fluids (blood and sex fluids), while casual contacts such as hand shaking, kissing, and hugging do not spread the disease. Valdeserri (2002) notes that research on 76 African American men in Chicago indicated that the stigma associated with AIDS has serious social implications as it makes the infected persons to be reluctant in using protection as they have low self-esteem and are at higher risk of abusing drugs. Vanable et al., (2006) showed that one in four uninfected Americans have stigma towards infected people, while publicly known HIV infected people are stigmatized frequently by their counterparts. People with HIV/AIDS have the right to employment under the American with Disability Act, Rehabilitation Act of 1973 and Workforce Investment Act of 1988 (ODEP, 2014). There have also been reports of discrimination of people living with HIV/AIDS in the workplaces. People who have tested positive to the disease are not hired, and in some cases are even fired. Barb Cardell was fired from her job as an executive chef three weeks after she knew of her HIV status. Her boss had insinuated that she might infect the clients while handling their food (Scassia, 2014). Most people living with HIV appear healthy these days and will not disclose their status at work for fear of discrimination as the condition is still a pervasive health issue (Scassia, 2014). Though it is a right for an individual with HIV/AIDS to participate in competitive sports in the USA, individuals with the condition are sometimes denied this right or chose not to be involved in competitive sports. Perhaps the most common sportsperson to publicly declare his HIV status was Earvin Johnson who was pivotal in creating awareness of the disease in the USA and the world (Leach, 2003). In some sports such as boxing, there is a small chance of transmitting the disease to a competitor; therefore, infected people are encouraged to look for less-risk alternative sports (Leach, 2003). Another important social impact of HIV/AIDS is relationships. Infected people find it hard to form new relationships or maintain current ones. Though it is possible to have sexual relationships between infected and non-infected partners, they seldom last as stigma often destroys the self-esteem of the infected partner. The implication of this is that infected individuals may not disclose their HIV status to their partner because of the fear of losing them. Economic Implications Personal health care cost is among the major economic costs of HIV/AIDS. CDC (2014) estimates that it cost approximately US$ 23000 per person in 2010 to manage the condition and US$ 379, 668 for lifetime treatment. In comparison, the lifetime cost of treating diabetes is approximated to be US$ 85,000. The federal government requested for US$ 30.4 billion for the 2015 fiscal year for domestic aids spending (Avert, 2014). The condition also impacts on hospitals as space and time are used to manage the disease; resources that could have been utilized in other sectors of healthcare if AIDS was manageable. Generally, the American healthcare scheme is under three categories with the first being private work scheme where employment or union provides insurance. The second option is government funded programs such as Mediaid and Medicare that cater for old citizens (over 65 years), citizens with disabilities and people with limited income. The third category is private health insurance purchased by people who are not on work-based schemes or are self employed. In theory, each and every American citizen should fall under one of these schemes. However, the reality is different as around 48 million Americans (15% of the population) are uninsured (Avert, 2014). The situation is dire among the individuals with HIV and AIDS, as 20% of the individuals have private health cover with approximately 30% of the infected individuals having no insurance cover at all. The socio-economic implication of delaying ART treatment is not only a threat to the life of the infected individual, but also to the general public who can be infected from unmanaged HIV cases. The positive news is that uninsured and underinsured people can access government-run health schemes such as Medicare, Medicaid, Ryan White Program and Aids Drug Resistance Programs (ADAP). Medicaid cost the federal government US$ 5.3 billion in 2012, while Medicare cost US$ 6.6 billion in 2014. Ryan White Program requested for US$ 2.3 billion for the 2015 budget, while ADAP supported 210,000 people, mainly those who have no means of paying for AIDS prescription drugs (Avert, 2014). With the number of people with HIV increasing by excess of 40000 each year and the ART treatment extending life, the amount of money for managing this condition will have to increase each year to provide better support to the citizens. The economic effect is that less money will most likely have to be spent in other areas to manage the disease better. The health reforms under President Obama’s administration aim at better access to health care to the population, but the future is uncertain as more individuals rely on public health institutions that are usually underfunded (Avert, 2014). Hutchison et al. (2006) estimated the cost of new infections of HIV in USA to be US$ 36.4 billion in 2002. This emanated from US$ 6.7 billion in direct medical costs and US$ 29.7 billion in productivity losses. Indirect cost of HIV epidemic refers to loss of economic output due to illness or death (productivity losses). They (Hutchison et al., 2006) also showed direct medical costs for whites (US$ 180,900 million) to be higher than the costs for blacks (US$ 160,400) despite AIDS being more prevalent in blacks as compared to whites. Since the cost of productivity losses is greater than medical costs, the economic implication is that the ART should be intensified and equitably distributed among the races in the country. However, estimating economic impacts of HIV as a health issue is quite tricky because of various limitations. Factoring in outpatient costs such as ambulance services, home health care, outpatient ancillary services and other similar support service is challenging because it difficult to collect and collate this type of data on macro-economic scale. Secondly, most economic analyses do not consider individuals with AIDS-related complications, while those infected with HIV do not seek professional health services. Silverberg et al., (2012) showed other illnesses such as anal cancer to be 30 times more prevalent in individuals with HIV, especially the MSM group. Economic cost estimation of HIV implication should, therefore, consider the cost of managing conditions emanating from HIV. Political Implications Rau and Collins (2005) claim that much of the responses to the HIV/AIDS pandemic are determined by political factors yet inadequate analyses have been put in place to dissect these political factors and motivations. Piot et al., (2007) vindicate this point by showing that many advances in health care during the 19th and 20th century as being a direct result of synergy between science and politics. It has been established that race and sexual orientation are significant variables in HIV/AIDS in USA. However, the issues of sexuality and race are highly controversial (Rai and Collins, 2005) in the USA such that politicians and decision-makers tend to misinform the public on issues related to this health concern to gain political mileage among other reasons. Some non-medical researchers have the perception that studying HIV/AIDS-related topics have negative impacts to their careers as some funding agencies do not want to be associated with studies discussing race and sexuality because of the controversies surrounding the issues. The implication of this is that lesser studies are done in the area to generate information for inter-disciplinary management of the AIDS scourge. There was a general perceived lack of political goodwill in tackling the health concerns of HIV/AIDS, especially in the 1980s and early 1990s in USA (Rai and Collins, 2005). This mainly emanated from the perception that HIV/AIDS affected only gay people, injecting drug users and people with immoral sexual behaviors by many political authorities. Most of the government action in the early 80s emanated from gay activism and community mobilization. During its emergence, AIDS was not a political issue, but was only active in circles of healthcare and gay community. In recent times however, the AIDS issue has received political attention in America and the world over. In fact, the UN general assembly in 2001 confirmed AIDS as a political issue requiring commitment at a national and international level. Part D: Controlling the HIV/AIDS Scourge Contemporary Approach and Procedures in Treatment of HIV/AIDS Aberg et al., (2009) provides guidelines for management of persons with HIV and AIDS for health care providers who care for infected patients or patients at risk of acquiring HIV. The guidelines were written by panelists with expertise on HIV/AIDS from Infectious Diseases Society of America. They provide the procedures in handling different types of HIV-related patients such as diagnosis, risk screening, behavioral interventions, CD4 counts, HIV resistance testing, complete blood count, stage of infection and breast cancer screening. It is recommended that HIV be diagnosed by a rapid HIV test or conventional enzyme-linked immunoabsorbent assay (ELISA) and confirmed by Western blot. It is typical to diagnose HIV by serological tests that represent the presence of antibodies to HIV. Since risky behavior has potential consequences to the patient and other individuals, it is paramount to ask about the sexual behavior of the patient during managing his/her condition. The individual should also be tested for sexually transmitted infections (STI) whose presence should be interpreted as the individual undertaking risky behavior irrespective of his/her response on the behavioral questionnaire. Messages in reference to risk reduction must be provided at all health care centers irrespective of risk behaviors reported by the patient. It is not mandatory for this message to be provided in face to face form, but can also be provided by pamphlets or videos. The health care provider is required to offer brief counseling, especially to patients with high-risk behavior and/or evidence of STIs. Patients with no records of their serostatus and those tested anonymously should undertake serologic test with the start of care once HIV is confirmed. This test is especially important for asymptomatic patients with low viral load and normal CD-4 count. The count is used to determine the stage of illness as therapy in the management of HIV is determined mainly by the stage of illness (Arberg et al., 2009). It is possible for drug resistance HIV virus to be transferred from one person to another. For this reason, all HIV positive patients should be tested for transmitted drug resistance to access the possibilities of super-infections. Some patients show resistance to ART treatment and studies have shown that enfuvirtide combined antiretroviral regimen can counter drug resistance in some cases (Lazerazi et al., 2003). People infected with HIV are likely to suffer from anaemia, leukopenia, and thrombocytopenia. For this reason, complete blood count and chemistry panel should be undertaken to confirmed HIV positive patients. The patients are also to be screened for tuberculosis, breast cancer, viral hepatitis, herpesviruses, syphilis and other STDs as they are opportunistic infections that exacerbate the impacts of HIV/AIDS on patients’ health (Arberg et al., 2009). It is widely known that AIDS has no cure. Nevertheless antiretroviral therapy (ART) significantly halts the progression of the HIV that causes AIDS. The drugs are usually taken as two or more, and this is referred to as combination therapy. Taking only one drug can result to the virus becoming resistant. It is common in the USA to take three or more drugs and this is referred to as Highly Active Antiretroviral Therapy (HAART). There are more than 20 recommended drugs for HIV/AIDS in the USA under various classes of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTs), Protease Inhibitors (PI), Fusion or Entry Inhibitors and Integrase Inhibitors. The availability of NRTI and NNRTs are widespread across the world, but Fusion Inhabitors and Integrase Inhabitors are a reserve to rich countries like America though they are not accessible to every citizen. There is need to tackle HIV-related diseases in addressing the control of this health problem. Silverberg et al., (2012) argue that increased primary and secondary prevention efforts among all the HIV positive groups as compared to targeted approach because of their findings that cases of anal cancer are more prevalent in HIV positive individuals. Girardi et al., (2005) showed the ART treatments have little impacts on tuberculosis and other interventions are necessary to control TB in patients receiving ART though risk of contracting TB reduce by between 70-90% in patients receiving ART. Public Healthcare Approach Public health refers to the theory and practice of preventing diseases, extending life and enhancing health through systematic efforts and well-versed choices of the society, communities and individuals. The major focuses of public health is enhancing the quality of health, reducing injuries and manage diseases through behavioral approach, surveillance of cases and promoting healthy habits. The US Public Health recommend that healthcare personnel who are exposed to HIV virus in form of blood or other body fluids should start regimens of postexposure prophylaxis (PEP) within 72 hours of exposure and the medication undertaken for 4 weeks continuous (Kuhar et al., 2013). Typically the HIV testing is concluded 4 months after exposure and if no newer testing platform is available, it is concluded six moths after exposure. Public health also includes measures undertaken to reduce the risk of acquiring HIV. It is important for both partners to get tested for HIV before engaging in unprotected sexual intercourse. The testing should also include for other STIs, for having an STI increases the risk of being infected with HIV. Individuals who have tested positive are advised to have few sexual partners. It is recommended that individuals have less risky form of sex. Oral sex is less risky in spreading the virus compared to vaginal or anal sex which has the greatest risk of spreading HIV. Bertozzi et al., (2006) suggest that any preventive strategy that is chosen should be based on the epidemiological profile and surveillance is therefore paramount for any public health response. Injected drugs are an important cause of HIV, and it is advised that individuals avoid injections. If they cannot avoid injections, then the equipment for injection of drugs should not be shared. Correct condom use is a much campaigned public health method of preventing HIV infection, for it prevents the exchange of bodily fluids during sex. Bertozzi et al., (2006) showed that condom promotion led to higher condom use and lower incidences of STIs. Behavioral changes were intensively advocated for in the last two decades in the USA, and indeed the world in public health efforts to stop the spread of HIV. However, the complex nature of HIV/AIDS has made it necessary to look at combination strategies that combine two or more HIV prevention interventions (Bertozzi et al., 2006; Avert 2014). The support for intensified public health strategies in controlling HIV have been advocated by organizations such as UNAIDS and others all over the world. Effectiveness of the Healthcare Systems in Dealing with HIV The HIV/AIDS condition has been in existence in the USA, and indeed the world for more than 3 decades. There has been significant progress in the research, identification and treatment of the condition. However, new individuals are infected by the virus each year in the country and this can be interpreted as ineffectiveness from the health care system in dealing with the problem. In as much as drugs are available to effectively manage the condition in America, the drugs are not available to the people who need them the most mainly because most of the population cannot afford the best drugs. Additionally, since 1 in 6 of every infected person does not know his /her status, it has been difficult for the health care system to contain the condition as these individuals continue to spread the virus to members of the public. Cases of HIV strains resistant to drugs, and the emergence of more AIDS related illnesses have also compounded the effectiveness of health care systems to deal with this health problem. In assessing the effectiveness of the public health systems in preventing or reducing the spread of the HIV health problem, it is seen that behavioral change strategies, that were heavily invested upon, are not effective in controlling the spread of the virus as compared to combination strategies. Despite of having the knowledge of AIDS from media campaigns and formal education in school, a significant portion of Americans still indulge in high risk activities that may cause them to be infected with the virus. The inability of health systems to counter stigma has led to many infected individuals intentionally not revealing their status even to their partners while engaging in risky activities that could cause HIV. Part E: Possible Solutions of Management of HIV/AIDS Reducing, and possibly eliminating HIV/AIDS in American society is a daunting task. However some societies have managed to reduce its prevalence to very low levels due to structured strategic activities and policies. Cuba for instance, has very low HIV prevalence rates (Hoffman, 2004) because HIV positive people were quarantined until 1994 when quarantine laws were relaxed, but the patients are still required to report to sanatoria every eight weeks where they are treated and counseled. While the Cuban approach is highly successful, it raises various ethical issues as well. My hypothetical plan in managing the disease in American society will include the five areas of: eliminating stigma, reducing new infections, improving access to treatment, targeting and monitoring vulnerable groups, and increasing political will to fight the disease. Eliminate Stigma Stigma remains a major impediment to proper management of HIV/AIDS in many parts of the world and America. Vanable et al., (2006) illustrated the extent of stigma in USA by reporting that HIV positive individuals in America experience stigmatic experience at least once in a day because of their status despite 75% of the uninfected population claiming that they do not treat infected people different. Stigmatization lowers the self esteem of infected people, discourage suspicious people to go for testing, encourage use and abuse of drugs and these can result to increased infections. The objective of reducing stigma is to sensitize the society to view HIV as a medical condition such as arthritis or diabetes, and not a judgment of character. My plan would involve enhancing the involvement of celebrities and successful people (preferably HIV positive ones) in making the public to be more receptive towards HIV positive people. The idea is not to make HIV/AIDS appear ‘cool’ but rather make the public understand that it is okay to interact with people infected by the virus, and it infects people of all walks of life. The outcome of this plan is that more people would go for testing, and infected people get comfortable support from family members and friends in managing the disease. Reduce new infections New HIV infections in America per annum have been over 45000 people infected over the last five years (Avert, 2014). The impact of new infection is that it increases the number of people who live with HIV each year, and this translates to additional budget costs in healthcare provision. More importantly, increase in the number of people living with HIV increases the probability of infections to HIV-negative individuals. The objective of this planned activity is to reduce the number of new infections every year in a time period, probably ten years, with the target of having 5000 new infection each year after the time period. To reduce the infections, I would propose rigorous HIV testing for every citizen in the country. This approach will definitely present ethical challenges, but if I succeed in eliminating stigma, I have the thinking that most law makers, lobby groups and citizens will support the idea of mandatory testing. Some estimates claim that one in every six HIV infected Americans do not know of their status (CDC, 2014) and this might be the major cause of new infections. The outcome of this plan is that with time, the population of HIV positive people will reduce as new infections reduce, and this will have positive impact on the economy and improved treatment regimes to infected individuals. Improve Access to Treatment The treatment of HIV/AIDS has improved over the couple of years (Avert, 2014) despite some drug resistant strains developing. Infected people can live for three decades with common ART treatment as compared to an average of ten years without treatment. However, quality therapy is out of reach to many groups because of the high costs of antiretroviral drugs. The suggested plan under this activity will be to decrease the cost of antiretroviral drugs. The major cause of the high cost is the intellectual property rights of pharmaceutical companies who rightfully make huge profits from HIV drugs, as a result of their research and innovation. My plan would be to increase subsidies on drugs and lobby for reduced intellectual property duration with the pharmaceutical companies. Additionally, increase in federal funds for research in universities and hospital on the issues surrounding HIV/AIDS. The outcome of this plan is that the number of healthier HIV positive individuals would increase. Healthier infected individuals have lower risks of spreading the virus as compared to unhealthy infected individuals, and are an asset to the economy because of their productivity. Target and Monitor Vulnerable Groups It has been established that HIV affects the American society disproportionally (Avert 2014: CDC, 2014). Blacks, MSM and Hispanics have a higher risk of getting infected as compared to other groups. The suggested solutions such as increase access to treatment, eliminating stigma, political will and reducing infection rates are therefore to be ideally targeted towards these high risk groups. Care should be taken in prioritizing with groups, so as not to mislead the society that HIV is reserved for particular groups. The aim of this strategy would be to achieve cost-effectiveness as resources are always limited. The expected outcome would be effective dissemination of information and actions to control the virus. Increase Political Will Any suggested solution to the HIV health problem would be futile if there is no political willpower. Political will is obtained by intensive lobbing and political sacrifices. It is observed that HIV is a controversial subject that has the variables of race and sexual orientation, which have powerful dimension of politics in today’s America society. The objective of increased political will is to dilute the tension surrounding controversial issues, resulting to a relatively easier concerted decisions making concerning tackling HIV. Costs of Suggested Solutions The suggested solutions come at some social, economic and political costs. The major social costs associated with my proposed solution are the ethical issues that might emerge from the strategies. For instance, the suggestion that there should be mandatory testing for all citizens is more likely to cause an ethical stand off in a free country as America, as it can be easily argued that testing ought to be a personal decision. Heavy economic costs are also expected as funding the ART program is not easy. Additional cost of training and hiring more healthcare workers also exists. The US federal fund has budgeted for US$ 30.4 billion for HIV in year 2015. However, this money is not adequate to cater for the needs of all the people infected by the virus in the country. To make treatment accessible, more money has to be sourced from a different sector, and this is a great economic cost. Political costs are the trade-offs decision and law makers make to ensure synergetic policies with HIV control strategies are in place. 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